
PROOF OF IMMUNIZATION COMPLIANCE Louisiana R.S. 17:170/Schools of Higher Learning Please Print Name: Semester of Enrollment: (Last) (First) (M.I.) Address: Email: (Street/P.O. Box) (City) (State).
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How to fill out the Final Draft Immun Form 06-13.docx online
Filling out the Final Draft Immun Form 06-13.docx is an essential step for students to demonstrate compliance with immunization requirements. This guide provides a clear, step-by-step approach to completing the form online, ensuring that you provide all necessary information efficiently.
Follow the steps to successfully complete the immunization form online.
- Click the ‘Get Form’ button to access the immunization form and open it in your editing software.
- Begin by entering your personal details at the top of the form. Fill in your full name, the semester of enrollment, your address, email, date of birth, LSU ID number, and telephone number.
- Review the immunization requirements outlined in the form. Ensure that you have received the necessary vaccines, such as MMR, Tetanus-Diphtheria, and Meningitis. Note that documentation must be provided by a qualified health care provider.
- Have your health care provider fill in the dates of administration for each required vaccine. Make sure the first and second doses of MMR are documented correctly, as per the guidelines.
- If you are applying for an exemption, check the appropriate box and provide any required information, including the reason for exemption and the signature of a parent or legal guardian if applicable.
- Complete the tuberculosis questionnaire by answering each question truthfully. If you answer 'yes' to any question, be prepared to have additional tests done as indicated.
- Once all sections are filled out, ensure your health care provider signs the form and includes their contact information.
- Finally, save your completed form. You may choose to download it or print it out. Make sure to submit the form to the LSU Student Health Center as directed through the various submission methods provided.
Complete your immunization form online today to ensure your compliance with university requirements.
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