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In the realm of public health and education, the Tennessee Department of Health Certificate of Immunization holds a pivotal role, serving as a cornerstone document required for children to attend schools and child care facilities within the state. Spearheaded into use on July 1, 2010, this certificate meticulously details vital immunization data alongside providing spaces for documenting exemptions, health examinations, and the administration of recommended vaccines, thus ensuring adherence to Tennessee's robust immunization schedule. Its design caters to various requirements, including those for entry to different educational levels and care settings, from child care to 7th-grade entry, underlining the state's commitment to safeguarding public health. Noteworthy for its inclusivity, the form accommodates religious exemptions and outlines the necessary vaccines alongside their requisite schedules, bolstered by a provider’s assessment to certify the vaccination status. This certificate stands not only as a record but also as a testament to coordinated efforts in preventing the spread of vaccine-preventable diseases in Tennessee's congregated settings, supported by detailed guidelines on the Tennessee Department of Health website and the Tennessee Web Immunization System.

Example - Tn Immunization Form

Use required on or after July 1, 2010.

Tennessee Department of Health

 

CERTIFICATE OF IMMUNIZATION

NOT A VALID CERTIFICATE

 

NOT A VALID

 

 

 

 

 

 

Child's Name (Last name, first name, middle)

 

 

Birthdate (mm/dd/yy)

NOT A VALID CERTIFICATE

 

 

 

 

 

 

 

 

 

 

 

Parent/Guardian Name (Last name, first name, middle)

 

 

 

 

 

NOT A VALID CERTIFICATE

 

 

 

 

 

 

 

 

 

 

 

Phone (please include area code xxx-xxx-xxxx)

 

 

 

 

 

NOT A VALID CERTIFICATE

 

 

 

 

 

 

 

 

 

 

 

Address

 

 

 

 

 

NOT A VALID CERTIFICATE

 

 

 

 

 

 

 

 

 

City

State

Zip Code

Section 1a. Religious Exemption฀

Check here if religious exemption to immunization selected by parent/guardian

1b. Health Examination Documentation (if required)

This child has been examined: MM / DD / YY

Certified by (Signature/Stamp)

1c. Check if needed

Dental Screening

Vision Screening

Unless specifically exempted by law, Tennessee law requires a certificate on file for each child in attendance in any school or child care facility in Tennessee. Detailed instructions for this form and explanation of requirements are in "Instructions for Completion of Immunization Certificates" and the "Official Immunization Schedule" at the Tennessee Department of Health website (http://health.state.tn.us/CEDS/required.htm) and on the Tennessee Web Immunization System.

VACCINE

DATE

DATE

DATE

DATE

DATE

DATE

MM / DD / YY

MM / DD / YY

MM / DD / YY

MM / DD / YY

MM / DD / YY

MM / DD / YY

 

 

 

 

 

 

Diagnosed (YY)

+Serology (YY)

History (YY)

Medical Exemption (X)

Section 2a. Required Vaccines for School or Child Care Attendance (Dates Required)

Hib

XXXXXXXX

 

 

 

 

 

Child Care Only (<5 years)

 

 

 

 

 

 

 

 

 

 

 

Pneumococcal (PCV)

XXXXXXXX

 

 

 

 

 

Child Care Only (<5 years)

 

 

 

 

 

 

 

 

 

 

 

DTP, DTaP, DT, Td

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

Poliomyelitis

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

Hepatitis B

XXXXXXXX

 

 

 

 

 

Check here if 11-15 years

 

 

 

 

 

 

 

 

 

 

 

2-dose schedule used

 

 

 

 

 

 

Hepatitis A

XXXXXXXX

 

 

 

 

 

Child Care Effective 7/2010

 

 

 

 

 

 

 

 

 

 

 

Kindergarten Effective 7/2011

 

 

 

 

 

 

Measles

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

Mumps

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

Rubella

XXXXXXXX

 

 

 

 

 

Varicella

XXXXXXXX

 

 

 

 

 

Tdap Booster

XXXXXXXX

 

 

 

 

 

7th Grade Entry Only

 

 

 

 

 

 

 

 

 

 

 

 

YY

 

 

 

 

 

YY

 

 

 

 

 

YY

 

 

 

 

 

YY

 

 

 

 

 

YY

 

 

 

 

YY

YY

YY

 

 

 

 

2b. Recommended Vaccines (Documentation Optional)

Rotavirus

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Influenza

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Meningococcal

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

HPV

XXXXXXXX

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Section 3. Provider Assessment (select one*, not valid if blank)

A) Temporary Certificate - Expires

MM / DD / YYYY

Expiration date one month after date next catch-up immunization is due.฀

B) Up to Date for Child Care Entry and <18 Months of Age

Only if requirements incomplete, but up to date for age. Expires at 19 months of age.

