Washington state immunization record 2025

1. Click ‘Get Form’ to open the Washington State Immunization Record in the editor.
2. Begin by entering your child’s last name, first name, middle initial, birthdate, and sex in the designated fields at the top of the form.
3. In the vaccine section, list each vaccine your child has received. For each vaccine, fill in the corresponding dose number and date (month, day, year) for accurate record-keeping.
4. If your child had chickenpox disease instead of receiving the vaccine, select one of the verification options provided and ensure any necessary documentation is attached.
5. Complete the 'Documentation of Disease Immunity' section if applicable. Have your healthcare provider sign and date this section along with attaching lab reports as needed.
6. Finally, ensure that you sign and date the form before submitting it to your child's school or childcare facility.

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