Get the free Certificate of Immunization Status form - Seattle Learning Center

Certificate of Immunization Status (CIS) DOH 348-013 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

How to fill out certificate of immunization status

How to fill out certificate of immunization status:

1. Obtain the certificate form: The first step is to obtain the appropriate certificate of immunization status form. This form can usually be obtained from your healthcare provider, school, or local health department.
2. Gather required information: Before filling out the form, make sure you have all the necessary information readily available. This typically includes personal details such as your full name, date of birth, and contact information.
3. Record immunization history: Begin by documenting your immunization history on the form. This involves listing the vaccinations you have received, along with the dates they were administered. Include both routine vaccinations, such as measles, mumps, and rubella (MMR), as well as any additional vaccines required for specific purposes.
4. Provide supporting documentation: In some cases, you may be required to provide supporting documentation to verify your immunization status. This can include copies of immunization records issued by healthcare providers or previous schools attended. Make sure to attach these documents securely to the form if needed.
5. Review and sign the form: Once you have completed all the required sections, carefully review the form for accuracy and completeness. Check that all the information provided is correct and legible. Finally, sign and date the form to certify its authenticity.

Who needs certificate of immunization status:

1. Students: Many educational institutions, including schools, colleges, and universities, require a certificate of immunization status for enrollment. This helps to ensure the safety and well-being of all students by preventing the outbreak of vaccine-preventable diseases within the campus community.
2. Healthcare professionals: Individuals working in healthcare settings may need to provide a certificate of immunization status as a part of their employment requirements. This is particularly important in settings where individuals are exposed to patients or vulnerable populations.
3. Travelers: Certain countries or regions may require proof of immunization status before granting entry or issuing a visa. This is especially common in areas where certain diseases, such as yellow fever or polio, are prevalent. Having a certificate of immunization status can facilitate smooth travel and prevent unnecessary delays at immigration checkpoints.
4. Some employers: Depending on the nature of the job or occupation, certain employers may require employees to provide a certificate of immunization status. This is especially true for roles that involve interacting with individuals who may be more susceptible to infectious diseases, such as childcare providers or those working in long-term care facilities.
5. Other situations: There may be other situations or events where a certificate of immunization status is required or recommended. This can include participation in organized sports, attending summer camps, or volunteering in certain community programs. It is always a good idea to check the specific requirements of the organization or event in question.

For pdfFiller’s FAQs

What is certificate of immunization status?

The certificate of immunization status is a document that verifies an individual's vaccination history.

Who is required to file certificate of immunization status?

Certain individuals, such as students, healthcare workers, and travelers may be required to file a certificate of immunization status depending on their specific circumstances.

How to fill out certificate of immunization status?

The certificate of immunization status can typically be filled out by providing details of each vaccination received, including the date and type of vaccine.

What is the purpose of certificate of immunization status?

The purpose of the certificate of immunization status is to ensure that individuals have received the necessary vaccinations to prevent the spread of certain diseases.

What information must be reported on certificate of immunization status?

The certificate of immunization status typically requires information such as the individual's name, date of birth, and details of each vaccination received.

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