C) Complete for Child Care / Pre-School*

Fulfills all requirements for child care / pre-school or pre-K under 5 years of age.฀

D) Complete K-6th Grade*

Fulfills requirements, Kindergarten through 6 th grade.

E) Complete 7th Grade or Higher

Fulfills requirements,7 th grade or higher.

*If age 4 years and fulfills requirements for Pre-School and Kindergarten, check BOTH Boxes C and D.

Section 4. (Required) Printed or Stamped Name, Address, Phone of Qualified Healthcare Provider (MD, DO, PA, Advanced Practice Nurse or Health Department):

NOT A VALID CERTIFICATE

NOT A VALID CERTIFICATE

NOT A VALID CERTIFICATE

NOT A VALID CERTIFICATE

NOT A VALID CERTIFICATE

 

MM

DD

YYYY

Certified by (Signature/Stamp)

Date of Issue

PH-4103 (Rev. 4/13)

NOT A VALID CERTIFICATE

RDA-N/A

Vaccine Requirements for Attending Child Care Facilities, Pre-Schools and Schools in Tennessee*

Recommended Schedule of Required Doses for Attendance in Child Care / Pre-School / Pre-K and School

For Children Who Started Immunizations Before Age 7 Years**

Required Vaccines with

2

4

6

12-15

16-18

4-6 Yrs.*

Total Doses Required*** For Assessment

Months

Months

Months

Month of

Month

(School

of Complete For School Attendance on

footnote numbers in [ ]

of Age

of Age

of Age

Age

of Age

Entry)

Immunization Certificate

 

 

 

 

 

 

 

 

 

 

 

[1]

Hib HbOC or

1

2

3

4

 

 

N/A for school (See Footnote [1])

[1]

Hib PRP-T or

1

2

3

4

 

 

N/A for school (See Footnote [1])

[1]

Hib PRP-OMP

1

2

 

3

 

 

N/A for school (See Footnote [1])

[2]

PCV

1

2

3

4

 

 

N/A for school (See Footnote [2])

[3]

DTP, DTaP, DT

1

2

3

4

 

5

5 or 4 (See Footnote [3])

[4]

Polio

1

2

 

3

 

4

5, 4 or 3 (See Footnote [4])

[5]

Hepatitis B

1

2

 

3

 

 

3 (See Footnote [5])

[6]

Hepatitis A

 

 

 

1

 

2

2 (See Footnote [6])

[7]

MMR

 

 

 

1

 

2

2 (See Footnote [7])

[8]

Varicella

 

 

 

1

 

2

2 (See Footnote [8])

[9]

Tdap

 

 

 

 

 

 

1 (7th grade only)

*These requirements were established in accordance with the current Recommended Childhood and Catch-Up Immunization Schedules, United States. Tennessee requirements for Kindergarten (5 years) include doses indicated for 4-6 years.

For children starting immunizations at age 7 years or older, refer to the catch up schedule available at the Department of Health website or the ACIP catch-up schedule for that age available at www.cdc.gov/vaccines.

***Children who are behind schedule may attend while in the process of completing the requirements with minimum intervals as indicated below.

Minimum Ages For Initial Immunization And Minimum Intervals Between Doses

 

Vaccine

Minimum Age For

Minimum interval

Minimum interval

Minimum interval

Minimum interval

With respect to the intervals, 1 month is a minimum of 4 weeks or 28 days.

