Immunizaton date report maricopa county form 2026

1. Click ‘Get Form’ to open the immunization date report maricopa county form in the editor.
2. Begin by filling in all areas at the top of the form, including the full name of your facility, facility ID, and contact information as shown in the sample report.
3. List children born on or after April 1, 2013 on separate pages from those born between October 1, 2009 and March 31, 2013.
4. For each child enrolled in your program, write their name and birthdate. Include children without immunization records.
5. Count and record the number of vaccine doses for each child. Ensure you place an 'X' in the appropriate column for any exemptions.
6. Before submitting, make copies of all completed forms for your records. Mail them by November 15 to the specified address.

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