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Send il immunization form via email, link, or fax. You can also download it, export it or print it out.
How to use or fill out the Illinois Immunization Form with DocHub
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Click ‘Get Form’ to open the Illinois Immunization Form in our editor.
Begin by filling out the Student Information section. Enter your Last Name, First Name, Middle Initial, and Date of Birth in the specified format (MM/DD/YYYY).
Indicate if you are an International Student by selecting 'Yes' or 'No' and provide your Student Reference Number if applicable.
Enter your email address and read the authorization statement. Ensure you understand that all submitted documents become property of DePaul University.
Sign and date the form in the designated areas, ensuring that both fields are completed accurately.
Choose either Option A or Option B for immunization records. If using Option A, attach a copy of your Official Immunization Records. If using Option B, leave it for your healthcare provider to complete.
If completing Option B, ensure your physician fills out all required immunizations and signs off on the form.
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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.
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.
What vaccines are required for school in Illinois in 2025?
Minimum Immunization Requirements for Children Enrolling or Entering a Child Care Facility or School in Illinois, 2025-2026 Diphtheria, Pertussis, Tetanus. Vaccine Requirement. Measles. Vaccine Requirement. Rubella. Mumps. Hepatitis B. Haemophilus influenzae type b (Hib) Invasive Pneumococcal Disease (PCV) Varicella.
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.
How do I get my immunization records from 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.
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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.
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.
Related links
Immunization Information | McKinley Health Center | UIUC
Download the immunization history form (Required). Print the form and complete the demographic (top) portion of the form. Ask your medical provider or nurse
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