Make My Immunization Record Online

Fill Out Your Immunization Record Form

The Immunization Record form serves as an official document that tracks an individual's vaccinations and immunization history. This form is essential for parents, as it provides proof of immunization required for school and childcare enrollment in California. Maintaining this record ensures compliance with state immunization requirements and helps safeguard public health.

Form Sample

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
	DATE			NEXT
	GIVEN			DOSE DUE
VACCINE	fecha de	DOCTOR OFFICE OR CLINIC		próxima
vacuna	vacunación	médico o clínica		vacuna

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)				[difteria, tétano, y tos ferina]
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

	DATE		NEXT
	GIVEN		DOSE DUE
VACCINE	fecha de	DOCTOR OFFICE OR CLINIC	próxima
vacuna	vacunación	médico o clínica	vacuna

	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
[Radiograﬁá]	Person is free of communicable tuberculosis		yes	no

(Necessary if skin test positive.)

Signature/Agency: __________________________________________________

PM 298 F2 (8/08) IMM-75LK

Misconceptions

Misconceptions about the Immunization Record form can lead to confusion for parents and guardians. Here are five common misconceptions explained:

It’s just a piece of paper. Many people think the Immunization Record is unimportant. In reality, it serves as official proof of a child's vaccinations and is often required for school enrollment.
All vaccines are the same. Some assume that all vaccines listed are interchangeable. Each vaccine protects against specific diseases, and it’s crucial to follow the recommended schedule for each one.
Once filled out, it’s no longer needed. Some believe that after completing the form, it can be discarded. However, parents should keep it safe, as it may be needed for future school admissions or medical appointments.
Immunization records are only for children. While the form is primarily for children, adults may also need to provide vaccination records for certain jobs or travel requirements.
Vaccines are optional. Many think that vaccinations are not mandatory. In California, children must meet immunization requirements to attend school and child care, making them essential for enrollment.

Key takeaways

When filling out and using the Immunization Record form, several key points should be considered to ensure compliance and proper documentation.

Accurate Information: Ensure that all personal details, including the child's name, birthdate, and allergies, are filled out accurately. This information is crucial for proper identification and safety.
Documentation Retention: Keep this document in a safe place. It serves as proof of immunization and may be required for school enrollment or childcare.
Understanding Vaccine Types: Familiarize yourself with the different vaccines listed on the form. Knowing the abbreviations and their meanings can help you track which vaccinations your child has received.
Follow-up Dates: Pay attention to the "Next Given Dose Due" section. It is important to schedule follow-up vaccinations on time to maintain compliance with immunization requirements.
Consult Healthcare Providers: If there are any questions or concerns regarding the immunization process, consult with a healthcare provider. They can provide guidance and ensure that your child’s immunization schedule is appropriate.

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