The COVID-19 vaccination pre-screening form is a document that allows a doctor to check your health status in advance and decide whether you can safely receive the vaccine. Anyone planning to receive a COVID-19 vaccination in Korea must complete this form on the day of their appointment. Below is a guide to each section of the form, provided alongside Russian translations.
From 7 March 2025, the pre-screening form was unified and revised under an amendment to the “Standards and Methods for Vaccination Implementation” (Korea Disease Control and Prevention Agency Notice No. 2025-3). This unified form is used for COVID-19 vaccinations as well. Versions in 12 languages including Russian (Nepali, Lao, Russian, Mongolian, Vietnamese, English, Uzbek, Japanese, Chinese, Khmer, Thai, and Filipino) can be downloaded from the Vaccination Help website (nip.kdca.go.kr). Official information about COVID-19 vaccination in general is also available at the KDCA COVID-19 Vaccination website (ncv.kdca.go.kr). Before proceeding, please check for the latest information by calling 1339 (COVID-19 telephone consultation) or 1345 (Immigration Contact Center).
Step-by-step Overview
- 1. Complete the pre-screening form in advance
Fill in the form on the day of your appointment, or complete it ahead of time online at Vaccination Help.
- 2. Confirm vaccination consent
Receive information about potential adverse reactions and indicate whether you consent to vaccination.
- 3. Fill in personal details and privacy consent
Write your name, alien registration number, and phone number, then answer the three personal information consent items.
- 4. Answer the health status questions
Answer yes or no to seven questions covering pregnancy, allergies, underlying conditions, and more.
- 5. Sign and submit
The person being vaccinated (or their legal guardian or caregiver) signs and dates the form, then submits it.
- 6. Doctor's pre-screening examination
After your temperature is taken, the doctor determines the outcome of the pre-screening (cleared, deferred, or contraindicated).
- 7. Wait 15 to 30 minutes after vaccination
Remain inside the vaccination facility so that any adverse reactions can be observed.
Vaccination Consent
At the top of the pre-screening form, two things are confirmed.
- Whether you have received sufficient information about COVID-19 vaccination and possible adverse reactions
- Whether you agree to receive the vaccination based on the doctor’s pre-screening outcome
Mark one of the following: Consent / Do not consent
Я получил(-а) достаточно информации о вакцинации против COVID-19 и возможных побочных реакциях. Я пройду вакцинацию в соответствии с заключением врача. Согласен(-на) / Не согласен(-на)
If you do not consent, you will not be able to receive the vaccination. If you have any concerns, please ask the doctor your questions first before making a decision.
Basic Personal Information
| Field | Details |
|---|---|
| Name (ФИО) | Full name |
| Resident registration number / Alien registration number | First 6 digits - last 7 digits, with gender checkbox |
| Phone number | Home phone / mobile phone |
Personal Information Processing Consent
Personal information is collected under Article 33-4 of the Infectious Disease Control and Prevention Act and Article 32-3 of its Enforcement Decree.
- Purpose of collection and use: Sending text messages about the next vaccination appointment, confirmation of vaccination completion, and any adverse reactions
- Items collected: Personal information (including resident or alien registration number), home and mobile phone numbers
- Retention and use period: 5 years
Answer Yes (Да) / No (Нет) for each of the three items below.
-
Consent to advance check of vaccination records You are asked whether you agree to have your existing vaccination records checked in advance through the COVID-19 Vaccination Management System before your appointment. If you do not consent, unnecessary additional or cross vaccinations may occur.
-
Consent to receive text messages about the next appointment and vaccination completion You are asked whether you would like to receive text messages on your mobile phone about your next vaccination appointment and confirmation of completion.
-
Consent to receive text messages about adverse reactions You are asked whether you would like to receive guidance text messages after vaccination regarding any adverse reactions.
Health Status Questions
The person being vaccinated (or their legal guardian or caregiver) answers the questions below.
| No. | Question | Response |
|---|---|---|
| ① | (For women) Are you currently pregnant? | Yes / No |
| ② | Do you feel unwell today in a way that is unusual for you? If yes, please describe your symptoms. | Yes / No + describe symptoms |
| ③ | Have you ever been diagnosed with a COVID-19 infection? If yes, please write the date of diagnosis. | Yes / No + write date |
| ④ | Have you received any vaccine other than a COVID-19 vaccine within the past 14 days? | Yes / No |
| ⑤ | Have you previously received a COVID-19 vaccine? If yes, please write the date(s) of vaccination. | Yes / No + write date(s) |
| ⑤-1 | Have you ever received treatment for a severe allergic reaction (anaphylaxis) after a COVID-19 vaccine? If yes, please also write which vaccine was involved. | Yes / No |
| ⑥ | Have you ever received treatment for a severe allergic reaction (anaphylaxis) for any reason? If you know the cause, please write it. | Yes / No |
| ⑦ | Do you have a blood clotting disorder, or are you currently taking anticoagulant medication? If yes, please write the name of the condition or medication. | Yes / No |
If you need to schedule other vaccinations (not COVID-19) before or around the time of your COVID-19 vaccination, please check your vaccination schedule at Vaccination Help. Details such as specific figures and deadlines may change, so please confirm the latest information with 1345 (Immigration Contact Center) or your local Korea Immigration Service office before proceeding.
Signature Section
After completing all the questions, fill in the following information and sign the form.
- Name and signature of the person being vaccinated (or legal guardian or caregiver)
- Relationship to the person being vaccinated (write “self” if you are signing for yourself)
- Date completed (year, month, day)
Doctor’s Pre-screening Result Section (completed by the doctor)
The doctor records the following information after the pre-screening examination. You do not need to fill in this section yourself.
- Temperature (°C) reading
- Confirmation that adverse reactions have been explained
- Confirmation that the person has been advised to wait 15 to 30 minutes after vaccination
The pre-screening result will be one of three outcomes.
- □ Vaccination cleared
- □ Vaccination deferred (reason to be recorded)
- □ Vaccination contraindicated (reason to be recorded)
Vaccination Administrator Record Section (completed by medical staff)
The medical staff member who administers the vaccination fills in this section.
| Field | Details |
|---|---|
| Manufacturer | Name of the vaccine manufacturer |
| Vaccine lot number | The lot number of the vaccine used |
| Injection site | □ Left upper arm / □ Right upper arm |
| Vaccinator’s name | Name of the medical staff member who administered the vaccine |
Reference Links
- Vaccination Help - Download multilingual pre-screening forms - Pre-screening forms in 12 languages including Russian (revised version effective 7 March 2025)
- KDCA COVID-19 Vaccination official website (ncv.kdca.go.kr) - General information about COVID-19 vaccination
- Vaccination Help - Complete the pre-screening form online in advance - You can fill in the pre-screening form before visiting the medical facility.
- HiKorea - Information about alien registration numbers and other residency-related matters
Details such as specific figures and deadlines may change, so please confirm the latest information with 1345 (Immigration Contact Center) or your local Korea Immigration Service office before proceeding.