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Page 3 of 4: IMMUNIZATION HISTORYHEALTH CARE PROVIDERS: Please photocopy immunization history from students record OR insert information below.
IMMUNIZATION EXEMPTION(S):
Medicate Issued:___ Reason:
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How to fill out student immunization record
How to fill out student immunization record
01
Obtain the student immunization record form from the school or healthcare provider.
02
Fill out the student's personal information, including name, date of birth, and student ID number.
03
Record the dates of each vaccination received by the student.
04
Include the type of vaccine given and the dosage received.
05
Make sure to have the form signed by a healthcare provider to validate the information provided.
Who needs student immunization record?
01
Students attending school or college.
02
Students participating in sports or extracurricular activities.
03
Students enrolled in childcare or preschool programs.
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What is student immunization record?
A student immunization record is a document that shows the vaccines a student has received.
Who is required to file student immunization record?
Parents or guardians are typically required to file a student's immunization record with the school or educational institution.
How to fill out student immunization record?
To fill out a student immunization record, parents or guardians must provide documentation of each vaccine dose the student has received.
What is the purpose of student immunization record?
The purpose of a student immunization record is to ensure that all students are up to date on required vaccinations to prevent the spread of communicable diseases.
What information must be reported on student immunization record?
A student's immunization record must include the types of vaccines received, the dates they were administered, and any exemptions or medical waivers.
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