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Return completed Immunization Record to: 2025

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The document is an Immunization Record form for students at Florida State University College of Medicine, detailing required vaccinations and tests, including measles, rubella, mumps, varicella, poliomyelitis, diphtheria, tetanus, pertussis, hepatitis B, tuberculosis, and influenza. It specifies documentation requirements for each immunization and outlines submission instructions.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name in the 'STUDENT NAME' field at the top of the form.
For each immunization listed, provide the required documentation. This includes dates and dosages for Measles, German Measles, Mumps, Varicella, Poliomyelitis, Diphtheria, Tetanus & Pertussis, Tetanus and Diphtheria, Hepatitis B, Tuberculosis (PPD), and Influenza.
Ensure you include test/lab results where applicable. For example, document positive titers for Measles and Hepatitis B if immunizations are not available.
Complete the physician or authorized signature section at the bottom of the form. Include their license number or office stamp with address.

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

What is the meaning of complete immunization?

A child is said to be fully immunized if child receives all due vaccine as per national immunization schedule within 1st year age of child. The two major milestones of UIP have been the elimination of polio in 2014 and maternal and neonatal tetanus elimination in 2015.

Do I need my immunization records?

Your vaccination record (sometimes called your immunization record) provides a history of all the vaccines you received as a child and adult. This record may be required for certain jobs, travel abroad, or school registration.

What vaccines are required by law?

Background Mumps; Measles; Rubella; Polio; Tetanus and Diphtheria Toxoids; Pertussis; Haemophilus influenzae type B; Hepatitis B;

What do you need immunization records for?

Immunization records often are needed for entry into child care, schools, camps, and new jobs, as well as travel abroad. If you are seeing a new healthcare provider, you will need this information to ensure you receive proper medical care.

Does VA keep immunization records?

Yes, you can use the VA Blue Button, to view, print or download a combined list of your Immunization information, to include: VA Immunizations from your VA health record.

can i get a copy of my immunization records online in india

Can I get a copy of my immunization records online Can I get a copy of my immunization records online New York State NYS immunization records New York State Immunization Information System NYC immunization records Citywide Immunization Registry Where to find old immunization records New York State Immunization information System login

Do doctors keep immunization records?

Doctors and health clinics keep records of the vaccines they give to your child. Keep in mind that they may save records for only a few years.

Do all states have immunization records?

While all states have an immunization registry, the effectiveness of these systems depends on factors such as provider participation, data completeness, and integration with other health information systems.

How long are vaccine records kept for?

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.