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Illinois immunization form health 2026

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  1. Click ‘Get Form’ to open the Illinois Immunization Form in our editor.
  2. Begin by entering your personal information at the top of the form. Fill in your last name, first name, middle initial, birth date, gender, and E#.
  3. Indicate the term you are entering EIU by selecting the semester and year from the dropdown menus.
  4. In the 'Required Immunizations' section, provide the month, day, and year for each required vaccine. Ensure you include details for DTP/Tdap and MMR vaccines as specified.
  5. For recommended immunizations like COVID-19, enter the vaccination dates and type in the designated fields.
  6. Ensure that a health care provider signs and dates the form at the bottom to verify your immunizations.
  7. Review all entries for accuracy before saving or submitting your completed form through our platform.

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The date the vaccine is administered. The name, office address, title and signature (electronic is acceptable) of the person administering the vaccine. Initials of the vaccine administrator will suffice as long as the office keeps a record of the person to whom the initials refer.
How do I access the IDPH Vax Verify portal (also known as Illinois Resident Immunization Portal) for my immunization record(s)? You can access your immunization records by visiting the Vax Verify portal.
Getting a vaccine at a doctors office or health department does not require a patient-specific prescription from another health care provider.
The State of Illinois requires immunizations, physcial examinations, eye and dental exams for children in school. These student health requirements apply to all schools in Illinois - public, charter or private. Noncompliance can result in a child being excluded from school.
Should students or student health offices complete the form? Students should complete the AAMC Standardized Immunization Form in conjunction with either the student health office at their medical school or with their primary care provider.

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Photocopies of immunization records from a licensed healthcare provider or clinic, or from a California K-12 school uploaded to My Health Portal. All records must show the vaccine type, dose, and date of each shot.
Proof of Immunity A combination of 3 shots for Tetanus/Diphtheria/Pertussis (DTP/Dtap/Td/ or Tdap). One of the three must be a Tdap. Two measles, mumps, rubella (MMR) vaccines given after one year of age and after December 31, 1967. One meningococcal conjugate vaccine for students age 21 or younger.

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