Get the free Immunization Requirements Form

This form is required for students to document their immunizations for Measles, Mumps, Rubella, and Hepatitis B, unless they graduated from a California public high school after January 2005.

How to fill out immunization requirements form

How to fill out Immunization Requirements Form

1. Obtain the Immunization Requirements Form from your healthcare provider or school administration.
2. Review the instructions provided on the form carefully.
3. Fill out your personal information, including your name, date of birth, and other identifying details.
4. List your immunization history, including dates and types of vaccines received.
5. Include documentation such as vaccination records or medical exemption letters if applicable.
6. Double-check for accuracy and completeness before submitting.
7. Sign and date the form where required.

Who needs Immunization Requirements Form?

1. Students entering school for the first time.
2. Children enrolling in childcare or pre-school programs.
3. Individuals applying for certain college or university programs.
4. Healthcare workers or students in healthcare programs.
5. Anyone participating in specific community programs or activities requiring vaccinations.

People Also Ask about

What information should a vaccine stock sheet record?

The recipient should record the vaccine type, brand, and batch number, expiry date and the date and time of receipt. Stock should be rotated to ensure that old stock is moved to the front of the fridge and expiry dates should be checked to ensure that expired vaccines are disposed of as per local protocol.

What information is required on an immunization record?

All records must show the vaccine type, dose, and date of each shot.

What information is needed when documenting immunizations?

By law, the following information must be documented on the patient's paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.

Which states have religious exemptions for vaccinations?

Modal title StatePersonal ExemptionReligious Exemption California No No Colorado Yes Yes Connecticut No No Delaware No Yes47 more rows • Mar 10, 2025

What details must be documented when a vaccination is given?

The date the VIS is provided (i.e., the date of the visit when the vaccine is administered). The office address and name and title of the person who administers the vaccine. The date the vaccine is administered. The vaccine manufacturer and lot number.

What shots are required for school in Florida?

Immunization Requirements DTaP vaccine (diphtheria, tetanus and pertussis) Polio vaccine. MMR vaccine (measles, mumps, rubella) Hepatitis B vaccine. Varicella vaccine (or date of disease) Haemophilus influenza type b (Hib) vaccine.

What information must be documented following administration of an immunization?

By law, the following information must be documented on the patient's paper or electronic medical record (or on a permanent office log): The vaccine manufacturer. The lot number of the vaccine. The date the vaccine is administered.

For pdfFiller’s FAQs

What is Immunization Requirements Form?

The Immunization Requirements Form is a document that outlines the required vaccinations for individuals, typically for school or employment purposes.

Who is required to file Immunization Requirements Form?

Individuals enrolling in schools or certain programs, as well as employees in specific fields, are often required to file the Immunization Requirements Form.

How to fill out Immunization Requirements Form?

To fill out the Immunization Requirements Form, individuals must provide personal information, list their vaccination history, and may need to include signatures from healthcare providers.

What is the purpose of Immunization Requirements Form?

The purpose of the Immunization Requirements Form is to ensure that individuals are up-to-date on their vaccinations to protect public health and comply with institutional policies.

What information must be reported on Immunization Requirements Form?

The Immunization Requirements Form must report personal details, vaccination dates, types of vaccines received, and possibly documentation from healthcare professionals.