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Certificate of Immunization Status (CIS) DOH 348013 January 2010 Please print. See back for instructions on how to fill out this form or get it printed from the Immunization Registry. Child's Last
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How to fill out certificate of immunization status
How to fill out a certificate of immunization status:
01
Obtain the necessary form: The certificate of immunization status can typically be obtained from a healthcare provider, school, or public health department. Make sure you have the correct form for your specific situation.
02
Personal information: Begin by filling out your personal information section of the form. This usually includes your full name, date of birth, address, and contact information. Fill in each field accurately and legibly.
03
Immunization records: In the next section, you will need to provide details about your immunization history. Write down the name of each vaccine you have received, along with the manufacturer, lot number, and the dates of administration. Include all required vaccinations as per your local regulations.
04
Non-immunized or incomplete records: If there are any vaccines that you have not received or the records are incomplete, note this on the form. Some forms may require an explanation of why a particular vaccine has not been administered.
05
Signature and date: Finally, sign and date the certificate of immunization status to verify its accuracy. If the form requires a witness or healthcare provider's signature, make sure to get that as well.
Who needs a certificate of immunization status:
01
School students: Many schools and colleges require students to provide a certificate of immunization status before starting their academic year. This helps ensure a safe and healthy environment for all students.
02
Healthcare workers: Professionals working in the healthcare field often need to submit a certificate of immunization status as a part of their employment requirements. This ensures that they are adequately protected against vaccine-preventable diseases and reduces the risk of transmission to patients.
03
Travelers: Some countries may require a certificate of immunization status, especially if you are traveling to areas with a higher risk of infectious diseases. This is particularly important for diseases such as yellow fever, meningococcal disease, or polio, where proof of vaccination may be mandatory.
04
New immigrants or refugees: When moving to a new country, individuals may be required to provide a certificate of immunization status to demonstrate their immunization history. This helps the receiving country determine the vaccination needs and protect public health.
Remember, the specific requirements for a certificate of immunization status can vary depending on your location and circumstances. It is always advisable to check with the relevant authorities or institutions for the most accurate and up-to-date information.
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What is certificate of immunization status?
The certificate of immunization status is a document that shows an individual's vaccination history.
Who is required to file certificate of immunization status?
Students entering school or college are usually required to file a certificate of immunization status.
How to fill out certificate of immunization status?
The certificate of immunization status can be filled out by a healthcare provider with the individual's vaccination records.
What is the purpose of certificate of immunization status?
The purpose of the certificate of immunization status is to ensure that individuals are protected against vaccine-preventable diseases.
What information must be reported on certificate of immunization status?
The certificate of immunization status must include the individual's name, date of birth, vaccine doses, and dates of vaccination.
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