Mandatory Immunization Health History Form - medicationtherapy cop ufl 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information at the top of the form, including your name, phone number, date of birth, and UF ID number. Ensure all details are accurate for proper identification.
3. In Section A, provide dates for required immunizations. For each vaccine listed (MMR, Hepatitis B, Menactra/MCV4), enter the date received and attach any necessary lab reports as indicated.
4. Complete the Tuberculosis screening section if applicable. Fill in the dates for the TB Skin Test or Interferon-based Assay and include results. Remember to attach relevant lab reports.
5. Proceed to Section B for additional immunizations required by MTM College of Pharmacy. Again, input dates and results as needed.
6. Finally, ensure Section C is completed with an official stamp from a healthcare provider along with their signature and date to validate your form.

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