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Missouri immunization consent form 2025

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The document is an Immunization Consent and History form from the Missouri Department of Health and Senior Services. It collects personal information about the patient, including demographics and vaccination history, while obtaining consent for various vaccines. The form outlines eligibility status for different health insurance programs and includes sections for recording vaccine details such as type, date administered, injection site, and signatures of both the vaccinator and the patient or guardian.

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Versions	Form popularity	Fillable & printable
2019	4.8 Satisfied (27 Votes)
2011	4.4 Satisfied (60 Votes)

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What is a copy of your immunization records?

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.

How to request immunization records in Missouri?

Alternatively, you may complete a Request for Official State of Missouri Immunization Records and submit it to the Missouri Department of Health and Senior Services, Bureau of Immunizations via fax at 573-526-0238 or email immunizationrecordrequests@health.mo.gov. For questions, call 800-219-3224 or 573-751-6124.

How do I request for official state of Missouri immunization records?

You may send your immunization documents to the Student Health Center by using this secure upload function in MyZou. If you want someone (e.g., a parent) to upload these documents for you, you must first give them additional authorized access.

How long do doctors keep immunization records?

Healthcare employees must keep the records of minors at least seven years after the most recent discharge date or one year after the patient turns 18 (whichever is longer).

Can you get immunization records from MyChart?

Go to My Record Health Summary and select the Immunizations tab. You can see the immunizations youve received and the dates on which you received them. Click the immunization name to learn more. If your immunizations are not up to date, please reach out to your clinic directly to have your information updated.