Get Form 896

Filling out the Form 896, the Maryland Department of Health and Mental Hygiene Immunization Certificate, is a crucial step in documenting immunizations required for school and program enrollment. This guide provides clear, step-by-step instructions to help users complete the form accurately and efficiently online.

Follow the steps to complete the Form 896 online easily.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by filling out the child's name in the provided fields, including last name, first name, and middle initial.
3. Indicate the child's sex by selecting either 'Male' or 'Female'.
4. Enter the child's birthdate using the format provided (Month/Day/Year).
5. Fill in the county, school name, and grade level.
6. Provide the parent or guardian's name and address. Include the phone number along with the city and ZIP code.
7. Record the immunization details for each vaccine type listed on the form, including the type of vaccine and the corresponding dose number and administration date.
8. If applicable, document the history of varicella disease and any other vaccines that have been administered.
9. Sign and date the form in the designated areas, ensuring that a licensed medical provider, local health department official, school official, or child care provider completes the certification.
10. Review all entered information for accuracy. Save any changes, and you can also download, print, or share the completed form as needed.

Complete your documents online to ensure your immunizations are documented correctly.