IMMUNIZATIONS - Missouri Department of Social Services 2025

1. Click ‘Get Form’ to open the IMMUNIZATIONS form in the editor.
2. Begin by entering the child's full name and date of birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Fill in the address section with the complete street address, city, state, and ZIP code. This helps maintain updated records.
4. List any known allergies in the provided space. This is important for health and safety considerations.
5. For infants, specify feeding times and amounts of breast milk or formula per feeding in the appropriate section.
6. In the immunizations section, check off the age group that applies to your child and mark each vaccination received (DTaP, POLIO, HIB, etc.) accordingly.
7. Complete the parent/guardian information by filling out names, contact numbers, and addresses. If both parents share an address, use the checkbox for convenience.
8. List authorized persons for pick-up and drop-off in the designated area to ensure proper custody arrangements.
9. Finally, sign and date at the bottom of the form to validate your submission.

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