 

First Dose

from dose 1 to 2

from dose 2 to 3

from dose 3 to 4

from dose 4 to 5

 

 

 

[1]

Hib (Primary Series)

 

 

 

 

 

 

 

HbOC & PRP-T

6 weeks

1 month

1 month

See Footnote [1]

N/A

Do not restart any series, no matter how long since the previous dose. Doses

 

PRP-OMP

6 weeks

1 month

See Footnote [1]

N/A

N/A

given ≤ 4 days before the minimum age or the minimum interval may be counted

[2]

PCV

6 weeks

1 month

1 month

See Footnote [2]

N/A

as valid.

[3]

DTP/DTaP (DT)

6 weeks

1 month

1 month

6 months

See Footnote [3]

Two different live vaccines must be given on the same day or spaced at least 28

[4]

Polio

6 weeks

1 month

1 month

See Footnote [4]

See Footnote [4]

days apart.

[5]

Hepatitis B

birth

1 month

See Footnote [5]

N/A

N/A

 

[6]

Hepatitis A

12 months

6 months

 

 

 

 

[7]

MMR

12 months

1 month

N/A

N/A

N/A

 

[8]

Varicella

12 months

3 months [8]

N/A

N/A

N/A

 

[9]

Tdap

See Footnote [9]

 

 

 

 

 

Footnotes

[1]The number of doses of Hib depends on age at 1st dose and brand of vaccine given. The last dose in the series necessary to meet requirements, whether 3rd or 4th, should be given at least 2 months after the previous dose and not before 12 months of age. One dose is sufficient to meet requirements if it is given at age 15 months or later. Hib is required for children younger than 5 years attending child care facilities. Hib is not required for kindergarten or higher grades and is not indicated for children who have reached the 5th birthday. If given on schedule, PRP-T and HbOC have a 3 dose primary series and a booster after age 12 months. PRP-OMP has a 2- dose primary schedule and a booster after 12 months. Providers are responsible for verifying that the child meets the appropriate schedule for the brand used.

[2]The number of doses in the PCV series depends on age at 1st dose. The last dose in the series should be given at least 2 months after the previous dose and not before 12 months of age. One dose of PCV is required for all children aged 24-59 months in child care with any incomplete schedule.

[3]The minimum interval between the 4th and 5th doses is 6 months: dose 4 may be given as early as 12 months, but typically is given at age 15-18 months. One dose of DTP/DTaP/DT must be on or after the 4th birthday. If the

4th dose was on or after the 4th birthday, the 5th dose is not needed. The 4th dose should be administered a minimum of 6 months after the 3rd dose. However, the 4th dose does not need to be repeated if administered ≥ 4 months after dose 3. Total doses of diphtheria and tetanus toxoids should not exceed 6 before the 7th birthday.

[4]The final dose of the polio vaccine series must be given on or after the 4th birthday and at least 6 months after the previous dose. If 4 doses are administered before the 4th birthday, a 5th dose should be given on or after the 4th birthday. If the 3rd dose of an all IPV or all OPV series is given on or after the 4th birthday and at least 6 months after the 2nd dose, a 4th dose is not needed.

[5]The 3rd valid dose of hepatitis B vaccine must be at least 4 months after dose 1 and 2 months after dose 2 and not before 24 weeks of age. If the 3rd dose given is not valid for all criteria, a 4th dose is necessary.

[6]One dose of hepatitis A vaccine is required for all children in child care aged 18 months or greater. The recommended schedule is for two doses, 6 to 18 months apart, beginning at one year of age. Proof of two doses, at least 6 months apart, is required for Kindergarten entry. Hepatitis A vaccine is not required for entry in older school grades.

[7]The MMR requirement is 2 doses of measles vaccine, 2 doses of mumps vaccine and 2 doses of rubella vaccine, in combination or separately. Dose 2 of MMR is routinely given at 4-6 years, but may be given as soon as 1 month after dose 1.

[8]The varicella requirement is for 2 doses of varicella vaccine or history of disease for all students entering K or 7th grade, and new entrants into a Tennessee school in any other grade. The second dose is recommended 3 or more months after the first dose, routinely at age 4-6 years; in keeping with CDC guidance, the second dose is acceptable if given at least 4 weeks after the first dose.

[9]A single dose of Tdap is required for 7th grade entry. Tdap meets the requirement if given any time after the 7th birthday. If Tdap is needed, it may be given regardless of interval since last Td.

