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Screening Questionnaire and Consent Form-CAIR

Screening Questionnaire and Consent Form-CAIR 2025

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The document is a Screening Questionnaire and Consent Form for vaccine administration at a clinic, specifically designed for patients to provide personal information, medical history, and consent for vaccination. It includes questions regarding health conditions, allergies, previous vaccinations, and authorizations related to sharing vaccination records with healthcare providers and the California Immunization Registry (CAIR). The form also outlines patient rights and responsibilities regarding the vaccination process.

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See more Screening Questionnaire and Consent Form-CAIR versions

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (94 Votes)
2017	4.4 Satisfied (108 Votes)
2017	4.4 Satisfied (58 Votes)
2016	4 Satisfied (43 Votes)
2016	4.2 Satisfied (57 Votes)

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Got questions?

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

Which vaccines are mandatory for school in California?

Students Admitted at TK/K-12 Need: Diphtheria, Tetanus, and Pertussis (DTaP, DTP, Tdap, or Td) 5 doses. (4 doses OK if one was given on or after 4th birthday. Polio (OPV or IPV) 4 doses. Hepatitis B 3 doses. Measles, Mumps, and Rubella (MMR) 2 doses. Varicella (Chickenpox) 2 doses.

Is CAIR mandatory in California?

As of January 1, 2023, a new state bill requires all providers who administer vaccines to enter immunizations, as well as patients race and ethnicity, into a California immunization registry. For Los Angeles County, CAIR is the immunization registry to use.

Can I refuse to vaccinate my child in California?

California Vaccination Requirements Some states recognize a religious belief exemption if vaccination requirements interfere with a regular practice of an established religion. In California, a student is only exempted from the vaccination requirement for medical purposes.

Can I opt out of CAIR?

CA law allows a patient/parent to decline to have their/their childs information in CAIR shared with other Organizations that use CAIR (opt out). In this case, their information may still be entered into CAIR but it must be locked by the Organization. See the Sharing Policy below for further information.

Can parents access Cair?

By law, you have the right to see information about your child thats in CAIR and to ask the medical office to make needed corrections.

Is it documented in Cair that the patient has been disclosed?

Once disclosure has been performed, this must be documented in CAIR by selecting Yes to the question: Has patient been disclosed (IZ/TB)? on the CAIR Add New Patient when creating the record in CAIR screen in the patient record in CAIR.

Is CAIR mandatory?

AB 1797 (Akilah Weber, 2022), a California bill effective January 1, 2023, requires providers to enter immunizations they administer as well as a patients race and ethnicity into a California immunization registry (CAIR or RIDE/Healthy Futures). Please see Enroll in CAIR2 below to enroll today.

Screening Questionnaire and Consent Form-CAIR 2025

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