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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link="#0563C1" vlink="#954F72"><div class=WordSection1><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><o:p> </o:p></p><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b>From:</b> Sigman, Brian <Brian.Sigman@ct.gov> <br><b>Sent:</b> Friday, April 9, 2021 4:55 PM<br><b>To:</b> DORS-DL BESB <DORS-DLBESB@ct.gov><br><b>Subject:</b> FW: Homebound COVID vaccination intake form - Please share<br><b>Importance:</b> High<o:p></o:p></p></div></div><p class=MsoNormal><o:p> </o:p></p><div><div style='border:none;border-top:solid #E1E1E1 1.0pt;padding:3.0pt 0in 0in 0in'><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif'>From: Sullivan, Kathleen <<a href="mailto:Kathleen.Sullivan@ct.gov">Kathleen.Sullivan@ct.gov</a>> <br>Sent: Friday, April 9, 2021 4:50 PM<br>Subject: FW: Homebound COVID vaccination intake form - Please share<o:p></o:p></span></b></p></div></div><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#050505;background:white'>Please share the following information with your partners</span></b><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#002060;background:white'>. </span></b><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#050505;background:white'><o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#050505;background:white'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#050505;background:white'>For Connecticut Residents:<o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#050505;background:white'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:#050505;background:white'>If you or someone you care for is physically or medically unable to leave their home to get the COVID-19 vaccine click here for the online homebound vaccination intake form (eligibility info included) <o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;letter-spacing:1.2pt'><a href="https://dphsubmissions.ct.gov/homebound?fbclid=IwAR1hPGRewhyxfiyPD-dXt5sF0yM-ogLsekMqwdHwFbSuizXLWV7Sixu73hU">https://dphsubmissions.ct.gov/homebound?fbclid=IwAR1hPGRewhyxfiyPD-dXt5sF0yM-ogLsekMqwdHwFbSuizXLWV7Sixu73hU</a><o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif;letter-spacing:1.2pt'><o:p> </o:p></span></b></p><p class=MsoNormal><strong><span style='font-size:16.0pt;font-family:"Arial",sans-serif;color:black;background:white'>If you only need a ride to get a COVID-19 shot, you should not complete this form. You should click on this <a href="https://portal.ct.gov/Coronavirus/Transportation-Resources" target="_blank"><span style='color:#337AB7'>Transportation Resources</span></a> link for help finding a ride</span></strong><b><span style='font-size:16.0pt;font-family:"Arial",sans-serif'> (<strong><span style='font-family:"Arial",sans-serif;color:black;background:white'><a href="https://portal.ct.gov/Coronavirus/Transportation-Resources">https://portal.ct.gov/Coronavirus/Transportation-Resources</a>)</span></strong><span style='letter-spacing:1.2pt'><o:p></o:p></span></span></b></p><p class=MsoNormal><o:p> </o:p></p></div></body></html>