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City of PhiladelphiaDepartment of Public HealthRegulations Governing the Immunization and
Treatment of Newborns, Children and Adolescents
Approved:
BOARD OF HEALTH
LAW DEPARTMENT
RECORDS DEPARTMENT
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01
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02
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04
Review each section of the form to understand the information required.
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Start filling out the form by entering your personal details such as name, address, and contact information.
06
Provide accurate information about your immunization history, including dates, vaccines received, and any relevant medical records.
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If applicable, provide details about any exemptions or waivers you may qualify for.
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Who needs regulations governing form immunization?
01
Individuals who are required to provide proof of immunization for specific purposes.
02
Students enrolling in educational institutions.
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Travelers visiting certain countries or regions.
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Employees in industries where immunization is mandatory for occupational health and safety.
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Children enrolling in schools or daycare facilities.
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Individuals seeking immigration or visa processes.
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Members of the military.
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Anyone seeking to comply with public health regulations.
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