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18002657293 Vaccine Order Inquiries Ext. 4170 General Immunization Information Ext. 4744SCHOOL BASED VACCINE REQUEST FAX TO: 5198234903Public Health offers Hepatitis B, and HPV vaccinations in the

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How to fill out school based vaccine request

01

Obtain the school based vaccine request form from your child's school or district office.

02

Fill out the student's information, including their name, date of birth, and school.

03

Provide the requested vaccine information, including the name of the vaccine, the date it was administered, and the lot number if available.

04

Make sure to sign and date the form.

05

Submit the completed form to the designated person or office at your child's school or district.

Who needs school based vaccine request?

01

School based vaccine request is needed for students who require vaccination verification for school entry or compliance.

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What is school based vaccine request?

School based vaccine request is a request made by schools for students to receive required vaccinations.

Who is required to file school based vaccine request?

School administrators or designated staff members are required to file school based vaccine request.

How to fill out school based vaccine request?

Schools can fill out the request form with the required vaccination information for each student.

What is the purpose of school based vaccine request?

The purpose of school based vaccine request is to ensure that students are up-to-date on their vaccinations and to prevent the spread of vaccine-preventable diseases.

What information must be reported on school based vaccine request?

The request must include each student's name, date of birth, vaccination status, and any exemptions.

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