DavNor COVID-19 Information Management System

Vaccinaton Pre-Registration

DATA PRIVACY NOTE

Your personal data will be used for COVID-19 Vaccination and will be stored securely in the Data Center of the Provincial Government of Davao del Norte. Said data will only be accessed by authorized permanent employee of the said agency. All data and information accessed through the DavNor Covid19 Information Management System (DCIMS) or as provided by the concerned person shall be treated and kept with utmost confidentiality and that any personal data and information shall not be used nor given to anybody else, except to those who are authorized to use the same to be used solely for the implementation of DCIMS specifically in furtherance of its purpose. You have the right to have a copy of the said data for correction or for any other purpose. On this regard, please call the numbers provided under Contacts on the Main Page.

DECLARATION

By clicking the proceed button, I give permission to share my data to authorized persons who are tasked to collect, store, transmit, use, distribute, disclose, share, retain, dispose, screen and process in Covid-19 vaccination.

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Personal Information

Scan QRCode (Optional)

Birth Date*
Click here for {{changedate ? 'date picker' : 'manual input' }} mm/dd/yyyy

Sex



Current Residing Address
Province*


City/Municipality* Please select province first


Barangay* Please select city/municipality first
+63

Priority Information


Priority Group*
NOTE: Please bring the child's Birth Certificate on the day of vaccicantion.

Sub-Priority Group*
NOTE: Due to the limited supply of vaccines, the family members of Healthcare Workers under Covid-19 Referral Hospitals, Hospitals catering Covid-19 Cases and Quarantine Isolation Facilities are prioritize.

Comorbidity*
Guardian's First Name*
Guardian's Last Name*
Supporting Document* (present any of this at the vaccination facility)


Category ID*
Indigenous Member*


Person with Disabilities (PWD):



Allergy to vaccine or components of vaccines:



With Comorbidity:

User Account

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QR Scanner

Scanning of QR Code is NOT a requirement for Pre-Registration, it is only intended for auto filling of your stored data.
 

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