Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Print the name and date of birth of the child in the designated area on the first page. Make sure to sign your name where required.
3. Indicate the date each vaccine was administered in the date columns (e.g., DD/MM/AA). If the child received a combination vaccine, refer to the guidelines below to correctly record each vaccine. For example, list Pediarix for diphtheria, tetanus, and pertussis as DTaP, Hepatitis B as Hep B, and Poliovirus as IPV.
4. If your child has a history of varicella (chickenpox) and has not received the vaccine, a healthcare provider must verify the diagnosis. If the provider confirms a history of chickenpox, they should check the box in the Documentation of Disease Immunity section and sign the form.
5. If your child shows positive immunity via a blood test (titer), ask your healthcare provider to check the corresponding boxes in the Documentation of Disease Immunity section and sign and date the form. You must provide laboratory reports with this CIS.
6. Ensure any verified medical records are provided as required. This documentation can include a printed Certificate of Immunization Status from the Washington State Immunization Information System or relevant healthcare records.
7. For children entering on a conditional status, ensure all immunizations are up to date. Document the required vaccines and provide proof of immunization following the guidelines.
8. Once completed, users can save changes, download, print, or share the form as needed.

Complete your documents online to ensure your child's immunization records are submitted correctly.