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The document is an Admission Health Record Packet for students at the School of the Art Institute of Chicago, requiring submission of immunization records to comply with Illinois law. It includes sections for personal information, authorization for record release, required immunizations (Tetanus/Diphtheria and MMR), recommended immunizations, and a verification section for healthcare providers. A non-refundable fine is imposed for incomplete records.

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Click ‘Get Form’ to open the printable immunization records in the editor.
Begin by filling in your personal information at the top of the form, including your name, date of birth, home phone number, SAIC email address, and student ID number.
Review the authorization section and provide your signature along with the date to allow the release of your immunization record.
Complete the required immunizations sections based on your status (International Student or U.S. Citizen). Fill in the dates for each immunization received.
If applicable, complete Sections 3 or 4 for MMR vaccinations. Ensure you include all necessary dates and any lab evidence if required.
For recommended immunizations in Section 5, fill out any that you have received, noting their dates as well.
Finally, have a healthcare provider sign and stamp the form to verify all provided information before submission.

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How to show proof of immunity?

There are two ways to verify immunization history: Vaccination records from health care providers: Confirm when, where and by whom certain vaccines were administered. When these records are unavailable: Results of a blood titer test can provide the documentation that a school or workplace may need.

Can I get a copy of my immunization records online on mychart?

Go to My Record Health Summary and select the Immunizations tab. You can see the immunizations youve received and the dates on which you received them. Click the immunization name to learn more. If your immunizations are not up to date, please docHub out to your clinic directly to have your information updated.

What is an example of immunization?

The measles, mumps, and rubella (MMR) vaccine and the varicella (chickenpox) vaccine are examples. Killed (inactivated) vaccines are made from a protein or other small pieces taken from a virus or bacteria. The whooping cough (pertussis) vaccine is an example.

How to get your immunization records online in CA?

Looking for Your Immunization Record? Visit the Digital Vaccine Record portal to download a copy of your immunization record from CAIR.

How can I get my old immunization records?

visits you made to local public health departments or neighborhood clinics. When physicians retire or a medical practice changes hands, old patient records may be sent to a medical record storage company. You may be able to obtain records directly from the company for a fee. baby books and school or camp forms.

printable immunization record template

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What is evidence of immunity?

Evidence of immunity means that you can show you are protected from (immune to) a disease. There are a few different ways to show evidence of immunity to measles: A vaccine record. A blood test showing you are immune. This is called a titer.

What counts as proof of immunization?

Photocopies of immunization records from a licensed healthcare provider or clinic, or from a California K-12 school uploaded to My Health Portal. All records must show the vaccine type, dose, and date of each shot.

What is required documentation when giving a vaccine?

The National Childhood Vaccine Injury Act requires that a VIS must be given to parents, legal representatives, or adult patients before administering the vaccine. A VIS must be provided prior to each dose, not just the first dose. Providers should be sure they are using the most current version of each VIS.

Printable immunization records 2026

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See more printable immunization records versions

Complete this form in 5 minutes or less

Got questions?

How to show proof of immunity?

Can I get a copy of my immunization records online on mychart?

What is an example of immunization?

How to get your immunization records online in CA?

How can I get my old immunization records?

Security and compliance

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What is evidence of immunity?

What counts as proof of immunization?

What is required documentation when giving a vaccine?

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