全仁醫務中心 - 新冠肺炎疫苗優先預訂登記
感謝閣下登記「新冠肺炎疫苗優先預訂」,政府正推行2019冠狀病毒病疫苗接種計劃 ,為香港市民免費接種新冠疫苗。

全仁醫務中心為是次參與疫苗接種計劃的私營診所,因應疫苗供應的情況,以及疫苗接種的進度,政府已按照聯合科學委員會的接種優先次序建議框架,除第一階段5個組別(1-5)及第二階段7類人士(6-12)外,再次擴大優先組別涵蓋的範圍,新增2類人士(13-14)優先接種「科興疫苗」:

1) 30 歲或以上人士(陪同70歲或以上長者接種疫苗的人士可以獲得接種,最多兩人)
2) 醫療服務場所工作人員及參與抗疫工作人員
3) 安老院/殘疾人士院舍院友及員工
4) 維持必要公共服務的人員
5) 跨境運輸、口岸、港口工作人員
6) 餐飲業、街市、超市、便利店員工及速遞員(包括外賣食品速遞員)
7) 公共交通從業員(例如:的士/巴士/小巴司機、鐵路車長、車站職員)
8) 註冊建築工人
9) 物業管理人員(例如:保安員、清潔人員、管理處職員)
10) 學校教職員(例如:幼稚園、中小學及大學教職員及支援人員;特殊學校職員;校車/保姆車司機及跟車保姆)
11) 旅遊業從業員
12) 《預防及控制疾病(規定及指示)(業務及處所)規例》(第599F章)的表列處所職員(例如:健身中心、美容院員工)
13) 香港以外就讀學生(16歲或以上)
14) 家庭傭工
15) 本人並不屬於優先組別,但希望預約在全仁接種新冠疫苗

如閣下符合優先接種資格(1-14),我們會盡快聯絡您,如選15,我們將稍後與你聯絡。因疫苗數量有限, 先到先得,如成功獲安排接種亦需要提供相關文件以供核實,謝謝。

**接種時需提交身份證明文件、優先接種組別證明(包括:僱員證、委任證、政府部門或其合約承辦商發出的身份證明信件、牌照、僱主信(必須使用政府網站下載樣式:https://www.covidvaccine.gov.hk/pdf/template_prioritygp_identity_proof.pdf))**
 
請提供以下資料作登記之用,每位客戶只需提交資料一次,重複提交將不獲處理。全仁醫務中心保留最終決定及解釋權。

Thank you for your registration. The Government is implementing the COVID-19 Vaccination Programme free of charge for all Hong Kong residents.

Trinity Medical Centre is a private clinic that participated in the COVID-19 vaccination program. According to the latest government's recommendation, people in fifteen groups (1-14) are given priority for receiving " Sinovac Vaccine":

1) People aged 30 years or above (a maximum of two carers who accompany elderly people aged 70 or above can also receive vaccination);
2) Personnel in healthcare settings and those participating in anti-epidemic related work;
3) Residents and staff of residential care homes for the elderly / persons with disabilities;
4) Personnel maintaining critical public services;
5) Personnel providing cross-boundary transportation or working at control points and ports;
6) Staff of food and beverages premises, markets, supermarkets, convenience stores and couriers (including takeaway food delivery);
7) Staff of local public transport service operators (e.g. taxi/bus/public light bus drivers, train captains and station staff);
8) Registered construction workers;
9) Staff of property management (e.g. security guards, cleaning staff and property management office staff);
10) Teachers and school staff (e.g. teaching and support staff of kindergartens, primary and secondary schools and universities; staff of special schools; and drivers and escorts of school buses and school private light buses);
11) Staff of the tourism industry; and
12) Staff of scheduled premises under the Prevention and Control of Disease (Requirements and Directions) (Business and Premises) Regulation (Cap. 599F) (e.g. staff of fitness centres and beauty parlours).
13) Students study outside Hong Kong who aged 16 or above
14) Domestic helpers
15) I do not belong to the priority groups for receiving COVID-19 vaccines but still want to make an appointment.

If you are eligible for priority vaccination, we will contact you as soon as possible, if not, we will contact you later. Due to the limited number of vaccines, they are first-come-first-served. If you are successfully vaccinated, you will need to provide relevant documents for verification. Thank you.

**For injection, please provide proof for priority group (if applicable; including staff card, warrant card, identity proof issued by Government departments and their service contractors, licence, employer's letter (must use the Government's template: https://www.covidvaccine.gov.hk/pdf/template_prioritygp_identity_proof.pdf))**

Please provide the following information for registration, EVERYONE CAN ONLY SUBMIT ONCE. Trinity Medical Centre reserves the right of final decision and interpretation.
閣下屬於哪一個優先組別? What is your Priority Group? *
英文姓名 (必須跟身份証明文件相同) English Full Name *
中文姓名 (必須跟身份証明文件相同) Chinese Full Name *
性別 Gender *
年齡 Age *
電郵 Email *
住址 Address
香港手提電話號碼 Hong Kong Phone number *
TMC code (如有,請提供)
(Please also read "Collection and Use of Personal Data" to indicate your choice. 請細閱「收集個人資料聲明」及選擇閣下意願。)
Collection and Use of Personal Data 收集個人資料聲明 *
私隱政策聲明全仁醫務中心有限公司 (以下簡稱”我們”) 致力於保護和尊重您的私隱。本聲明乃遵照香港特別行政區《個人資料(私隱)條例》(第486章)的要求而發出,通知閣下收集資料的目的及依據。有關所收集的個人資料及資訊將陳列於相關的使用條款及《私隱政策聲明》之內,本聲明會不時更改,故請定期查閱,以了解我們向您(“用戶”或”最終用戶”)收集哪些資料,以及我們如何使用那些資料。請仔細閱讀本私隱權政策。一旦訪問或使用我們的網站,即表示您承認已閱讀、理解並同意遵守本私隱政策聲明的 所有條款及我們網站的所有使用條款。如果您對我們的私隱權政策有任何疑問,請發電郵向我們查詢。
Required
Direct Marketing 直接促銷 *
1 在取得您的同意(包括不反對的表示)後,我們有機會使用您提供的以下個人資料作直接營銷用途:-(a) 姓名; 及(b) 聯絡資料。2. 根據第1條,我們可能會銷售,提供和/或宣傳以下類別的產品,服務和主題: -(a) 與醫療有關的產品和服務(如身體檢查,疫苗接種,身體檢查計劃,醫學美容服務);(b) 與健康和生活方式有關的產品和服務。
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Trinity Medical. Report Abuse