Guidance For Completing Form CDPH 286. Review the pupil's immunization record for admission to: • Pre-kindergarten (child care or preschool);. • Transitional
California pre-kindergarten (child care or preschool) facilities are required to check immunizations for all new admissions and at each age checkpoint.
IMMUNIZATION HISTORY: (Fill out or enclose California Immunization Record PM-298.) VACCINE. DATE EACH DOSE WAS GIVEN. 1st. 2nd. 3rd. 4th. 5th. POLIO (OPV OR
The School and Child Care Immunization Record has been moved to a new location: View new link: cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/
Family Child Care Consumer Awareness Information (LIC 9212) - This form must be given to the parents of each child in care. ○. California School Immunization
Local health departments shall have access to this record in schools child care facilities
Local health departments shall have access to this record in schools child care facilities
Copy the date of each vaccine onto the California School. Immunization Record (Blue Card CDPH-286). 3. Determine whether children meet requirements above.
The Child Care Guide has been been moved. View new link: https://www.cdph.ca.gov/Programs/CID/DCDC/CDPH%20Document%20Library/Immu- · nization/IMM-230.pdf.
IMMUNIZATION HISTORY: (Fill out or enclose California Immunization Record PM-298.) VACCINE. DATE EACH DOSE WAS GIVEN. 1st. 2nd. 3rd. 4th.
CALIFORNIA IMMUNIZATION REQUIREMENTS FOR. PRE-KINDERGARTEN. (any private or public child care center day nursery
Local health departments shall have access to this record in schools child care facilities
HIB (Required only for child care and preschool). HEPATITIS B Yellow California Immunization Record ... STATE OF CALIFORNIA—DEPARTMENT OF PUBLIC HEALTH.
Copy the date of each vaccine onto the California School. Immunization Record (Blue Card CDPH-286). 3. Determine whether children meet requirements above.
California School Immunization Record (blue card) (PM 286) - For every infant toddler
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY. CALIFORNIA DEPARTMENT OF SOCIAL SERVICES. FORMS/RECORDS TO KEEP IN YOUR. FAMILY CHILD CARE HOME.
California Department of Public Health. CALIFORNIA PRE-KINDERGARTEN AND SCHOOL IMMUNIZATION RECORD Pre-kindergarten (child care or preschool);.
Pre-kindergarten (child care or preschool) facility* or school staff must: 1. Obtain each child's personal immunization record even if the child may qualify
A. Identification and Emergency Information - Child Care Centers (LIC 700). California School Immunization Records (“blue cards” PM 286) for ...
California Pre-Kindergarten and School Immunization Record Staff must record the required vaccine dose information and status of requirements for each pupil See reverse side for guidance Pupil Name (Last First Middle): Statewide Student Identifier (SSID): Name of Parent/Guardian (Last First): Birthdate (Month/Day/Year): Ethnicity:
Please provide a report on above-named child using the form below I hereby authorize release of medical information contained in this report to the above-named Child Care Center (SIGNATURE OF PARENT GUARDIAN OR CHILD’S AUTHORIZED REPRESENTATIVE) (TODAY’S DATE) PART B – PHYSICIAN’S REPORT (TO BE COMPLETED BY PHYSICIAN)
California Immunization Requirements for K-12th Grade (continued) Conditional Admission Schedule for Grades K-12 Before admission a child must obtain the first dose of each required vaccine and any subsequent doses that are due because the period of time allowed before exclusion has elapsed
administer inhaled medication to a child in care this form must be completed and filed in the child's record and in the personnel file A separate form must be filled out for each person who administers inhaled medication to the child Identification and Emergency Information (LIC 700) - This form must be kept for each child in care
1 Complete child’s name and address information section or ask parent or guardian to complete this section only (This form is not to be sent home or given to parents to complete ) 2 School or child care personnel then ˜ll in date (month/day/year) of each immunization the student has received from the Immunization Record presented by