Get the free Certificate of Immunization Status form - Heritage University

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 a certificate of immunization status:

1. Start by gathering all relevant information, such as your name, date of birth, and contact details.
2. Next, ensure that you have the necessary documentation regarding your immunization history. This may include records of vaccines received, dates of vaccinations, and any booster shots.
3. Obtain a copy of the certificate of immunization status form, either from a healthcare provider or from the respective institution that requires it.
4. Fill in your personal information accurately and legibly on the form, including your full name, date of birth, and contact information.
5. Provide details about each vaccine you have received. Include the name of the vaccine, the date it was administered, and the administering healthcare professional or facility.
6. If applicable, include information about any booster shots or additional immunizations you have received. This is important for maintaining an up-to-date record of your immunization status.
7. Review the completed form for any errors or missing information. Double-check that all dates and vaccine names are correct.
8. Sign and date the form, confirming that the information provided is true and accurate to the best of your knowledge.

Who needs a certificate of immunization status:

1. Students: Many educational institutions require students to provide a certificate of immunization status as part of their enrollment process. This is to ensure a safe and healthy environment for all students.
2. Healthcare workers: Professionals working in the healthcare field, such as doctors, nurses, and technicians, often need to provide proof of immunization status to protect themselves and their patients from communicable diseases.
3. Travelers: Some countries or airlines may require a certificate of immunization status as a condition of entry or travel. This is particularly true for destinations with prevalent diseases or outbreaks that can be prevented through vaccination.
4. Employment: Certain employers, especially those in high-risk industries or healthcare settings, may require employees to provide a certificate of immunization status to safeguard the health and well-being of their workforce and clients.
5. Volunteers: Organizations or events that involve close contact with vulnerable populations, such as children, the elderly, or those with compromised immune systems, may request a certificate of immunization status from volunteers to ensure the safety of all participants.

For pdfFiller’s FAQs

What is certificate of immunization status?

The certificate of immunization status is a document that provides proof of an individual's immunization history and vaccination records.

Who is required to file certificate of immunization status?

Parents or guardians of school-age children are generally required to file the certificate of immunization status.

How to fill out certificate of immunization status?

The certificate of immunization status can typically be filled out by providing information on the individual's name, date of birth, vaccination history, and healthcare provider details.

What is the purpose of certificate of immunization status?

The purpose of the certificate of immunization status is to ensure that individuals are up-to-date on their vaccinations in order to prevent the spread of communicable diseases.

What information must be reported on certificate of immunization status?

The certificate of immunization status typically requires information on the individual's name, date of birth, vaccine doses received, and dates of vaccination.

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