VISITING STUDENT IMMUNIZATION RECORD 041404 2 doc - som uthscsa 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your personal information at the top of the form, including your name, date of birth, school, and SSN.
  3. Proceed to the immunization record section. For each vaccine listed, check the appropriate box indicating whether you have completed the required doses and provide dates where necessary.
  4. For Tetanus-Diphtheria and Tuberculosis, ensure you include test results and any relevant details about previous treatments or vaccinations.
  5. Complete the Hepatitis B section by indicating the doses received and providing titer results if applicable.
  6. If applicable, fill in details for Chicken Pox immunity based on serologic proof or physician records.
  7. Finally, ensure that a physician, nurse, or school official certifies your immunization record by signing and dating the certification section at the bottom of the form.

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All Utah local health departments use or are connected to Utah Statewide Immunization Information System (USIIS). Contact your local health department and ask them to print an Official USIIS Personal Utah Immunization Record for you.
Docket makes it easier than ever for residents of AK, DC, ID, ME, MN, MO, NJ, ND, UT, and WY to access personal and family immunization records.
Check with your high school and/or college health services for dates of any immunizations. Keep in mind that generally records are kept only for 1-2 years after students leave the system. Check with previous employers (including the military) that may have required immunizations.
USIIS is a confidential, web-based information system that contains immunization histories for Utah residents.
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 docHub out to your clinic directly to have your information updated.

People also ask

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.