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Immunization record form pdf

Illinois immunization form health 2026

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The document outlines the immunization requirements for domestic students at Eastern Illinois University, including necessary vaccines, compliance policies, deadlines for submission, and procedures for reporting vaccination status. It emphasizes the importance of providing signed and dated records from healthcare providers and details penalties for non-compliance.

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Click ‘Get Form’ to open the Illinois Immunization Form in our editor.
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#.
Indicate the term you are entering EIU by selecting the semester and year from the dropdown menus.
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.
For recommended immunizations like COVID-19, enter the vaccination dates and type in the designated fields.
Ensure that a health care provider signs and dates the form at the bottom to verify your immunizations.
Review all entries for accuracy before saving or submitting your completed form through our platform.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (105 Votes)
2021	4.4 Satisfied (61 Votes)
2018	4.2 Satisfied (52 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Do you need a doctors order for vaccines?

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.

Can I get a copy of my immunization records online in Illinois?

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.

Who can administer vaccines in New York?

Getting a vaccine at a doctors office or health department does not require a patient-specific prescription from another health care provider.

What are the health requirements for school in Illinois?

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.

Who can fill out my immunization form?

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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What counts as proof of immunization?

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.

What immunizations are required in Illinois?

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.