Get the free Medical Immunization Records - UIC Office of the Registrar

2021 IMMUNIZATION RECORD All immunization records must be submitted in English prior to registration. Please complete this form and return it to Student Affairs (Barter Student Center) or email to

How to fill out medical immunization records

How to fill out medical immunization records

1. Obtain a copy of the medical immunization record form from your healthcare provider or school.
2. Fill out your personal information including your name, date of birth, and contact information.
3. Provide details of all vaccines you have received including the date, type of vaccine, and dosage.
4. Make sure to include any relevant medical history or allergies that could affect your immunization status.
5. Sign and date the form to certify that the information provided is accurate.
6. Submit the completed form to the appropriate healthcare provider or school.

Who needs medical immunization records?

1. Anyone who is required to provide proof of immunization for school or work purposes.
2. Individuals traveling to certain countries that require proof of specific vaccinations.
3. Healthcare workers who need to maintain a record of their immunizations for occupational health and safety purposes.

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What is medical immunization records?

Medical immunization records are documents containing information about an individual's vaccination history.

Who is required to file medical immunization records?

Healthcare providers, schools, and other organizations may be required to file medical immunization records.

How to fill out medical immunization records?

Medical immunization records can be filled out by recording the dates and types of vaccinations received by an individual.

What is the purpose of medical immunization records?

The purpose of medical immunization records is to track and document an individual's vaccination history for medical and administrative purposes.

What information must be reported on medical immunization records?

Information such as the type of vaccine, date of administration, and the healthcare provider administering the vaccine must be reported on medical immunization records.