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Dhhs 3987 form-2026
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- Click ‘Get Form’ to open the dhhs 3987 form in the editor.
- Begin by filling out the patient information section, including the name, date of birth, and address of both the patient and parent/guardian.
- Indicate the school or child care program that the patient is associated with.
- Review the list of vaccines and check any applicable contraindications or precautions that apply to the patient. Be sure to document any specific reactions as required.
- Complete the section regarding when the exemption ends and provide your name as a physician, ensuring it is printed clearly.
- Attach a copy of the most current immunization record before finalizing your submission.
- Retain a copy for your records and return the original form to the requesting party.
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1. Complete and sign the form. 2. Attach a copy of the most current immunization record. 3. Retain a copy for the patientsRead more
Complete and sign the form. 2. Attach a copy of the most current immunization record. 3. Retain a copy for the patients medical record. 4Read more