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CO Certificate of Immunization 2018 free printable template

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COLORADO CERTIFICATE OF IMMUNIZATION www.coloradoimmunizations.com This form is to be completed by a health care provider (physician (MD, DO), advanced practice nurse (APN) or delegated physicians
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CO Certificate of Immunization Form Versions

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CO Certificate of Immunization 2023
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CO Certificate of Immunization 2018
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CO Certificate of Immunization 2004
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How to fill out CO Certificate of Immunization

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How to fill out CO Certificate of Immunization

01
Obtain the CO Certificate of Immunization form from your healthcare provider or the official Colorado state health website.
02
Start by filling out your personal information including your name, date of birth, and address.
03
Record the date of each immunization received, along with the type of vaccine administered.
04
Include the name and address of the healthcare provider who administered the vaccines.
05
If applicable, provide any exemptions or medical reasons for not receiving certain immunizations.
06
Review the form for accuracy and completeness.
07
Sign and date the certificate.

Who needs CO Certificate of Immunization?

01
Children entering school or daycare in Colorado.
02
Students attending college or university in Colorado.
03
Individuals participating in certain public health programs or activities.
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COLORADO CERTIFICATE OF IMMUNIZATION This form is to be completed by a health care provider (physician (MD, DO), advanced practice nurse (APN) or delegated physician's assistant (PA)) or school health authority. School required immunizations follow the ACIP schedule.
The Colorado Immunization Information System (CIIS) is a lifelong immunization record tracking system under the Colorado Immunization Registry Act of 2007. CIIS has signed agreements with all participating sites that are authorized to provide information to or access information from CIIS.
Your vaccination record (sometimes called your immunization record) provides a history of all the vaccines you received as a child and adult. This record may be required for certain jobs, travel abroad, or school registration.
Patients and guardians of minors can now use the CIIS Public Portal to view and print an official record of their immunizations.
Vaccines required to enter school (K-12) *Students 4 through 6 years of age are required to have their final doses of DTaP, IPV,MMR and Varicella prior to kindergarten entry. **Students are required to have Tdap prior to entry into 6th grade. One dose of Tdap is required for 6th through 12th grades.

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The CO Certificate of Immunization is a document that verifies an individual's immunization status, detailing the vaccines received and any relevant health information.
Individuals enrolling in schools or childcare facilities in Colorado are typically required to file a CO Certificate of Immunization to prove compliance with vaccination requirements.
To fill out the CO Certificate of Immunization, provide personal information such as name and date of birth, list the vaccines received along with dates, and ensure a healthcare provider signs the form if needed.
The purpose of the CO Certificate of Immunization is to ensure that individuals have received the necessary vaccinations to protect public health and prevent outbreaks of vaccine-preventable diseases.
The information that must be reported on the CO Certificate of Immunization includes the individual's name, date of birth, vaccination dates, types of vaccines administered, and any exemptions that may apply.
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