The Immunization Record form is an essential document that tracks an individual's vaccination history. This form is particularly important for children in California, as it helps ensure compliance with state immunization requirements for school and child care enrollment. Parents should retain this record as proof of immunization, which may be needed for future reference.
The Immunization Record form is a crucial document for parents and guardians, especially in California, where meeting immunization requirements is essential for school and childcare enrollment. This form serves as a comprehensive record of a child's vaccination history, detailing their name, birthdate, and any allergies they may have. It includes sections for tracking vaccine reactions and provides spaces for the dates of vaccinations, the next doses due, and the doctor’s office or clinic information. Parents will find that the form lists various vaccines, such as DTaP, MMR, and HPV, alongside their corresponding translations in Spanish, ensuring accessibility for diverse families. Additionally, the form highlights the importance of retaining this document as proof of immunization, which may be required for school entry. It also includes information on tuberculosis skin tests and chest x-rays, further emphasizing the need for thorough health documentation. Overall, this record not only keeps track of a child's immunization status but also plays a vital role in safeguarding public health by ensuring that children are protected against preventable diseases.
When filling out the Immunization Record form, it’s important to be thorough and accurate. Here are some guidelines to help ensure the process goes smoothly.
When filling out and using the Immunization Record form, it is important to keep several key points in mind:
By following these guidelines, you can effectively manage your child’s immunization records and ensure compliance with health regulations.
Guardianship Paperwork - The form can help establish a clear communication plan between parents or guardians.
USCIS Form I-864 - Supporting documentation should accompany the I-864 to strengthen the application.
IMMUNIZATION RECORD
Comprobante de Inmunización
Name nombre
Birthdate
Sex
fecha de nacimiento
sexo
Allergies
alergias
Vaccine Reactions
reacciones a la vacuna
RETAIN THIS DOCUMENT — CONSERVE ESTE DOCUMENTO
DATE
NEXT
GIVEN
DOSE DUE
VACCINE
fecha de
DOCTOR OFFICE OR CLINIC
próxima
vacuna
vacunación
médico o clínica
Parents: Your child must meet California’s immunization requirements to be enrolled in school and child care. Keep this Record as proof of immunization.
Padres: Su niño debe cumplir con los requisitos de vacunas para asistir a la escuela y a la guardería. Mantenga este Comprobante: lo necesitará.
DT/Td = Diphtheria, tetanus
[difteria, tétano]
DTaP/Tdap = Diphtheria, tetanus, and pertussis (whooping cough)
[difteria, tétano, y tos ferina]
DTP = Diphtheria, tetanus, pertussis (whooping cough)
HEP A = Hepatitis A
HEP B = Hepatitis B
HIB = Hib meningitis (
Haemophilus influenzae
type b)
[meningitis Hib]
HPV = Human papillomavirus
[virus del papiloma humano]
INFV = Influenza [la gripe]
MCV = Meningococcal conjugate vaccine [vacuna meningocócia conjugada]
MMR = Measles, mumps, rubella [sarampión, paperas y rubéola (sarampión alemán)]
MPV = Meningococcal polysaccharide vaccine
[vacuna meningocócia polisacárida]
PNEUMO = Pneumococcal vaccine [neumocócica]
POLIO = Poliomyelitis
[poliomielitis]
RV = Rotavirus [rotavirus]
VZV = Varicella (chickenpox)
[varicela]
Registry ID Number
TB SKIN TESTS*
Pruebas de la Tuberculosis
Type**
Date given
Given by
Date read
Read by
mm/indur
Impression
* A chest x-ray may be indicated if skin test is positive.
** If required for school entry, must be Mantoux unless exception granted by local health department.
CHEST X-RAY
Film date: ____/____/____
Interpretation:
normal
abnormal
[Radiografiá]
Person is free of communicable tuberculosis
yes
no
(Necessary if skin test positive.)
Signature/Agency: __________________________________________________
PM 298 F2 (8/08) IMM-75LK
Misconceptions about the Immunization Record form can lead to confusion and misinformation. Here are six common misconceptions explained: