Get Hi Epi 12a 2006-2025
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How to fill out the HI EPI 12A online
The HI EPI 12A form is essential for documenting immunization assessments for child care centers, preschools, and Head Start programs in Hawai'i. This guide will provide a clear and supportive walkthrough of how to complete this form online, ensuring you accurately report all incompletely immunized children.
Follow the steps to fill out the HI EPI 12A form easily online.
- Click ‘Get Form’ button to obtain the form and open it in the editor.
- Begin by filling in the facility name and the name of the person preparing the report. Make sure to include the total enrollment at the facility.
- Provide the mailing address, city, and ZIP code, along with the title and phone number of the individual responsible for the report.
- Ensure to list the location address accurately, including the city and ZIP code.
- Record the date of report completion and include the fax number if necessary.
- Indicate the number of students under 19 months and those aged 19 months or older.
- In section #2, confirm whether all enrollees meet immunization requirements by selecting Yes or No.
- If you select No, proceed to complete Section #3, wherein you list the names of children missing required immunizations or those with exemptions.
- For each child listed, document their birthdate and entry date in the provided fields.
- Mark an 'X' in the columns of the missing vaccine doses for each immunization requirement listed, including DTaP, Polio, Hib, Hepatitis B, MMR, and Varicella.
- If applicable, include any additional notes that may be necessary.
- Finally, make sure to obtain the director's signature before submitting the form.
Complete and submit your HI EPI 12A form online today for accurate immunization reporting.
A notable percentage of children in Hawaii are fully vaccinated against various preventable diseases. The data aligns with the guidelines of HI EPI 12A, ensuring a safer environment for all kids. This success is a result of community awareness and robust health education programs. Parents play a crucial role by keeping their children's vaccinations up to date.
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