Certificate of Immunization Status (CIS) DOH 348-013 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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Filling out the Certificate Of Immunization Status Form is a crucial step in documenting your child's vaccination history. This guide provides clear, step-by-step instructions for completing the form accurately and efficiently, ensuring you meet any necessary requirements.
Follow the steps to fill out your certificate with ease.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by entering your child's last name, first name, middle initial, birthdate in mm/dd/yyyy format, and sex in the designated fields.
- Next, list the vaccines your child has received under the 'Vaccine' column. For each vaccine, record the date of each dose in the appropriate columns for month, day, and year.
- For combination vaccines, refer to the reference guide to correctly note each vaccine type in the correct columns, ensuring accurate documentation.
- If your child has had chickenpox disease instead of the vaccine, choose one of the four options provided to verify this history, and fill in the necessary details.
- If applicable, have your health care provider fill in the documentation of disease immunity, marking the relevant diseases and providing a signed lab report if necessary.
- Make sure to sign and date the form in the specified area near the top right before submitting the document.
- After completion, you have the option to save changes, download, print, or share the form as required.
Complete your documents online today to ensure your child's vaccination status is up to date.
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