Are you eligible for COVID-19 vaccination?

See if you are eligible

Vaccine supplies are limited. Please help those who need vaccination the most by answering truthfully.

Are you a healthcare worker providing direct patient care in a clinical setting?


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Are you 75 years of age or older?


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Are you a Frontline Essential Worker?


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Are you 65 years of age or older?


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Are you between the ages of 16-64 years, and have a high risk medical condition?


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Are you an essential worker?


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Are you 16-64 years of age or older without high risk medical conditions?


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You are eligible for COVID-19 vaccination.

To schedule an appointment to receive your vaccination, you will need to log in to kp.org.

Please select the description that applies to you:


I have a KP health plan and am registered with kp.org

Select this option if you are an active KP member with a Medical/Health Record Number and a registered user ID for kp.org.


I have a KP health plan but am not registered with kp.org

Select this option if you are an active KP member with a Medical/Health Record Number but have not registered for a user ID on kp.org.


I do not have a KP health plan and am not registered with kp.org

Select this option if you are a first-time patient of KP and have not registered for a user ID on kp.org.

You’re not eligible for the vaccine at this time

Information

Because the initial supply is limited, the COVID-19 vaccine is being administered in phases. It’s available to people who meet the criteria at each phase, as defined by state health officials. See the eligibility guidelines in your state to find out when you might be able to get vaccinated. Supplies will increase over time, and all adults should be able to get vaccinated later in 2021.

Stay safe while you wait to get vaccinated

Vaccines are vital to ending the pandemic, but it will take several months for communities to achieve widespread vaccination. It’s important for everyone to keep taking steps to help reduce the spread of COVID-19.
 

Icon face mask

Wear a mask

Icon social distance

Stay 6 feet apart

Icon Hand-Wash

Wash your hands

Icon people

Avoid crowds

Information

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Please provide some information about yourself

To register with kp.org and receive a unique Medical/Health Record Number (MRN) from Kaiser Permanente, please fill in the information below. All fields are required unless marked as optional.

NOTE: You are registering with California. If you would rather make an appointment to receive the vaccine in a different state or region, please go to kp.org/covidvaccine page to make your selection.

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An email containing a One-Time Passcode code will be sent to the email address you have provided.

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Confirm your details

A new code has been generated for you and sent to your email.

Please review the details below before submitting. You are registering with Kaiser Permanente California. If you would rather make an appointment to receive the vaccine in a different state or region, please go to kp.org/covidvaccine page to make your selection. If you need to make any other changes, select the “Back” button.

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If you didn’t receive the email with your passcode, please check your spam folder.

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You have successfully submitted your details.

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You will receive an email from Kaiser Permanente California with your unique Medical/Health Record Number (MRN), usually within 24 hours.

If you do not already have a kp.org user ID, you will need to register on kp.org so that you can sign in and schedule an appointment for vaccination.


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Authorization for the Use or Disclosure of Health Information from Kaiser Permanente

Signing this HIPAA Authorization (“Authorization”) allows us* to the use and disclose the fact of your COVID 19 vaccination for purposes of administering KP COVID 19 Sweepstakes reward.

I understand that Kaiser Permanente* is required to maintain and safeguard the privacy and security of my information under applicable federal, state and local health information privacy rules that govern the use and disclosure of my information, including but not limited to the Health Insurance Portability and Accountability Act of 1996 (HIPAA), as amended from time to time.

By agreeing to this Authorization, I authorize Kaiser Permanente to use and disclose within and among the Kaiser Permanente Entities (see below), such as my regional health plan and regional Permanente Medical Group, and other designated entities that collaborated in vaccine administration, including but not limited to the sweepstakes administrator, the fact of my COVID 19 vaccination, the contact information that I have provided to kp.org (my name, mailing and email addresses, and telephone number, which is protected health information (PHI) under HIPAA and applicable state law, so that Kaiser Permanente may use and disclose my information to deliver rewards under for the COVID 19 Vaccination Sweepstakes that Kaiser Permanente is offering. As required by applicable law, this Authorization lasts for one (1) year from the date of your signature (December 31, 2022 for California residents) unless I revoke it.

I understand that I have the right to revoke this Authorization, in writing, at any time. Instructions for revocation can be found by visiting the kp.org page provided in the submission confirmation email that will be sent upon submission of this authorization with subject line “Next steps for Kaiser Permanente ImmUNITY Sweepstakes.” If I revoke my HIPAA authorization agreement, I will be ineligible to receive the reward. Kaiser Permanente will stop using or disclosing my information for these purposes upon Kaiser Permanente’s receipt of my revocation. However, my revocation will not be effective with respect to actions Kaiser Permanente took in reliance of my Authorization.

I understand that once information is used or disclosed under this Authorization, there is a potential for it to be redisclosed and may no longer be protected under federal or state privacy law. However, state law may prohibit the person receiving my information from making future disclosures of my information unless another authorization for disclosure is obtained from me, or unless such disclosure is specifically required or permitted by law.

I understand that I have a right to receive a copy of this Authorization by visiting the kp.org page provided in the submission confirmation email that will be sent upon submission of this authorization with subject line “Next steps for Kaiser Permanente ImmUNITY Sweepstakes.“

Kaiser Permanente will not condition my treatment, payment, or eligibility for benefits on whether I agree to this Authorization electronically or on paper. I have read the above information and authorize the use and disclosure of my information by Kaiser Permanente for the purposes described herein.

By clicking and typing your name below, you acknowledge that you have read and agree to the terms of this Authorization.

I have read and agree to the terms of this Authorization for the use and disclosure of my information by Kaiser Permanente. I understand that if I do not sign this Authorization, I cannot win any of the rewards offered in the Kaiser Permanente COVID 19 Sweepstakes
OR

If you are the parent or personal representative of the Individual(e.g., a minor under age 18), by clicking and typing the names indicated below, you acknowledge on behalf of the Individual that you have read and agree to the terms of this Authorization.

I have read and agree to the terms of this Authorization on behalf of for the use and disclosure of their information by Kaiser Permanente.
State the nature of your relationship with the Individual and describe your authority to act for the Individual.

*For purposes of this HIPAA Authorization, “Kaiser Permanente Entities” or “us” means:

Kaiser Foundation Health Plan, Inc. The Permanente Medical Group, Inc
Kaiser Foundation Hospitals Southern California Permanente Medical Group
Kaiser Foundation Health Plan of Colorado Colorado Permanente Medical Group
Kaiser Foundation Health Plan of Georgia The Southeast Permanente Medical Group
Kaiser Foundation Health Plan, Inc.; Hawaii Region Hawaii Permanente Medical Group
Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc. Mid-Atlantic Permanente Group, P.C.
Kaiser Foundation Health Plan of the Northwest Northwest Permanente Medical Group
Kaiser Foundation Health Plan of Washington Washington Permanente Medical Group
Kaiser Foundation Health Plan of Washington Options, Inc.