Get Please Complete This Form And Return It To D-101e (immunizations Office), A-334c (health Services

Completing the Immunization Record form is an essential step for registration. This guide will help you navigate the process of filling out the form accurately and efficiently, ensuring that you meet all requirements.

Follow the steps to complete your immunization record form.

1. Click ‘Get Form’ button to access the form and open it.
2. In Part 1, provide your student information. This includes printing your name clearly, entering your date of birth in the specified format (mm/dd/yyyy), and your EMPL ID number.
3. Moving on to Part 2, address the meningococcal meningitis section. Select one option in Section A regarding the vaccine status. If you have received the vaccine, include the date you received it in the format (mm/dd/yyyy). If you choose not to receive it, acknowledge your understanding of the risks by providing your signature along with the date.
4. In Part 3, relay your immunization history to your healthcare provider. They will need to document all vaccine dates and types clearly, including the minimum age requirements and previous immunization details. Make sure that all fields are filled, and the documentation of the vaccines is attached.
5. Finally, ensure your healthcare provider's information is included with their signature and license number. This step is critical as incomplete documentation may lead to processing issues.
6. Once you have filled out the form completely, save any changes as needed. You may also download, print, or share the form as per your requirement before submission.

Complete your immunization record form online today for a smooth registration process.