Get Measles Mumps And Rubella Consent Forms

Filling out the Measles Mumps And Rubella Consent Forms is a crucial step for ensuring your immunization status is documented correctly. This guide will walk you through the process step-by-step, making it easy to complete the form online.

Follow the steps to complete the form accurately and efficiently.

1. Click ‘Get Form’ button to access the Measles Mumps And Rubella Consent Form and open it in your preferred document editor.
2. In the first section, labeled 'Students complete this section,' provide your full name (Last, First), address, date of birth in the format MM/DD/YYYY, and a contact phone number. If you have a Columbia ID, you may provide that instead.
3. Leave the health care provider section blank for now. You will need to have this completed by a physician or health care provider.
4. You will have two main sections to fill out under the health care provider's section. Section A requires documentation of MMR vaccinations, while Section B needs information regarding measles, mumps, and rubella independently. Ensure your provider completes one of these sections completely.
5. For Section A, the provider must document both MMR doses: the first must be administered after your first birthday and after January 1, 1972, and the second dose at least 28 days after the first.
6. In Section B, the provider can either provide MMR details separately by completing Part 1 for Measles, Part 2 for Mumps, and Part 3 for Rubella, or provide documentation for immunity through illness or serological testing. The exact details should be recorded including administration dates.
7. Once completed, make sure the health care provider signs the form, includes their name (printed), stamp, and license number.
8. Once you have the completed form, save any changes and make a copy for your records. Submit the original form to the Immunization Compliance Office or fax it to the provided number by the deadline.

Start filling out your Measles Mumps And Rubella Consent Form online today to ensure your immunization is documented on time.