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NYP CBO Partner - Armory Vaccine Referrals

NYP Community Partner - Armory Referrals

This form is intended for community partners of NewYork-Presbyterian (NYP) to refer members eligible for vaccination (according to New York State's phased roll out) to be scheduled at NYP's vaccination site at the Armory (651 West 168th Street).

Please Note:
  • Vaccine Referrals must be submitted by 7pm;  48 hour minimum prior to the requested appointment date
  • NYP will provide a confirmation list of scheduled appointments (date + time) 24 -48 hours prior to the requested appointment date
  • CBOs are responsible for outreaching their members prior to form submission (to confirm interest, preferred date, and required details), and for following up with those members to confirm their appointment date + time and share important notices prior to the patient's arrival
Thank you for joining in us in protecting our community against COVID-19!
1. Verification & Attestation:

Please verify that this patient is 30 years or older OR that this patient is 18 years or older with the following comorbidities and/or underlying medical conditions:
  • Cancer (current or in remission, including 9/11-related cancers)
  • Chronic kidney disease
  • Pulmonary Disease, including but not limited to, COPD (chronic obstructive pulmonary disease), asthma (moderate-to-severe), pulmonary fibrosis, cystic fibrosis, and 9/11 related pulmonary diseases
  • Intellectual and Developmental Disabilities including Down Syndrome
  • Heart conditions, including but not limited to heart failure, coronary artery disease, cardiomyopathies, or hypertension (high blood pressure)
  • Immunocompromised state (weakened immune system) including but not limited to solid organ transplant or from blood or bone marrow transplant, immune deficiencies, HIV, use of corticosteroids, use of other immune weakening medicines, or other causes
  • Severe Obesity (BMI 40 kg/m2), Obesity (body mass index [BMI] of 30 kg/m2 or higher but < 40 kg/m2)
  • Pregnancy
  • Sickle cell disease or Thalassemia
  • Type 1 or 2 diabetes mellitus
  • Cerebrovascular disease (affects blood vessels and blood supply to the brain)
  • Neurologic conditions including but not limited to Alzheimer's Disease or dementia
  • Liver disease
Patients must be New York City resident from the following zip codes:
  • 10026, 10027,  10029, 10030,  10031, 10032, 10033,
  • 10034, 10035, 10037, 10039,
  • 10040, 10451,10452, 10453, 10454, 10455,
  • 10456, 10459, 10460, 10461, 10462,
  • 10463, 10464, 10465, 10472, 10473, 10474

If they are below age 30+/ or 18+ and do not have any of the aforementioned medical conditions and not a New York City resident they are not eligible for vaccination at the Armory.

Can you attest that this patient is eligible to be vaccinated at the Armory?
  *This question is required.
This patient is ineligible to be vaccinated at the Armory, and therefore cannot be submitted to our team for scheduling.