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Certificate of Immunization Status (CIS) DOH 348013 January 2010 Please print. See back for instructions on how to fill out this form or get it printed from the Immunization Registry. Child's Last

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How to fill out certificate of immunization status

01

Gather all necessary information, including personal details and immunization records.

02

Obtain a copy of the certificate of immunization status form.

03

Fill out personal information, such as name, date of birth, and contact information.

04

Provide details about vaccination history, including the name of each vaccine, date received, and dosage.

05

Include any exemptions or waivers, if applicable.

06

Sign and date the form.

07

Submit the completed certificate of immunization status to the relevant authority or organization.

Who needs certificate of immunization status?

01

Children attending schools or daycare facilities often require a certificate of immunization status.

02

Individuals enrolling in college or university may need to provide proof of immunization.

03

Certain professions, such as healthcare workers or those in the education sector, may be required to have a certificate of immunization status.

04

International travelers may need to show a certificate of immunization status to enter certain countries.

05

Individuals participating in certain activities or events, such as sports or camps, may need to provide proof of immunization.

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What is certificate of immunization status?

The certificate of immunization status is a document that provides information on an individual's immunization history.

Who is required to file certificate of immunization status?

All individuals, especially students, are required to file a certificate of immunization status in certain institutions such as schools and universities.

How to fill out certificate of immunization status?

To fill out the certificate of immunization status, one must provide accurate information about their immunization history, including dates and types of vaccines received.

What is the purpose of certificate of immunization status?

The purpose of the certificate of immunization status is to ensure that individuals are properly immunized against preventable diseases for the safety and well-being of the community.

What information must be reported on certificate of immunization status?

The certificate of immunization status must include information on the individual's name, date of birth, vaccine records, and healthcare provider details.

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