Get Immunization Form - University Of Pennsylvania - Xrt Upenn

Completing the Immunization Form required by the University of Pennsylvania School of Medicine is an essential step for visiting students looking to enroll in clinical electives. This guide aims to provide clear, step-by-step instructions to help users navigate the process effectively.

Follow the steps to successfully complete the immunization form.

1. Press the ‘Get Form’ button to access the immunization form and open it in the suitable editor.
2. Fill in the applicant's name and birthdate in the designated fields at the top of the form.
3. Review the immunization requirements listed on the form carefully. For each vaccine, record the appropriate doses received or other requested information.
4. Provide details regarding the measles, mumps, and rubella (MMR) vaccinations, including the dates of doses or alternative evidence of immunity.
5. Complete the section for Hepatitis B, indicating whether you have received the required three doses or have a positive blood test showing immunity.
6. Document the Varicella (chickenpox) immunization, indicating the doses received or any evidence of immunity.
7. Fill out the Tetanus-Diphtheria and Polio vaccination details, ensuring the information is current and accurate.
8. Complete the section on Meningococcal immunization, indicating whether you have received the vaccine or are opting for a waiver. If choosing the waiver, ensure to fill out and sign the waiver section.
9. Indicate the date when the Tuberculosis (PPD) test was administered and ensure any positive results are documented.
10. Include the health care provider's information, including name, signature, phone number, and address, confirming completion of the form.
11. After filling out all sections, review the document for accuracy. Save your changes, and you may choose to download, print, or share the completed immunization form.

Complete your immunization form online today to ensure your eligibility for clinical electives at the University of Pennsylvania.