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VISITING STUDENT IMMUNIZATION RECORD FORM Name: Date of Birth: (Print) Mass Medical School requires that all visiting students requesting enrollment in our clinical electives show proof of immunity
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How to fill out visiting student immunization record

How to fill out visiting student immunization record:
01
Obtain a copy of the immunization form from the school or educational institution where you will be visiting as a student.
02
Gather all relevant immunization records including records of vaccines received and dates of administration.
03
Fill out your personal information on the form, including your full name, date of birth, and student identification number if applicable.
04
Provide information about your current school or educational institution, including the name, address, and contact details.
05
Review the immunization requirements of the visiting school and ensure that you have received all the necessary vaccinations.
06
Enter the details of each vaccination you have received in the appropriate sections of the form, including the vaccine name, manufacturer, dose, and date administered.
07
If there are any required booster shots or additional vaccinations, make sure to schedule and receive them before completing the form.
08
Provide any additional information or documentation required by the visiting school, such as a signed consent form or medical exemption documentation.
09
Double-check all the information filled out on the form for accuracy and completeness.
10
Sign and date the form, indicating that the information provided is true and accurate.
Who needs visiting student immunization record:
01
Students who are planning to visit a different school or educational institution as part of a study abroad program or exchange program.
02
Students who are attending a school temporarily for a specific course or training program.
03
Students who are transferring from one educational institution to another and need to provide proof of immunization.
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What is visiting student immunization record?
The visiting student immunization record is a document that contains information about the immunization history of a visiting student.
Who is required to file visiting student immunization record?
All visiting students are required to file their immunization record.
How to fill out visiting student immunization record?
Visiting students can fill out the immunization record by providing information about their past immunizations, such as the date, type of vaccine, and the administering healthcare professional.
What is the purpose of visiting student immunization record?
The purpose of the visiting student immunization record is to ensure that visiting students are properly vaccinated and protected against communicable diseases.
What information must be reported on visiting student immunization record?
The visiting student immunization record must include details about the vaccines received, such as the vaccine name, date of administration, and any applicable expiration dates.
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