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Record Review Request

Use this form to determine how to have your information reviewed for accuracy.
1. Which Pass were you trying to retrieve? *This question is required.
Has it been more than 15 days since your final vaccine dose? *This question is required.First dose of J&J or second dose of Pfizer or Moderna
Were you vaccinated in New York State? *This question is required.
Were you a part of a vaccine trial? *This question is required.
Were you vaccinated at a federally run vaccination site? *This question is required.(i.e., VA facilities, federally run facilities)