COVID Vaccine – Non-Employed Provider Self-Reporting
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.
Provide Vaccination Documentation
If you have already been vaccinated, please provide your vaccination documentation via our vaccination reporting form.
- Important: When you click the button below, the submission form will not appear if you are using Internet Explorer.
- Please use Google Chrome, Microsoft Edge, Safari or Firefox to access the form. Learn how to find other browsers on your computer.