Get Mandatory Immunization Documentation Form - Chicago

Filling out the Mandatory Immunization Documentation Form is an essential step for your admission to the UIC College of Medicine. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently online.

Follow the steps to successfully complete your immunization documentation form.

1. Click ‘Get Form’ button to obtain the form and open it in your editor of choice.
2. Begin by filling in your personal information in the designated fields, which include your student name, UIN number, and email address.
3. Provide your immunization information for measles (rubeola), mumps, and german measles (rubella) by confirming immunity through the titer tests. Fill in the dates and results as required and ensure to attach the lab report for each.
4. Complete the hepatitis B section by documenting the three immunizations and confirming immunity with a titer. Fill in all relevant dates and results and attach the necessary lab report.
5. For tetanus and diphtheria, note down the immunization dates or the last booster date within the last 10 years, if applicable, or provide your exemption status along with a physician’s statement.
6. In the polio section, indicate completions of the immunization requirements as per the three immunizations or last booster shot and provide documentation if immunity is confirmed by titer.
7. Sign the certification by the health care professional filling out the form, including their name, address, and institution, and date when the immunization was conferred.
8. Fill out the tuberculosis section carefully, indicating whether you have had the disease or not. Complete the TST information if applicable and attach necessary documentation.
9. After completing all sections, ensure that all documentation is attached and accurate, then review your form for any missing information.
10. Save changes to the form, then choose to download, print, or share the form as necessary before returning the original form to the appropriate office.

Complete your Mandatory Immunization Documentation Form online today to ensure a smooth admission process!