Certificate immunization 2026

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  1. Click ‘Get Form’ to open the Certificate of Immunization Status (CIS) in the editor.
  2. Begin by entering your child’s last name, first name, middle initial, and birthdate in the designated fields.
  3. Indicate whether you give permission for your child’s school or childcare to add immunization information into the Immunization Information System by checking the appropriate box.
  4. If applicable, acknowledge conditional status by checking the box and ensure you provide required documentation by established deadlines.
  5. Fill in the dates of each vaccine received in the corresponding columns using MM/DD/YY format. Refer to the provided reference guide for correct vaccine names if needed.
  6. If your child has a history of chickenpox disease, ensure a health care provider verifies this and signs in the Documentation of Disease Immunity section.
  7. Finally, sign and date where indicated as a parent or guardian, ensuring all information is accurate before submission.

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Versions Form popularity Fillable & printable
2021 4.9 Satisfied (53 Votes)
2019 4.3 Satisfied (160 Votes)
2016 4.2 Satisfied (24 Votes)
2015 4.1 Satisfied (52 Votes)
2011 4.3 Satisfied (35 Votes)
2010 4.1 Satisfied (70 Votes)
2006 4 Satisfied (27 Votes)
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The IIS only accepts medically verified vaccination dates into the system. Therefore, any CIS printed directly from the IIS is medically verified. No additional parent or health care provider signature is needed to verify the accuracy of the information. There are two versions of a CIS that prints from the IIS.
Immunization status, or previous exposure to diseases, is often assessed using serology. This testing can evaluate protection from diseases such as pertussis, hepatitis A, hepatitis B, measles, mumps, rubella, chickenpox, shingles, and polio.
Certificate of immunization means documentation from a health official of the administration of an immunization, specifying the vaccine administered and the date it was administered.
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.
This certificate program does not require renewal.

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People also ask

A Certified Immunizer is a trained healthcare professional, such as a pharmacist, nurse, or pharmacy technician, who is authorized to administer vaccines. They complete specialized training on vaccine administration, storage, safety, and patient care.
How to Contact Your Jurisdictions IIS contact the IIS in your state or in the state where you or your child received their last shots to see if they have records. contact your immunization provider directly or your local or state immunization program through your states health department.

immunization certificate format