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CERTIFICATE OF IMMUNIZATION Name: Birth Date: Immunizations refused 2026

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The document is a Health Record Form for Radford University that outlines the requirements for submitting a Certificate of Immunization and Tuberculosis Screening prior to enrollment. It includes instructions for online and offline submission, lists required and recommended immunizations, and provides sections for exemption requests based on medical or religious grounds. Additionally, it details the tuberculosis screening process and necessary documentation.

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Click ‘Get Form’ to open the Certificate of Immunization in the editor.
Begin by entering your full name and date of birth in the designated fields at the top of the form.
Fill in your Student ID number, ensuring accuracy for proper identification.
In Part I, check the required immunizations you have received. For each vaccine, indicate the doses administered by selecting either a 2-dose or 3-dose series and entering the corresponding dates.
If you are opting for a waiver for any immunization, make sure to check that option and provide any necessary documentation as indicated.
Complete Part II regarding Tuberculosis Screening by answering the questions truthfully and providing dates for tests if applicable.
For exemptions in Part III, select the appropriate exemption type and provide signatures where required. Ensure all information is complete before submission.

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Versions	Form popularity	Fillable & printable
2022	4.8 Satisfied (54 Votes)
2020	4 Satisfied (40 Votes)
2018	4.4 Satisfied (35 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the ICD 10 code for parent refusal to vaccinate?

Ultimately, the parent has a right to refuse any medical intervention or treatment for their child, including a vaccine. Their decision, however, may conflict with a pediatricians advice.

How do you document parental refusal to have their children vaccinated?

For parents who refuse one or more recommended immunizations, document your conversation, the provision of the VIS(s), and have the parent sign the vaccine refusal form and keep the form in the patients medical record.

What is vaccine refusal?

Vaccine hesitancy is a relatively new term used in research over the past few years to describe anyone who is doubtful about vaccinations or who chooses to delay or refuse immunizations even when they are readily available.

What is a religious reason to not get vaccinated?

Objection to vaccination was also related to: faith in divine protection and healing for Protestants, Catholics, Jewish and Muslims (10); the use of aborted fetal cells for vaccines production among Amish and Catholic communities (including during the COVID-19 outbreak when Senior Catholic leaders from the US and

Can I say no to vaccines for my child?

The only valid reasons for medical exemptions for immunizations are: An allergic or other serious reaction to the same vaccine in the past. The physician who ordered the first one and witnessed the reaction would be glad to write the exemption. This is, however, extremely rare with todays vaccines.

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What is the form to decline immunizations?

For healthcare providers who want to assure that these parents fully understand the consequences, Immunize.org has produced a form titled Record of Vaccine Declination. This form facilitates and documents the discussion that a healthcare professional can have with parents about the risks of not having their child

Can a parent refuse to vaccinate their child?

All states allow exemptions from school immunization requirements for children who are unable to receive vaccines for medical reasons. State laws vary regarding non-medical exemptions, for religious or personal reasons. Personal exemptions are also referred to as philosophical exemptions by some states.

CERTIFICATE OF IMMUNIZATION Name: Birth Date: Immunizations refused 2026

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