Get Immunization And Laboratory Record Form - Student Life & Services

Completing the Immunization And Laboratory Record Form is an essential step for students to ensure their health compliance. This guide will support you in accurately filling out the form online, following each required section for a smooth submission process.

Follow the steps to successfully complete the form online.

1. Click the ‘Get Form’ button to access the required form and open it in your preferred editor.
2. Begin by entering your date of birth in the designated field provided at the top of the form.
3. Clearly print your full name in the 'Student’s Name' section, followed by your program of study.
4. Complete the section for the Tuberculin Skin Test by providing the date it was administered, the date it was read, the lot number, manufacturer, and result in millimeters of induration.
5. Indicate your history of BCG vaccination and any previous positive tuberculin tests, including relevant dates and treatment information.
6. If applicable, attach results from a blood-based tuberculosis test or report of a chest X-ray taken within the past year.
7. Fill in the polio vaccine series dates, ensuring to list all relevant dates clearly.
8. Provide information regarding the Tdap vaccine received within the last ten years, noting any medical contraindications.
9. Document the MMR immunization dates or positive titer results, attaching laboratory slips as needed.
10. Record any history of chickenpox and, if necessary, the varicella vaccination dates or antibody titer results.
11. Complete the hepatitis B vaccine series dates, alongside any lab results regarding the hepatitis B surface antigen and antibody.
12. Include lab study results for complete blood count and urinalysis, ensuring to submit copies of lab slips.
13. If applicable, list any optional vaccines received—making sure to maintain clarity in the dates of administration.
14. Have your physician or healthcare provider complete the signature section, providing their name, address, and licensing information.
15. Lastly, save your changes, then download, print, or share the form to complete the submission process.

Complete your Immunization And Laboratory Record Form online today to ensure a smooth registration process!