PH-4103 (Rev. 4/13)

Use Required on or After July 1, 2010

RDA-N/A

Form Breakdown

Fact Detail
Form Name Tennessee Department of Health Certificate of Immunization
Validity Start Date Required on or after July 1, 2010
Law Requirement Tennessee law requires an immunization certificate for each child in any school or child care facility.
Religious Exemption Option available for exemption due to religious beliefs.
Health Examination Documentation of a health examination is required.
Additional Screenings Options for dental and vision screening are included.
Provider Assessment Provider must indicate the certificate type based on immunization and age.
Required Vaccines for Attendance Includes a list of vaccines required for school or child care attendance, with specifics on age and dose requirements.
Recommended Vaccines Includes additional vaccines that are recommended but not required.

Detailed Instructions for Filling Out Tn Immunization

Filling out the Tennessee Immunization Form is a crucial step to ensure that all children attending school or child care facilities in Tennessee meet the state's immunization requirements. This document is not only a record of vaccinations but also includes sections for religious exemptions, health examinations, and screenings, making it integral for comprehensive health documentation. Careful completion ensures compliance with state laws and promotes the health and safety of all children in public spaces.

  1. Start with the child's information section at the top of the form. Enter the child's Name (Last name, first name, middle), Birthdate (mm/dd/yy).
  2. Fill in the Parent/Guardian Name (Last name, first name, middle).
  3. Provide a Phone number, including the area code in the format xxx-xxx-xxxx.
  4. Enter the home Address, including City, State, and Zip Code.
  5. If applicable, check the box for Religious Exemption under Section 1a.
  6. For health examination documentation under Section 1b, indicate the date the child was examined (MM/DD/YY) and have it certified by a healthcare provider's signature or stamp.
  7. In Sections 1c, check if a Dental Screening or Vision Screening is needed.
  8. Under Section 2a, for each required vaccine, enter the dates of immunization in the format (MM/DD/YY). If there is a medical exemption, diagnosed condition, or serology, mark the appropriate columns. Refer to the Tennessee Department of Health for the specific vaccine and documentation requirements.
  9. If leveraging the 2-dose schedule for Hepatitis B for children aged 11-15 years, make sure to check the designated box.
  10. Under Section 2b, while the recommended vaccines are not mandatory, documenting them is beneficial for complete health records. Fill in accordingly.
  11. In Section 3, select the appropriate provider assessment that applies to the child’s immunization status – either A) Temporary Certificate, B) Up to Date for certain age criteria, C) Complete for Child Care / Pre-School, D) Complete K-6th Grade, or E) Complete 7th Grade or Higher. Ensure one option is checked to validate the form.
  12. Section 4 requires the printed or stamped Name, Address, and Phone of the qualified healthcare provider along with their signature and stamp, and Date of Issue.

After accurately completing and reviewing the form for any errors, submit it to the relevant school or child care facility before the deadline. This submission is key to maintaining health compliance and ensuring the well-being of the educational community. It's advisable to keep a copy for your records and future reference.

More About Tn Immunization

What is the Certificate of Immunization form used for in Tennessee?

The Certificate of Immunization form is a mandatory document required by the Tennessee Department of Health for all children attending any school or child care facility in Tennessee. It certifies that a child has received the necessary vaccinations as per the state's law, unless an exemption applies.

Are there exemptions to the immunization requirements in Tennessee?

Yes, exemptions are available for religious reasons and specific medical conditions. Parents or guardians who choose not to vaccinate their children due to religious beliefs must indicate this on the Certificate of Immunization form. For medical exemptions, a healthcare provider must document the condition that contraindicates immunization.

What vaccines are required for school or child care attendance in Tennessee?

  1. Hepatitis B
  2. DTP, DTaI', or DT (Diphtheria, Tetanus, Pertussis)
  3. Polio
  4. MMR (Measles, Mumps, Rubella)
  5. Varicella (Chickenpox)
  6. Hepatitis A
  7. Tdap Booster (for 7th grade entry)

What is the provider assessment section on the Certificate of Immunization?

The provider assessment section is filled out by a qualified healthcare provider. It documents the child's immunization status, indicating whether the child is up to date with vaccinations, has temporary exemption due to a catch-up schedule, or has completed all required vaccinations for their current level of care or education.

