Care or home day care. This information is being collected on behalf of the Oregon Health Authority and may be released to the Authority or the local public health department by the school or children s facility upon request of the Authority. La ley de Oregon requiere que se entregue un comprobante de vacunaci n o de exenci n firmado antes de que un(a) menor asista a la escuela, al preescolar, a un centro de cuidado infantil o a una guarder a. Esta informaci n se recopila en nombre de la.
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How to use or fill out the OR DHS 53-05A online
Filling out the OR DHS 53-05A form is essential for providing proof of immunization or exemption for children attending school or child care facilities in Oregon. This guide will help you navigate the form step by step to ensure accurate and timely submission.
Follow the steps to successfully complete the OR DHS 53-05A form.
- Click ‘Get Form’ button to obtain the form and open it in your preferred editor.
- Provide your child's contact information by entering their last name, first name, middle name, birth date, and phone number. This information is crucial for identifying your child's immunization record.
- Complete the parent or guardian's names to establish responsibility for the child's immunization status.
- Fill in the dates that your child received each required vaccine, listing the doses in the order they were administered. Ensure you check with your child's school or daycare for required vaccinations based on their age or grade.
- If your child has received any other vaccines not listed, use the second page to document their names and the corresponding dates.
- If applicable, provide documentation for medical exemptions by ensuring a letter signed by a licensed physician is included with your submission.
- To claim a nonmedical exemption, select the appropriate options and attach the required documents regarding immunization benefits and risks.
- Review the accuracy of the filled-out information and sign the form to verify its correctness. Remember that people aged 15 and older can sign their records.
- Once completed, you can save changes, download, print, or share the form as needed.
Complete your OR DHS 53-05A form online today to ensure your child's compliance with immunization requirements.
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