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Certificate of Immunization Status (CIS) For Kindergarten12th Grade / Child Care Interoffice Use Only:Reviewed by:Date:Signed Cert. Of Exemption on file? Yes Please print. See back for instructions
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How to fill out certificate of immunization status

01
To fill out a certificate of immunization status, follow these steps:
02
Write the name and contact information of the person being immunized at the top of the form.
03
Fill in the date of birth and gender of the person being immunized.
04
List the vaccines that have been received by the person and fill in the dates of administration.
05
Include information about any related medical conditions or allergies, if applicable.
06
If the person hasn't received any vaccines, indicate it on the form.
07
Finally, sign and date the certificate to certify its accuracy and completeness.

Who needs certificate of immunization status?

01
A certificate of immunization status may be required by various entities such as schools, colleges, and workplaces.
02
It is typically needed for enrollment in educational institutions, especially for students entering kindergarten, elementary school, or college.
03
Additionally, some employers may require the certificate as part of their health and safety protocols for certain occupations.
04
Furthermore, individuals who are planning to travel to certain countries or participate in specific activities may need to provide proof of immunization.
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The certificate of immunization status is a document that shows whether an individual has been vaccinated against certain diseases.
All individuals, especially students, are required to file a certificate of immunization status.
To fill out a certificate of immunization status, you need to provide details of the vaccines you have received and when you received them.
The purpose of the certificate of immunization status is to ensure that individuals are protected against vaccine-preventable diseases.
The certificate of immunization status must include details of the vaccines received, dates of vaccination, and healthcare provider information.
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