This government document is issued by Maryland Emergency Management Agency for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:n_j4xw0tms8&q=https://mema.maryland.gov/community/Documents/Equitable-COVID-19-Vaccine-Administration-Submission-Template.pdf&sa=U&ved=2ahUKEwj35-We7KrxAhXNk4sKHV9kABk4HhAWMAZ6BAgDEAI&usg=AOvVaw0KmTTpb_oDtwuyulKIXBee