How can parents/guardians obtain the Certificate of Immunization for their child?

Parents or guardians can obtain the Certificate of Immunization from their child's healthcare provider. The form must be completed, signed, or stamped by a qualified healthcare provider, indicating the child's current immunization status.

Is there a catch-up schedule for children who start their immunizations late or who are behind?

Yes, there is a catch-up schedule for children who did not start their immunizations on time or who are behind. The Tennessee Department of Health provides guidelines for catch-up vaccinations that outline the minimum ages for initial immunization and minimum intervals between doses.

Are there any recommended vaccines that are not required for school entry?

While not required for school entry, the Tennessee Department of Health recommends additional vaccines such as Rotavirus, Influenza, Meningococcal, and HPV. These are recommended to protect children from diseases that are preventable by vaccination, though documentation for these vaccines is optional on the Certificate of Immunization.

What happens if a child’s Certificate of Immunization is not up to date?

A child whose Certificate of Immunization is not up to date may be denied entry into school or child care facilities. Children who are behind on their immunization schedule may attend while catching up on vaccinations, provided that they adhere to a state-approved catch-up schedule.

How recent must the health examination documentation be for school or child care entry?

The health examination documentation for school or child care entry must be performed within a timeframe consistent with the Tennessee Department of Health’s requirements. Specific details can be found on their website, but typically, exams should be recent enough to accurately reflect the current health status of the child.

Common mistakes

Filling out the Tennessee Immunization Form requires careful attention to detail to ensure accuracy and compliance. However, mistakes can happen. Here are nine common errors that can occur when completing this form:

  1. Incorrect Child's Information: Entering the wrong name spelling, birthdate, or leaving these fields blank is a common mistake. It's crucial that the child's name matches other legal documents, and the birthdate is correctly formatted as mm/dd/yy.
  2. Parent/Guardian Information Errors: Similar to the child's information, entering incorrect or incomplete details for the parent or guardian can lead to confusion or delays.
  3. Phone Number Formatting: The form requires a specific format (xxx-xxx-xxxx) for phone numbers. Omitting area codes or incorrectly formatting the number can cause communication issues.
  4. Address Details: Often, the address, city, state, and zip code are not fully filled out or are incorrect. Ensuring these details are accurate is essential for any future correspondence.
  5. Overlooking Religious or Medical Exemptions: Failing to check the appropriate box for religious exemptions or to document any medical exemptions under Section 1 can result in unnecessary follow-ups.
  6. Vaccine Dates Misentry: One of the most critical sections, yet often filled with errors, involves the dates vaccines were administered. These should match the healthcare provider’s records exactly.
  7. Incomplete Provider Information: The healthcare provider's name, address, and phone number must be clearly printed or stamped. Missing or inaccurate provider details can invalidate the form.
  8. Signature and Date of Issue: The form is not valid without the healthcare provider's signature and the date of issue. Skipping these steps can lead to it being rejected.
  9. Selection of Provider Assessment: The provider assessment section is essential but can be incorrectly filled. Selecting the wrong status for the child's immunization (temporary, up to date, or complete) can cause unnecessary administrative hassle.

To mitigate these errors, it's recommended that parents and guardians:

  • Double-check all entries for accuracy.
  • Confirm vaccine dates with healthcare provider records.
  • Ensure the form is fully completed before submitting.

By avoiding these common mistakes, the process of complying with Tennessee's immunization requirements can be smoother and more efficient for all involved.

Documents used along the form

When managing health and immunization records, especially in environments like schools or childcare facilities, a comprehensive understanding and collection of the necessary documentation are crucial. Apart from the Tennessee Immunization Form, there are several other forms and documents often used to ensure a child's health information is up-to-date and comprehensive. These documents are not just about vaccinations but also cover other aspects of a child's health that can impact their school attendance and participation.

