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The Immunization Record form is a crucial document that tracks a person's vaccination history, ensuring they meet necessary health requirements for school and childcare enrollment. This record not only serves as proof of immunization but also helps parents keep track of upcoming vaccinations. To ensure your child is compliant with California's immunization requirements, fill out the form by clicking the button below.

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The Immunization Record form is an essential document for parents and guardians, particularly in California, where it serves as proof of a child's vaccinations required for school and child care enrollment. This form includes critical information such as the child's name, birthdate, and sex, along with a section to document any allergies and vaccine reactions. It details the vaccines administered, including common ones like DTaP, MMR, and HPV, alongside the dates when each dose was given and when the next doses are due. Additionally, the form provides space for the healthcare provider's information, ensuring that all vaccination records are easily accessible and organized. Parents are advised to retain this document carefully, as it may be necessary for school registration and other health-related requirements. Furthermore, the form includes sections for tuberculosis skin tests and chest x-ray results, which may be required under certain circumstances. Overall, the Immunization Record form plays a vital role in maintaining a child's health history and ensuring compliance with state regulations.

Sample - Immunization Record Form

IMMUNIZATION RECORD

Comprobante de Inmunización

Name nombre

Birthdate			Sex
fecha de nacimiento			sexo
Allergies
alergias
Vaccine Reactions
reacciones a la vacuna
RETAIN THIS DOCUMENT — CONSERVE ESTE DOCUMENTO
	DATE			NEXT
	DATE			NEXT
	GIVEN			DOSE DUE
VACCINE	fecha de	DOCTOR OFFICE OR CLINIC		próxima
vacuna	vacunación	médico o clínica		vacuna

Parents: Your child must meet California’s immunization requirements to be enrolled in school and child care. Keep this Record as proof of immunization.

Padres: Su niño debe cumplir con los requisitos de vacunas para asistir a la escuela y a la guardería. Mantenga este Comprobante: lo necesitará.

DT/Td = Diphtheria, tetanus		[difteria, tétano]
DTaP/Tdap = Diphtheria, tetanus, and pertussis (whooping cough)					[difteria, tétano, y tos ferina]
DTP = Diphtheria, tetanus, pertussis (whooping cough)				[difteria, tétano, y tos ferina]
HEP A = Hepatitis A
HEP B = Hepatitis B
HIB = Hib meningitis (	Haemophilus inﬂuenzae		type b)	[meningitis Hib]
HPV = Human papillomavirus		[virus del papiloma humano]
INFV = Inﬂuenza [la gripe]
MCV = Meningococcal conjugate vaccine [vacuna meningocócia conjugada]
MMR = Measles, mumps, rubella [sarampión, paperas y rubéola (sarampión alemán)]
MPV = Meningococcal polysaccharide vaccine			[vacuna meningocócia polisacárida]
PNEUMO = Pneumococcal vaccine [neumocócica]
POLIO = Poliomyelitis	[poliomielitis]
RV = Rotavirus [rotavirus]
VZV = Varicella (chickenpox)		[varicela]

Registry ID Number

	DATE		NEXT
	GIVEN		DOSE DUE
VACCINE	fecha de	DOCTOR OFFICE OR CLINIC	próxima
vacuna	vacunación	médico o clínica	vacuna

	TB SKIN TESTS*		Pruebas de la Tuberculosis

Type**	Date given	Given by	Date read	Read by	mm/indur	Impression

* A chest x-ray may be indicated if skin test is positive.

** If required for school entry, must be Mantoux unless exception granted by local health department.

CHEST X-RAY	Film date: ____/____/____	Interpretation:	normal	abnormal
[Radiograﬁá]	Person is free of communicable tuberculosis		yes	no
[Radiograﬁá]	Person is free of communicable tuberculosis		yes	no

(Necessary if skin test positive.)

Signature/Agency: __________________________________________________

PM 298 F2 (8/08) IMM-75LK

Document Breakdown

Fact Name	Description
Purpose of the Form	The Immunization Record form serves as official proof of a child's vaccinations, required for school and childcare enrollment in California.
Key Information Included	This form includes essential details such as the child's name, birthdate, sex, allergies, vaccine reactions, and a record of administered vaccines.
California Law	Under California law, children must meet specific immunization requirements to attend school and childcare facilities, as outlined in the California Health and Safety Code.
Retention of the Document	Parents should keep this document in a safe place, as it is necessary for future school enrollment and may be required for other health-related purposes.
Skin Test Requirements	If a TB skin test is required for school entry, it must be the Mantoux test unless an exception is granted by the local health department.

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Misconceptions

Understanding the Immunization Record form is crucial for parents and guardians. However, several misconceptions can lead to confusion. Here are six common misconceptions explained:

My child does not need an immunization record if they are healthy. Many believe that if their child appears healthy, immunizations are unnecessary. In reality, vaccinations protect against serious diseases, and the record serves as proof of compliance with school enrollment requirements.
All vaccinations are optional. Some parents think that they can choose which vaccines to give their children. However, certain vaccinations are mandated by California law for school and childcare enrollment, ensuring community health and safety.
Immunization records are only needed for school entry. While these records are essential for school enrollment, they are also important for other situations, such as daycare, summer camps, and travel, where proof of vaccination may be required.
Once my child is vaccinated, I can discard the immunization record. Keeping the immunization record is vital. It serves as proof of vaccinations received and may be needed for future school transfers or health care appointments.
Vaccines can be given at any time without concern for timing. Parents often believe that vaccines can be administered at their convenience. However, vaccines have specific schedules and timing to ensure maximum effectiveness and protection against diseases.
My child can skip vaccines if they have had the illness. Some think that having had a disease like chickenpox means their child does not need the vaccine. This is not true. Vaccination provides stronger immunity and protects against potential complications from the illness.

Addressing these misconceptions can help ensure that children receive the necessary immunizations for their health and safety.

Documents used along the form

The Immunization Record form is a crucial document for parents and guardians to keep track of a child's vaccinations. However, several other forms and documents are often used in conjunction with this record to ensure compliance with health regulations and to facilitate the enrollment process in schools and childcare facilities. Below is a list of these related documents.

Health History Form: This document collects information about a child's medical history, including previous illnesses, allergies, and any chronic conditions. It helps healthcare providers understand the child's health background.
Consent for Immunization: This form provides consent from a parent or guardian for a child to receive vaccinations. It typically includes details about the vaccines to be administered and acknowledges potential side effects.
School Entry Health Examination Form: Required by many schools, this form verifies that a child has undergone a health examination. It often includes information about immunizations and any necessary medical assessments.
Tuberculosis (TB) Screening Form: This document is used to record the results of TB skin tests or chest X-rays. Schools may require this screening to ensure that children are not carriers of communicable diseases.
Do Not Resuscitate Order Form: This legal document allows individuals to express their wishes regarding resuscitation efforts in emergencies. For more information on how to complete this form, visit Florida PDF Forms.
Emergency Contact Form: This form lists individuals to contact in case of an emergency involving the child. It typically includes names, phone numbers, and relationships to the child.
Medical Exemption Form: If a child cannot receive certain vaccinations for medical reasons, this form must be completed by a healthcare provider. It explains the medical basis for the exemption.
Immunization Registry Consent Form: This document allows healthcare providers to enter a child's immunization records into a state or local immunization registry. It helps maintain accurate vaccination data for public health tracking.

Understanding these documents is essential for ensuring that children meet immunization requirements and have access to necessary healthcare services. Keeping all records organized and up to date can facilitate smoother enrollment processes in educational settings.