The personal health information on this form is being collected in accordance with the COVID 19, Vaccination Reporting Act, 2021 for the purpose of providing care and creating an immunization record, and because it is necessary for the administration of Ontario’s COVID-19 vaccination program. This information will be used and disclosed for these purposes, as well as other purposes in accordance with the Personal Health Information Protection Act, 2004 and as authorized and required by law.

For example -

• It will be disclosed to the Chief Medical Officer of Health and Ontario public health units where the disclosure is necessary for a purpose of the Health Protection and Promotion Act. And
• It may be disclosed, as part of your provincial electronic health record, to health care providers who are providing care to you.
• The information will be stored in a health record system under the custody and control of the Ministry of Health. Where a Clinic Site is administered by a hospital, the hospital will collect, use, and disclose your information as an agent of the Ministry of Health.