Immunization History Form For Associated Personnel for A and AC 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by filling out Section I with your personal information, including your last name, first name, date of birth, BCH ID number, and title with BCH. Ensure all details are accurate.
3. Review the immunization requirements specific to your role as outlined in the email accompanying this form. This will guide you on what vaccinations need to be documented.
4. Once you have completed Section I, share this form with your healthcare provider for them to fill out Section II. They will attest to your immunization history.
5. After your healthcare provider completes Section II, ensure they sign and provide their contact information. This section is crucial for validation.
6. Finally, submit the completed form via email to AP_OHS2@childrens.harvard.edu. Remember not to submit without your BCH ID number.

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