Dhec 4024 form printable-2025

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The document outlines the Vaccines for Children (VFC) Program Patient Eligibility Screening Record Form, which is used to determine and document the eligibility of children aged 18 and under for publicly funded vaccines during immunization visits. It specifies that records must be maintained for at least three years and details the eligibility categories for VFC and state vaccine programs, including criteria for underinsured children. The form must be completed by a parent, guardian, or healthcare provider at each immunization encounter.

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Click ‘Get Form’ to open the dhec 4024 form in the editor.
Begin by entering the Child’s Name and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for eligibility verification.
Next, fill in the Parent/Guardian/Individual of Record's details. This section requires their full name to establish responsibility for the child’s immunization records.
Input the Provider’s Name, ensuring it matches the healthcare provider administering the vaccines.
Record the date of each immunization visit and assess eligibility by marking the appropriate columns (A-D for eligible, E-G for not eligible) based on your assessment of insurance status.
Review all entries for completeness and accuracy before saving or printing your completed form.

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Versions	Form popularity	Fillable & printable
2024	4.7 Satisfied (40 Votes)
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How to get a religious exemption for vaccines in South Carolina?

The South Carolina Certificate of Religious Exemption may only be obtained at a county public health department. Forms cannot be e-mailed or mailed.

How do I get my SC immunization certificate?

How do I locate my immunization record? Visit the SIMON public portal to get your shot records, or contact your local health department or immunization provider. For help accessing your record using the SIMON public portal, click here.

How to transfer immunization records to South Carolina?

An out-of-state student must take his/her immunization record to a doctor or health department to receive a South Carolina Certificate. All incoming students with an international immunization record must take their immunization record to the health department for a South Carolina Certificate.

What is a certificate of immunization?

Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.

What is DHEC Form 4024?

All students entering school are required by State law to have a South Carolina State Certificate of Immunization (DHEC 4024). South Carolina Department of Health and Environmental Control (SCDHEC) Immunization requirements for the 2023-2024 school year may be found here.