Immunization Forms

GUIDE TO IMMUNIZATIONS

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IDAHO CERTIFICATE OF IMMUNIZATION EXEMPTION

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IMMUNIZATION EXEMPTION

SCHEDULE OF INTENDED IMMUNIZATIONS FORM

IDAHO CONDITIONAL ADMISSION TO SCHOOL

Schedule of Intended Immunizations Form

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Immunization Requirement by Age

Doses of Vaccines Required

Children born on or before September 1, 1999 must have a minimum of:

(4) Diphtheria, Tetanus, Pertussis (DTaP)
(1) Measles, Mumps, and Rubella (MMR)
(3) Polio
(3) Hepatitis B

Children born after September 1, 1999 through September 1, 2005 must have a minimum of:

(5) Diphtheria, Tetanus, Pertussis (DTaP)2
(2) Measles, Mumps, and Rubella (MMR)
(3) Polio
(3) Hepatitis B

Children born after September 1, 20051 must have a minimum of:

(5) Diphtheria, Tetanus, Pertussis (DTaP)2
(2) Measles, Mumps, and Rubella (MMR)
(4) Polio3
(3) Hepatitis B
(2) Varicella (Chickenpox)4
(2) Hepatitis A

7th GRADE IMMUNIZATION REQUIREMENTS

Immunization Requirement by Grade5

Doses of Vaccines Required

Children admitted to 7thgrade must meet the following minimum immunization requirements in addition to school entry requirements:

(1) Tetanus, Diphtheria, Pertussis (Tdap)
(1) Meningococcal
  1. Preschool children need only be age-appropriately immunized with the required vaccines.
  2. DTaP: The 5th dose is not necessary if the 4th dose was administered at age 4 years or older.
  3. Polio: The 4th dose is not necessary if the 3rd dose was administered at age 4 years or older and at least 6 months after previous dose.
  4. Varicella: History of chickenpox disease documented by a physician or licensed health care professional meets the requirement.
  5. 7th Grade Requirements: These requirements apply to all 7th-12th grade students.

EXEMPTIONS: Idaho law allows a parent/guardian to claim an exemption from immunization requirements for their child for medical, religious, or other reasons. A medical exemption requires the signature of a licensed physician and certification that the child has a medical condition which prevents him or her from receiving required vaccinations. Exemptions for religious or other reasons must be documented on the official State of Idaho form provided by the Idaho Department of Health and Welfare, Immunization Program. Schools should maintain an up-to-date list of pupils with exemptions so they can be excluded quickly if an outbreak occurs.

REFERENCE: Section 39-4801, Idaho Code: Idaho Department of Health and Welfare Rules, IDAPA 16, Title 02, Chapter 15 “Immunization Requirements for Idaho School Children.”