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Get the free Certificate of Immunization Status Form. Immunizations - doh wa

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Certificate of Immunization Status (CIS) Please print. See back for instructions on how to fill out this form or get it printed from the Washington Immunization Information System. Childs Last Name:First
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How to fill out certificate of immunization status

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How to fill out certificate of immunization status

01
Obtain the Certificate of Immunization Status form from your healthcare provider or the relevant health department.
02
Fill in your personal information, including your full name, date of birth, and contact information.
03
List all vaccinations received, including the dates of each vaccination.
04
Ensure that all information is accurate and up to date.
05
Sign and date the form to verify that the information provided is correct.
06
Submit the form to the required institution or keep it for your personal records.

Who needs certificate of immunization status?

01
Children attending school or daycare.
02
College or university students.
03
Individuals traveling to certain countries.
04
Healthcare workers and those in medical training.
05
People entering certain jobs that require proof of immunization.
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A certificate of immunization status is an official document that records an individual's immunizations, showing which vaccines have been administered and the dates they were given.
Typically, parents or guardians of children entering school or daycare, as well as adults required to show proof of immunization for certain employment or travel, are required to file a certificate of immunization status.
To fill out a certificate of immunization status, one must provide personal information including the individual's name, date of birth, and the details of immunizations received, including the type of vaccine, dates administered, and the name of the provider.
The purpose of the certificate of immunization status is to provide proof of immunization to help prevent the spread of vaccine-preventable diseases and ensure compliance with school or public health requirements.
The information that must be reported includes the recipient's name, date of birth, list of vaccines received, dates of administration, and the name and address of the healthcare provider administering the vaccines.
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