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YORKSHIRE ACADEMY 2017/18 IMMUNIZATION RECORD/STATEMENT of HEALTH Name: D.O.B.: Parent/Guardian: Sex: Hepatitis (Herb) Rotavirus (RV) DTP/Tap His Pneumococcal (PCV) Polio (IPA) MMR Varicella Hepatitis
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How to fill out immunization recordstatement of health
How to fill out immunization recordstatement of health
01
Gather all necessary personal information and vaccination records.
02
Ensure you have a copy of the immunization recordstatement of health form.
03
Fill out the personal information section accurately, including name, date of birth, and contact information.
04
List all previous vaccinations received, along with the date and type of vaccine.
05
Indicate any known allergies or adverse reactions to vaccines.
06
Provide the required information related to healthcare providers or clinics where vaccinations were administered.
07
Review the completed form for accuracy and legibility.
08
Sign and date the form to certify the information provided.
09
Submit the filled out immunization recordstatement of health form to the appropriate authority or healthcare provider.
Who needs immunization recordstatement of health?
01
Anyone who requires proof of immunization or vaccination history may need an immunization recordstatement of health.
02
This includes individuals enrolling in educational institutions (schools, colleges, universities), new employees, individuals applying for a visa or passport, and individuals entering certain countries.
03
Parents may also need to provide an immunization recordstatement of health for their children when enrolling them in childcare facilities or schools.
04
Additionally, individuals traveling to areas with high disease prevalence or participating in certain activities such as healthcare workers may need an immunization recordstatement of health.
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