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Click ‘Get Form’ to open the Tennessee Immunization Form PDF in our editor.
Begin by entering the child's name and birthdate at the top of the form. Ensure accuracy as this information is crucial for identification.
In Section 1a, check the box if a religious exemption is selected by the parent or guardian. Fill in their name in the provided fields.
Complete Section 1b by documenting any health examination details, including dates and signatures where required.
Proceed to Section 2a, where you will list required vaccines along with their respective dates. Make sure to check any applicable boxes for exemptions or special cases.
In Section 3, select one option regarding provider assessment based on your child's vaccination status.
Finally, ensure that a qualified healthcare provider's information is filled out in Section 4, including their printed name, address, and phone number.
Start filling out your Tennessee Immunization Form today using our platform for free!
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There are two ways to verify immunization history: Vaccination records from health care providers: Confirm when, where and by whom certain vaccines were administered. When these records are unavailable: Results of a blood titer test can provide the documentation that a school or workplace may need.
How do I get a TN certificate of immunization?
To begin a TN immunization record request, please call the TDH at (615) 741-7247 and provide the following information about the person whose record is needed: Individuals full name (first, middle, and last name) Individuals maiden name and/or all previous last names. Individuals date of birth.
What is immunization paperwork?
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.
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One dose of hepatitis A vaccine is required for all children in child care aged 18 months or greater. The recommended schedule is for two doses, 6 to 18 months
Detailed instructions for this form and explanation of requirements are in TDH Summary of Immunization Rules- Certificate Instructions at the Tennessee
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