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Certificate of Immunization Status (CIS) DOH 348013 January 2015 Office Use Only: Reviewed by: Date: Signed Cert. Of Exemption on file? Yes No Please print. See back for instructions on how to fill
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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 a copy of the certificate of immunization status form from your healthcare provider or the relevant government agency.
02
Fill in your personal information, such as your full name, date of birth, and contact information, in the designated fields.
03
Provide details about your immunizations, including the name of the vaccine, the date it was administered, and the healthcare provider or facility where it was given. Make sure to accurately record all the required vaccines.
04
If applicable, indicate any exemptions or medical contraindications to certain vaccines. This may require additional documentation or a signature from a healthcare professional.
05
Review the completed form for accuracy and completeness. Make sure all the required information is provided and there are no errors or omissions.
06
Sign and date the form to verify that the information provided is true and accurate.
07
Submit the completed certificate of immunization status form to the appropriate authority or organization that requires it, such as your school, employer, or government agency.

Who needs certificate of immunization status:

01
Students: Many educational institutions, including schools, colleges, and universities, require students to provide a certificate of immunization status as part of their enrollment process.
02
Healthcare workers: In order to ensure patient safety, healthcare facilities often request proof of immunization from their employees to minimize the risk of transmitting communicable diseases.
03
Travelers: Certain countries or regions may require visitors to provide a certificate of immunization status as a precaution against the spread of infectious diseases.
04
Employment: Some industries, particularly those involving childcare, healthcare, or food handling, may require employees to provide proof of immunization to protect both workers and customers.
05
Government regulations: Depending on your jurisdiction, there may be specific government regulations that mandate a certificate of immunization status for various purposes, such as licensing, benefits eligibility, or immigration requirements.
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The certificate of immunization status is an official document that shows whether an individual has received certain vaccines.
Any individual, typically students or healthcare workers, who are required to provide proof of immunization status.
The certificate is usually completed by a healthcare provider who administers the vaccines, and includes details about the vaccines received.
The purpose of the certificate is to ensure that individuals are properly vaccinated against certain diseases.
The certificate typically includes the individual's name, date of birth, vaccine information, and the healthcare provider's signature.
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