COVID Vaccine – Non-Employed Provider Self-Reporting and Declination
To help ensure the health and safety of patients and staff, UMMS is compiling information about the COVID-19 vaccination status for our providers.
If you are a non-employed provider at a University of Maryland Medical System hospital and have not provided your vaccine documentation to an UMMS Medical Staff Office already, please submit your vaccination documentation or reasons for declination via our secure online form. Acceptable file formats are PDF, .gif, .jpg and .png.
Note: If you are using Internet Explorer or Microsoft Edge, the form may not display. Please use a different browser, such as Google Chrome, Safari or Firefox, to use the form.
Provide Vaccination Documentation
If you have already been vaccinated, please provide your vaccination documentation via our vaccination reporting form.
Declining the COVID Vaccination
UMMS expects all staff members and non-employed UMMS providers to be vaccinated against COVID-19. In accordance with Federal and State law, UMMS provides exceptions for individuals with medical contraindications, those who have objections based on their own sincerely held religious beliefs and individuals who request a postponement due to pregnancy.
Declining the vaccination for medical reasons
- If a non-employed UMMS provider has a medical contraindication such as an allergy to the vaccine or vaccine component in the Pfizer, Moderna or J&J vaccines or another medical reason that would prevent receipt of the COVID-19 vaccines: The provider must attest to the medical contraindication and submit supporting medical documentation from the treating medical provider attesting to the medical reason for not being able to receive the COVID-19 vaccine(s). The medical provider should complete the Vaccine Contraindication Form.
- Team members who are pregnant can postpone getting the COVID-19 vaccination and should request their medical provider complete the Vaccine Contraindication Form.
Declining the vaccination for religious reasons
- To decline on religious grounds, a non-employed UMMS provider must attest that they have a sincerely held belief and must submit supporting documentation in the form of
- A sworn affidavit from the provider using the Affidavit in Support of Religious Objection to COVID-19 Vaccination Form OR
- A letter from a member of the clergy attesting to the individual’s sincerely health religious beliefs. Letters from clergy must be printed on letterhead.