Get Immunization Screening And Referral Form For School K-12th Grade - Azdhs

Filling out the immunization screening and referral form for school K-12th grade is an important step in ensuring that your child meets Arizona's immunization requirements. This guide will walk you through each section of the form, providing clear instructions on how to complete it efficiently and accurately.

Follow the steps to complete the form online.

1. Click the ‘Get Form’ button to obtain the form and open it in your browser.
2. Begin by entering the student's name in the designated field as it appears on their official documents.
3. Next, fill in the date of birth of the student. Ensure that the format is consistent with any previous documentation.
4. Indicate the school name where the student is enrolled. This information is vital for school records.
5. Enter the date of notice. This should be the date you are filling out the form.
6. Provide the contact person's name at the school and their phone number. This allows for effective communication regarding the student’s health records.
7. Review the section that details the required immunizations, noting which immunizations are marked as missing by the school staff. Circle or highlight these doses appropriately.
8. If your child has received the necessary immunizations, ensure to attach the updated immunization record, clearly showing all required details.
9. If your child has not received the immunizations, take the immunization record and this form to a physician or local health department to acquire the necessary vaccines.
10. Once the immunizations are obtained, make sure to bring the updated records back to the school along with this form.
11. Finally, after double-checking all entries for accuracy, save your changes, download the completed form, or print it for submission.

Complete your immunization documentation online to ensure your child is ready for school.