Edit, Download, and Sign the Florida School Immunization Consent Form
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How do I fill this out?
To fill out the form, provide accurate information as requested in each field. Mark the necessary vaccines to be administered and answer the medical screening questions. Finally, sign the form to provide consent for vaccination.
How to fill out the Florida School Immunization Consent Form?
1
Provide the student's legal last name, first name, and date of birth.
2
Fill in the mailing address, daytime phone, and medical insurance details.
3
Select the vaccines your child needs and initial each selection.
4
Answer the medical screening questions honestly.
5
Sign and print your name as the parent or guardian to provide consent.
Who needs the Florida School Immunization Consent Form?
1
Parents who need to provide consent for their child's school immunization.
2
Guardians managing the immunization records for multiple children.
3
School nurses who need to keep track of student immunization records.
4
Healthcare providers administering vaccines to students.
5
School administrators ensuring compliance with state immunization requirements.
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You can edit this PDF on PrintFriendly by clicking on the text fields and entering the required information. Make necessary changes to the selections and initials. Save the edited PDF after making all the changes.
1
Open the PDF on PrintFriendly.
2
Click on the text fields to enter your information.
3
Initial and sign the document electronically.
4
Review the entered information for accuracy.
5
Save the edited PDF.
What are the instructions for submitting this form?
Submit the completed form to your child's school administration office. You may also send it via email to the school's health coordinator or fax it to the provided fax number. If submitting a physical copy, ensure it is delivered to the designated school official or health office. For online submissions, upload the completed form to the school's online portal if available.
What are the important dates for this form in 2024 and 2025?
School vaccination clinics are generally scheduled at the beginning of the school year and mid-year. Specific dates will be communicated by the respective school administration.
What is the purpose of this form?
The purpose of the School Immunization Consent Form is to gather essential information about the student and obtain parental or guardian consent for immunizations. This form ensures that students are up-to-date with necessary vaccines to comply with Florida state immunization requirements. Accurate completion of this form helps schools and healthcare providers manage and track student immunization records efficiently.
Tell me about this form and its components and fields line-by-line.
- 1. Student's Legal Last Name: Field to enter the legal last name of the student.
- 2. First Name: Field to enter the first name of the student.
- 3. Date of Birth: Field to enter the student's date of birth in MM/DD/YYYY format.
- 4. Mailing Address: Field to enter the mailing address of the student.
- 5. Daytime Phone: Field to enter a contact phone number for daytime hours.
- 6. Medical Insurance: Field to provide medical insurance information.
- 7. Sex: Field to select the student's sex (Male, Female, Other).
- 8. Parent/Guardian Last Name: Field to enter the last name of the parent or guardian.
- 9. Parent/Guardian First Name: Field to enter the first name of the parent or guardian.
- 10. City: Field to enter the city of residence.
- 11. State: Field to enter the state of residence (pre-filled as Florida).
- 12. Zip: Field to enter the ZIP code of the mailing address.
- 13. Student ID#: Field to enter the student's identification number.
- 14. Grade: Field to enter the student's grade level.
- 15. Medical Insurance ID#: Field to enter the medical insurance identification number.
- 16. School: Field to enter the name of the student's school.
- 17. Medical Group#: Field to enter the medical group number associated with the insurance.
- 18. Race: Field to select the student's race.
- 19. Ethnicity: Field to select the student's ethnicity.
- 20. Vaccines Initials: Fields to select and initial the vaccines for consent, including TDAP, HPV, MEN ACWY, and Hepatitis A.
- 21. Medical Screening Questions: Fields to answer medical screening questions related to allergies and previous vaccine reactions.
- 22. Consent Signature: Field for the parent or guardian to sign and give consent for vaccination.
- 23. Print Name: Field for the parent or guardian to print their name.
- 24. Clinic Use Only: Fields for clinic use only, including vaccine, lot number, site/route, and vaccinator information.
What happens if I fail to submit this form?
Failing to submit this form may result in your child not receiving necessary immunizations.
- Missed Immunizations: Your child may miss out on important vaccines needed for their health and school compliance.
- Non-Compliance: Your child may not meet the state immunization requirements for school attendance, which could result in exclusion from school activities.
How do I know when to use this form?
- 1. School Enrollment: When enrolling your child in school to ensure they meet immunization requirements.
- 2. Vaccine Updates: When updating your child's vaccine records with new immunizations.
- 3. Health Check-Ups: During routine health check-ups to keep your child's immunization records current.
- 4. School Health Programs: For participation in school health programs that require up-to-date immunizations.
- 5. Documenting Immunizations: To document and track the immunizations your child has received.
Frequently Asked Question
How do I edit the form on PrintFriendly?
Click on the text fields to enter your information, make necessary changes, and save the edited PDF.
Can I sign the form electronically on PrintFriendly?
Yes, you can sign the form electronically using the available signing tools.
How do I share the completed form?
Use the share option to enter the recipient's email or generate a shareable link to send the PDF.
What information do I need to provide on the form?
You need to provide the student's details, vaccine selections, medical screening answers, and your consent signature.
Can I save the completed form on PrintFriendly?
Yes, you can save the completed form after editing and signing it.
Do I need to print the form after completing it on PrintFriendly?
No, you can electronically share or save the form without printing it.
How do I know which vaccines my child needs?
Consult the vaccine requirements listed on the form and your healthcare provider for guidance.
Can I make changes to the form after signing it?
Yes, you can make changes before finalizing and saving the edited form.
What is the purpose of the medical screening questions?
The medical screening questions help determine if there are any reasons your child should not receive certain vaccines.
Do I need to provide my child's medical insurance details?
Providing medical insurance details is recommended but not mandatory.
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