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ULM Proof of Immunization Compliance 2018-2025 free printable template

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PROOF OF IMMUNIZATION COMPLIANCE Louisiana R.S. 17:170/170.1/Schools of Higher Learning Please use PDF interactivity or print with ink to complete this form (information must be legible to be accepted).
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How to fill out proof immunization form

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How to fill out ULM Proof of Immunization Compliance

01
Obtain the official ULM Proof of Immunization Compliance form from the ULM website or student services.
02
Gather your immunization records, including vaccinations for measles, mumps, rubella (MMR), hepatitis B, and any other required immunizations.
03
Fill in your personal information such as your name, student ID, and date of birth on the form.
04
Enter the dates of your immunizations as indicated on your immunization records.
05
Have a healthcare provider sign and date the form to verify the accuracy of your immunization records.
06
Submit the completed form to the designated office at ULM by the deadline provided.

Who needs ULM Proof of Immunization Compliance?

01
All incoming students at the University of Louisiana Monroe, including freshmen, transfers, and international students.
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Documenting Vaccination 1.The vaccine manufacturer.2.The lot number of the vaccine.3.The date the vaccine is administered.4.The name, office address, and title of the healthcare provider administering the vaccine.7 more rows • 8 Jan 2021
Job Aid Date of administration. Vaccine manufacturer. Vaccine lot number. Name and title of the person who administered the vaccine and address of the facility where the permanent record will reside. Vaccine information statement (VIS) Date printed on the VIS. Date the VIS was given to the patient or parent/guardian.
There are different delivery methods for immunizations, including oral, intranasal, subcutaneous, and intramuscular. Post-vaccination, there can be complications such as anaphylaxis. Epinephrine autoinjection is crucial in these settings.
Give infants and children 5 doses of DTaP. Give one dose at each of these ages: 2 months, 4 months, 6 months, 15 through 18 months, and 4 through 6 years.
Babies need 3 shots of DTaP to build up high levels of protection against diphtheria, tetanus, and whooping cough. Then, young children need 2 booster shots to maintain that protection through early childhood.
1. Via the NHS app, where you can access your digital QR code. It is quick and easy to set up an account.

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ULM Proof of Immunization Compliance is a requirement for students to demonstrate that they have received the necessary vaccinations as mandated by the university or state law.
All students enrolling at the University of Louisiana at Monroe (ULM) are required to file Proof of Immunization Compliance.
To fill out ULM Proof of Immunization Compliance, students should complete the required form provided by the university, ensuring to include details about their vaccination history and signatures from healthcare providers if necessary.
The purpose of ULM Proof of Immunization Compliance is to ensure that students are vaccinated against certain communicable diseases to protect both individual health and public health within the university community.
The information that must be reported on ULM Proof of Immunization Compliance includes the dates of vaccinations received, the type of vaccines, the name of the healthcare provider, and any additional medical documentation if applicable.
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