Background: Patients with cancer are at-risk for increased severity of infections due to compromised immunity, potentially leading to poorer patient outcomes. We aimed to increase documentation of Covid-19 assessment from 0% to 60% by implementing a quality improvement intervention impacting each patient encounter, beginning in a pilot rural oncology clinic. Methods: We engaged in a quality improvement initiative to implement, improve, and sustain a new process for COVID-19 assessment. A method to easily document Covid-19 status was needed in the EMR (OncoEMR). A Covid-19 verification, binary (yes-vaccinated/no-not vaccinated) checkbox tool was created and integrated into the patient assessment workflow and OncoEMR. This tool was piloted at one, then four additional rural clinics, but was available across the system. Spontaneous uptake in CARTI’s other nine clinics allowed us to identify early adopters who then became the champions to promote the application throughout the entire CARTI health system. Results: Beginning in May 2023, the pilot clinic assessment results reached 52% (n=25/48) after 4-weeks, and the tool was implemented into four additional rural clinics. An assessment rate of 57% (n=282/496) was achieved after 8 weeks at the other rural clinics and subsequently implemented throughout all CARTI clinics. In March 2024, Covid-19 assessment rates exceeded our initial aim of 60% reaching 88% (n=1692/1918) in the 5 rural clinics and 73% (n=8849/12195) throughout the entire health system. An initiation of immunization culture change was observed as a result of the initiative. Conclusions: Successful implementation of Covid-19 assessment tool was initiated by nursing and physician innovators and amplified by early adopters who propagated a cultural change emphasizing the importance of immunizations as part of cancer patient care. The resulting culture change resonates throughout the CARTI health system with dedication to increasing positive patient outcomes through completion of routine vaccinations for all who are eligible. With the continued support of innovators, CARTI has maintained Covid-19 assessment rates above 50% for the past nine months and plans to implement further immunization standards focusing on Covid-19 and other CDC recommended vaccines including the flu, shingles, pneumococcal and TdaP.