  • Medical Examination Report: A form detailing a child's general health assessment, often required for initial enrollment in school or sports participation.
  • Birth Certificate: Used to verify a child’s age and legal name, as both can affect immunization schedules and school enrollment eligibility.
  • Emergency Contact Information: Provides contact details for parents or guardians, and potentially others, in case of an emergency.
  • Medication Administration Form: Required for students who need to take medication during school hours, detailing dosage and timing.
  • Allergy Action Plan: Documents any allergies, the severity, emergency contacts, and the plan of action should an allergic reaction occur.
  • Asthma Action Plan: Similar to the allergy action plan, but for managing asthma, including triggers, treatment, and rescue inhaler use.
  • Exemption Form: For families who choose not to vaccinate due to religious or medical reasons, outlining the specific exemption.
  • Dental Health Record: A summary of a child's dental health assessments and any necessary treatments or interventions.
  • Vision Screening Report: Documents the results of vision screenings, important for identifying issues that might affect learning.
  • Health Insurance Information: Provides details on the child’s health coverage, which is crucial for billing purposes for any treatments or interventions provided at school.

Collectively, these documents help create a comprehensive profile of a child’s health and wellness, facilitating better care and planning for their needs within the school setting. It is important for parents and guardians to provide accurate and updated information on all forms and to understand the significance of each document in safeguarding their child’s health and educational experience.

Similar forms

The Tennessee Immunization Form shares similarities with other official documents that are instrumental in ensuring public health and safety within educational and childcare settings. One such document is the School Entry Health Exam Certification, which, akin to the immunization form, is required for enrollment in schools. This certification focuses on a comprehensive health examination, ensuring that children are physically fit to attend school, similar to how the immunization form verifies vaccination against communicable diseases.

Another document resembling the Tennessee Immunization Form is the Child Care Attendance Record. This document tracks a child's attendance in childcare facilities, which parallels the immunization form's role in confirming a child's eligibility to attend based on their vaccination status. Both are critical in managing health and wellness within child care environments, safeguarding against outbreaks of vaccine-preventable diseases.

The Medical Exemption Form for Vaccinations is closely related to the Tennessee Immunization Form as it also deals with immunizations, specifically providing a legal means for children to be exempt from vaccines due to medical reasons. While the immunization form records vaccination status and exemptions, the medical exemption form substantiates the grounds for exemption, ensuring that only those with legitimate health concerns bypass vaccination requirements.

Similar to the Tennessee Immunization Form is the Dental Screening Certification, which is another health requirement document for school-aged children. Instead of focusing on immunizations, this certification verifies that a child has undergone a dental health assessment, highlighting the broader scope of health evaluations deemed necessary for school enrollment, akin to the immunization check.

The Vision Screening Certificate, much like the Tennessee Immunization Form, serves as a prerequisite for school entry, emphasizing the importance of health screening in educational settings. This document ensures that visual acuity is assessed, supporting a child's learning by identifying and addressing potential vision problems, similar to how the immunization form aims to prevent disease spread through vaccination verification.

The Religious Exemption Certificate for Vaccinations is another document related to the Tennessee Immunization Form. It provides an avenue for parents to legally exempt their children from vaccinations due to religious beliefs, mirroring the section on the immunization form that accommodates religious exemptions. Both forms play roles in the administration of vaccine policies within the state, balancing public health objectives with individual rights.

Analogous to the Tennessee Immunization Form is the International Certificate of Vaccination or Prophylaxis, commonly used for travel. Although the context differs, both documents serve as official records of vaccination, the former for educational access within the state and the latter for international travel requirements, showcasing the universal importance of vaccine documentation in safeguarding public health.

Last but not least, the Adolescent Health Record is akin to the Tennessee Immunization Form in its purpose to consolidate a teenager's health information, including vaccination status, for school and medical use. This document encompasses a broader range of health data, but similarly underscores the significance of maintaining up-to-date immunization records for the wellness and safety of the adolescent population.

Dos and Don'ts

Completing the Tennessee Immunization Form is a critical step in ensuring the health and safety of children attending school or childcare facilities in Tennessee. It's essential to handle this form accurately and diligently. Here are several important dos and don'ts to keep in mind:

