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TENNESSEE DEPARTMENT OF HEALTH TENNESSEE SCHOOL IMMUNIZATION CERTIFICATE This form and any attachments must be filed in the child s health record. I. IDENTIFYING INFORMATION Child s Name Birth Date First Middle Last Parent/Guardian s Name Phone No* Address Street City State Zip II. REQUIRED IMMUNIZATIONS Children entering school K-12 must have the following immunizations or an appropriately documented exemption VACCINE COMMENT DTP/DTaP/DT/Td 4 or 5 A 5th dose is not required if the 4th dose is given after the 4th birthday. Only 3 doses are needed if DT or Td must be used and the first dose is given after 12 months of age. Polio 3 or 4 If the 3rd dose is given after age 4 the 4th dose is not required* If the child has received both OPV and IPV a total of 4 doses are needed regardless of age. Hepatitis B 2 or 3 Required for Kindergarten entry 3 doses and 7th grade. For adolescents a 2dose vaccine preparation is available. MMR Required on or after the 1st birthday first dose may be given ....

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How to fill out the Tennessee Child Health Record Form online

Completing the Tennessee Child Health Record Form online is essential for ensuring that your child meets the necessary health requirements for school. This guide provides a straightforward, step-by-step approach to help you navigate the form with confidence.

Follow the steps to complete the form effectively.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Begin by filling in the identifying information section at the top of the form. Provide your child’s complete name, including first, middle, and last names, followed by their birth date.
  3. In the next part, enter the parent's or guardian's name along with a valid phone number. Make sure to include the complete address, including street, city, state, and zip code.
  4. Locate the required immunizations section and check the appropriate boxes based on the vaccines your child has received. Ensure to include any documented exemptions if applicable.
  5. Fill in the current immunization record by recording the dates for each vaccine your child has received, following the MM/DD/YY format specified. If applicable, check the box for a 2-dose hepatitis B vaccine schedule for adolescents.
  6. In the immunization certifications section, indicate whether your child has received the required immunizations or was granted an exemption. If a medical exemption is indicated, ensure to include the medical provider's name and signature.
  7. Check the required health examination box and provide the necessary details regarding medical and dental screenings. Sign and date the form as required.
  8. Once completed, review the information for accuracy. You can save changes, download, print, or share the form as needed.

Complete your Tennessee Child Health Record Form online today to ensure your child's health documentation is in order.

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Children with medical or religious exemption to requirements The medical reason for the exemption does not need to be provided. Religious – This exemption requires a signed statement by the parent/guardian that vaccination conflicts with their religious tenets or practices.

An Official TN Immunization Certificate must be submitted to childcare centers, preschools, or schools to satisfy attendance requirements for childcare through 12th grade. This certificate is available at your local TN Health Department and at any medical office with TennIIS access.

$20.00 for medical records 5 pages or less in length. $0.50 per page for each page copied after the first 5 pages. Actual cost of mailing.

The privacy of one's medical records is protected by both federal and state law, which generally consider this information confidential. Under Tennessee law, hospital records are considered property of the hospital and only accessible by court order or a written request by the patient.

The HIPAA Privacy rule: Restricts disclosure of individually identifiable health care information to the minimum necessary amount needed for the intended purpose; and. Establishes safeguards and restrictions on access to records for certain public responsibilities.

ImmTrac2, the Texas Immunization Registry Only doctors, schools, child-care centers, public healthcare providers, and other authorized healthcare organizations may directly access ImmTrac. Immunization records are NOT available to view online by the general public, including parents or legal guardians.

Unless prohibited by law, a... Hospitals must retain patient care records for 10 years following the patient's discharge or death. For patients who are minors or have a...

Call the Tennessee Health Professional Board at 615-532-3202.

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