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Immunization Certificate.pdf - PDF Archive 2025

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The document outlines the immunization and tuberculosis screening requirements for students at Georgetown University. It specifies that all students must complete a TB risk assessment, submit immunization records for various diseases, and adhere to deadlines to avoid registration blocks and fees. Additional sections detail the completion of forms by both students and healthcare providers, including requirements for those under 26 years old and specific conditions necessitating TB testing. It also includes information on exemptions for religious or medical reasons.

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Click ‘Get Form’ to open the Immunization Certificate in the editor.
Begin with Part I, where you will enter your personal information. Fill in your last name, first name, GoCard number, home phone number, age, city, date of birth, country of birth, state, and zip code.
Select the school you are entering and indicate your date of entry by checking the appropriate box.
Proceed to Part II for healthcare provider details if you are under 26 years old or a health professions student. Ensure that all vaccination dates are accurately filled in.
Complete Part III by answering TB screening questions. If applicable, provide your name and signature.
If required, fill out Part IV regarding PPD or QFT testing results and ensure it is signed by your healthcare provider.
Continue through Parts V to VII as necessary, ensuring all sections are completed before submitting the form.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I get a copy of my immunization records online in Illinois?

You can access your immunization records by visiting the Vax Verify portal.

Is asking for proof of vaccination a HIPAA violation?

Disclosure of an Individuals Vaccine Status by a Healthcare Provider. Healthcare providers can ask if a patient has been vaccinated as asking the question in no way violates HIPAA.

How long do schools keep immunization records?

Check with your high school and/or college health services for dates of any immunizations. Keep in mind that generally records are kept only for 1-2 years after students leave the system. Check with previous employers (including the military) that may have required immunizations.

Is it legal to ask about vaccination status in a job interview?

Its important to note that even though asking an applicant about their vaccination status is permissible, youll need to ensure you are treating the information as confidential if you collect proof of vaccination, the same you would with any other medical information.

Is it legal to ask for proof of vaccination?

Under HIPAA (but not all state laws), employers are permitted to ask employees about their vaccine status, but employees are not required to provide that information to their employer. There could, however, be consequences for failing to provide that information to an employer.

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What is a copy of your immunization records?

Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.

Can you ask employees if they are vaccinated?

Yes, HIPAA does not prevent employers and businesses from asking their employees and visitors whether they have been vaccinated against COVID-19 and for proof of such vaccination.

Can you ask people if they are vaccinated?

It is not a violation of HIPAA to ask someone about their vaccination status. The Health Insurance Portability and Accountability Act (HIPAA) restricts doctors and insurance companies from disclosing information about their patients.

Immunization Certificate.pdf - PDF Archive 2025

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Got questions?

Can I get a copy of my immunization records online in Illinois?

Is asking for proof of vaccination a HIPAA violation?

How long do schools keep immunization records?

Is it legal to ask about vaccination status in a job interview?

Is it legal to ask for proof of vaccination?

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What is a copy of your immunization records?

Can you ask employees if they are vaccinated?

Can you ask people if they are vaccinated?

covid vaccine certificate format download pdf

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