  • Do carefully read and follow the "Instructions for Completion of Immunization Certificates" and the "Official Immunization Schedule" available on the Tennessee Department of Health website before starting the form.
  • Do ensure all the information provided is accurate and up-to-date, including the child's name, birthdate, and parent/guardian contact information.
  • Do check the appropriate boxes for any exemptions (such as religious exemptions) and provide necessary documentation or statements as required by Tennessee law.
  • Do include dates for all required vaccines as listed under Section 2a. Ensure these dates align with the Recommended Schedule of Required Doses for Attendance in Child Care/Pre-School/Pre-K and School.
  • Don't overlook the need for a healthcare provider's signature or stamp, along with their printed or stamped name, address, and phone number in Section 4. This verification is crucial for the form's validity.
  • Don't ignore the section about provider assessment (Section 3). Select the correct option that accurately describes the child’s immunization status and ensure the expiration date is filled out if a temporary certificate is issued.
  • Don't forget to review the form for any missed fields or inaccuracies, as incomplete or incorrect forms will not be accepted and may delay processing.
  • Don't hesitate to contact a qualified healthcare provider or the Tennessee Department of Health for any questions or clarifications regarding vaccine schedules, exemptions, or form completion.

By adhering to these guidelines, you can help ensure that the immunization form is filled out correctly and efficiently, facilitating a smoother process for school or childcare entry in Tennessee.

Misconceptions

Understanding the Tennessee Immunization Form requires clarity on several points often misunderstood by the public. Here are nine common misconceptions:

  1. All vaccines listed must be received exactly as indicated on the form. While it's important to follow immunization schedules, the form allows for recognized exemptions, medical exemptions, and catch-up schedules as outlined by the Tennessee Department of Health and the CDC.

  2. A religious exemption requires additional documentation to be valid. The form itself has a section for religious exemption that must be checked by the parent or guardian, negating the need for additional documents specifically for the exemption.

  3. The form is only for school-aged children. The Tennessee Immunization Form is used not only for school entry but also for child care facilities, including pre-school and pre-K attendance, indicating broader applicability.

  4. Dental and vision screenings are mandatory for the form's completion. Checkboxes for dental and vision screenings are provided for optional documentation, not as a requirement for the form’s validity.

  5. Vaccine dates must be filled in for the form to be considered complete. There are cases, such as religious exemption or medical exemption (noted with an ‘X’), where vaccines might not be administered, and the form can still be complete and valid.

  6. The form is valid indefinitely once completed. The provider assessment section includes temporary certificates with expiration dates, indicating that the form must be updated or confirmed at specific intervals depending on the child's immunization status.

  7. All sections of the form must be filled for every child. Depending on the exemption status, age, or specific catch-up schedules, some sections may not be applicable and thus not required to be completed for form validity.

  8. Immunization dates after the child's current age are required on the form. The form requires past immunization dates to assess compliance with state requirements, not future scheduled vaccinations.

  9. Every child attending school in Tennessee must follow the exact same immunization schedule. While there is a standardized schedule, variations are permitted based on age at the start of immunizations, catch-up schedules, and exemptions, allowing for individual differences in vaccination timing.

These clarifications aim to provide better understanding and adherence to the Tennessee Department of Health's requirements, ensuring children's health and safety while respecting individual circumstances and legal exemptions.

Key takeaways

Filling out and using the Tennessee Immunization Form is crucial for ensuring children meet the state's health requirements for school or child care attendance. Here are key takeaways to help guide you through the process:

  • Starting date: The usage of this form is mandated from July 1, 2010. It's essential for parents and guardians to use the updated form to comply with current health regulations set by the Tennessee Department of Health.
  • Religious Exemption: There is a provision for religious exemption to immunization for families whose beliefs conflict with vaccination. If applicable, parents or guardians must check the specific box to indicate their choice of religious exemption.
  • Health Examination and Screenings: Besides immunization, the form includes sections for documenting a child’s health examination, dental, and vision screenings. These additional health checks are critical for early detection of potential health issues.
  • Provider Assessment Section: Healthcare providers have to assess the child's immunization status against specific age-related requirements and indicate the assessment result. This part of the form distinguishes between temporary certificates, complete for child care or school entry, and other specific conditions. It ensures that children are appropriately vaccinated for their age or catch-up schedules are initiated.

It's important for parents, guardians, and healthcare providers to understand each section of the form and the significance of each vaccine and health check. Ensuring the form is accurately filled out and submitted to the relevant school or child care facility is key to compliance with Tennessee’s health requirements. As such, everyone involved plays a vital role in safeguarding the health of Tennessee's children.

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