COVID-19 Vaccine Waiting List

Refugio County Memorial Hospital District is currently waiting on its next allocation of the Moderna Covid-19 Vaccine. Once received, those people who are registered and fall within the Tier 1A and 1B category will be eligible to receive the vaccine. Depending upon the amount of vaccine allotted and other factors, we may schedule patients individually or we may hold one or large scale vaccination clinic. Once you complete this form, your information will be placed in a scheduling queue at the Refugio County Memorial Hospital. When the vaccine arrives you will be contacted by phone or email to notify/schedule you for your vaccination.

Please complete the following information to be put on a waiting list for Tier 1B distribution of the Moderna COVID-19 vaccine.

Per Texas Health and Human Services, to qualify for Tier 1B you must be:

  • 65 years of age or older


  • 16 years of age or older with at least one chronic medical condition that puts you at increased risk for severe illness from the virus that causes COVID-19, such as but not limited to:
    • Cancer
    • Chronic kidney disease
    • COPD (chronic obstructive pulmonary disease)
    • Heart conditions, such as heart failure, coronary artery disease or cardiomyopathies
    • Solid organ transplantation
    • Obesity and severe obesity (body mass index of 30 kg/m2 or higher)
    • Pregnancy
    • Sickle cell disease
    • Type 2 diabetes mellitus