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Certificate of Immunization Status CIS DOH 348-013 January 2015 Office Use Only Reviewed by Date Signed Cert. Documentation of Disease Immunity laboratory evidence of immunity titer to the diseases marked. Signed lab report s MUST also be attached. Diphtheria Hepatitis A Hib Measles Mumps Polio Rubella Tetanus Varicella Other Instructions for completing the Certificate of Immunization Status CIS printing it from the Immunization 1 To print with information filled in First ask if your healthcare provider s office puts vaccination history into the WA Immunization Be sure to review all the information sign and date the CIS and return it to school or child care. Form is correct and verifiable. Required for Child Care/Preschool Only Recommended but not required Parent/Guardian Signature Required Date Parent/Guardian Signature Required Vaccine Dose Month Day Year Hepatitis B Hep B or Hep B - 2 dose alternate schedule for teens Rotavirus RV1 RV5 Diphtheria Tetanus Pertussis DTaP DTP DT Tetanu....

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
WA DOH 348-013
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