Teammates use this form if you received your influenza vaccine from an outside provider such as a retail pharmacy or any personal physician’s office (Atrium Health or other primary care provider).

The Atrium Health Flu Campaign starts Oct. 1. All teammates must comply with Atrium Health Policy Infectious Diseases Prevention Policy HR-4.05  by Oct. 31.

Use this form if you received your vaccine from outside of the Atrium Health Teammate Health program, like your Atrium Health personal provider, a retail pharmacy or other outside physician.

Teammates must fill out this electronic form to demonstrate proof of compliance. The document you submit must contain type of flu vaccine, manufacture, lot number and expiration date. Upon submission, you will receive a badge sticker to demonstrate your compliance.

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Vaccine Information