IMMUNIZATION REPORT OHIO DEPARTMENT OF HEALTH 2026

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  1. Click ‘Get Form’ to open the IMMUNIZATION REPORT in the editor.
  2. Begin by entering the student's name in the designated field at the top of the form. Ensure accuracy for proper record-keeping.
  3. Select the student's sex by checking either 'Male' or 'Female'.
  4. Input the date of birth in the specified format, ensuring it aligns with legal requirements.
  5. For each vaccine listed, record complete dates (month, day, year) of doses given. This includes vaccines such as DTP, Polio, and MMR.
  6. If applicable, attach a copy of the child's immunization record for additional verification.
  7. Complete the section indicating who provided this information by filling in either Health Care Provider or Parent/Guardian details.
  8. Finally, sign and print your name along with the date to validate the report before submission.

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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.

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