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Click ‘Get Form’ to open the COMMONWEALTH OF KENTUCKY IMMUNIZATION CERTIFICATE in the editor.
Begin by entering the child's name in the designated fields for Last, First, and Middle names. Then, input the birthdate in the provided format.
Next, fill in the name of the parent or guardian along with their address, ensuring all details are accurate for effective communication.
Proceed to document the dates immunizations were administered. For each vaccine listed (Diphtheria, Tetanus, Pertussis; Hib; PCV; Polio; Hepatitis B; MMR; Varicella; Tdap; Meningococcal), enter the corresponding dates in MM/DD/YYYY format.
Indicate if the child has had chickenpox or zoster disease by marking 'X' in the appropriate box. Ensure all sections are completed before finalizing.
Finally, have a licensed healthcare professional sign and date the certificate. This signature is crucial for validation.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (105 Votes)
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2010	4.3 Satisfied (159 Votes)

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How do I get a Kentucky immunization certificate?

Visit KYIR Public Portal and follow the steps below to access your immunization record. You will be asked to enter information about yourself or your child to view and download/print records. To access your COVID-19 QR code online, download your COVID-19 Record from the KYIR Public Portal.

How can I find my old immunization records?

visits you made to local public health departments or neighborhood clinics. When physicians retire or a medical practice changes hands, old patient records may be sent to a medical record storage company. You may be able to obtain records directly from the company for a fee. baby books and school or camp forms.

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COMMONWEALTH OF KENTUCKY IMMUNIZATION CERTIFICATE - beta calloway kyschools 2026