#TMCSLCares

COVID-19 Vaccine
Pre-Registration Form

Consent for Use and Disclosure of Personal Data


I am giving my consent to The Medical City South Luzon to collect and process my personal data for COVID-19 Vaccination Program in accordance with the provisions of Data Privacy Act of 2012.


I understand that the declared purpose of the processing of my personal data is to establish a masterlist of eligible population for vaccination to enable health authorities to decide on who can be safely vaccinated from a clinical perspective.


I further understand that after immunization, the LGUs as well as the private sector are likewise required to submit the masterlist of persons who have already been inoculated through the VIMS-IR, subject to further guidance as may be issued by the DOH and the Department of Information and Communications (DICT).


On the issuance of vaccine cards, I understand that a standard form shall contain necessary information as prescribed by the DOH. I was assured that this vaccine card will not be given to anyone or posted publicly, and that I will be able given an electronic copy of my vaccine card only through the email address that I provided.


I am also assured by the collector that they have installed appropriate physical, organizational, and technical security measures to ensure that my personal data are protected.



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