Get Or Dhs 53-05a 2019-2025

Filling out the OR DHS 53-05A, also known as the Oregon Certificate of Immunization Status, is an essential process for ensuring that children receive required immunizations before attending school or childcare. This guide provides clear and comprehensive steps to help users accurately complete the form online.

Follow the steps to successfully complete the OR DHS 53-05A form online.

1. Click the ‘Get Form’ button to obtain the OR DHS 53-05A form and open it in the online editor.
2. Complete the contact information section by entering your child's full name, birthdate, current mailing address, and the names and home telephone number of their parents or guardians. This information is crucial for any follow-up regarding your child's immunization history.
3. In the required vaccines section, fill in the date (month/day/year) your child received each dose of vaccine. Ensure that the doses are listed in the order they were administered. Utilize the shaded boxes for doses not routinely given if necessary.
4. For the recommended vaccines section on the back of the form, record the dates of any vaccines your child has received that are not required by law but are generally recommended for children. Again, list these in the order received, including any dates in the shaded boxes as needed.
5. Sign the certification statement to verify that the information provided is accurate. This signature can be from a parent, guardian, student of at least 15 years, medical provider, or county health department staff member.
6. If applicable, complete the exemptions section by checking the appropriate boxes to indicate any vaccines your child is exempt from, and include the required documentation as specified.
7. Finally, review the entire form for completeness and accuracy, then save your changes, download, or print the document as needed for submission.

Start completing your OR DHS 53-05A form online today to ensure your child's immunization requirements are met.