CA CDPH 8608P IMM-542P 2017-2025 free printable template

State of California Health and Human Services Agency California Department of Public Health Immunization Record and History PATIENT NAME Last Name First Name Middle Initial BIRTHDATE Male NUMBER KNOWN REACTIONS TO VACCINES/ALLERGIES PRACTICE NAME/ADDRESS Female VACCINES FOR CHILDREN VFC ELIGIBILITY check one No health insurance CHDP/Medi-Cal eligible Under-insured insurance does not cover immunizations may be vaccinated with VFC vaccines only at federally qualified and rural health centers...

How to fill out immunization record history 2017-2025

How to fill out CA CDPH 8608P IMM-542P

1. Begin by downloading the CA CDPH 8608P IMM-542P form from the California Department of Public Health website.
2. Read the instructions carefully to understand the purpose of the form and required information.
3. Fill out your personal information including name, address, and contact details in the designated sections.
4. Provide accurate details regarding the type of service for which you are applying, including the applicable codes.
5. Complete any additional sections as required, such as medical history or declarations.
6. Review all the information for accuracy and completeness.
7. Sign and date the form, confirming that the information provided is true.
8. Submit the completed form as per the submission guidelines provided in the instructions.

Who needs CA CDPH 8608P IMM-542P?

1. Individuals or organizations applying for a public health permit or license related to medical services.
2. Healthcare providers seeking to comply with California state regulations.
3. Entities involved in the management of health-related facilities that require documentation to operate.

Video instructions and help with filling out and completing immunization record history

Instructions and Help about immunization record history 2017-2025

Welcome to step two of the immunization reporting process in this step you will be assessing the immunization records for all the kids enrolled in your facility to do this you'll need your transparent overlays the primary review table and photocopies of your completed CIS forms since the overlays are age specific start by organizing your CIS forms by age let's assess a record together we'll start by determining elves remember we need to know his age as of the first reporting deadline next we'll place the appropriate overlay onto his CIS form we want to see dates in all those shaded boxes good news ALF is up to date now we can note this on his CIS form but what happens if there are shaded boxes without dates one possibility is that the child may have an exemption to a particular vaccine look on the back of the CIS form for these exemptions a non-medical exemption is valid when the back of the CIS form is signed and dated by the parent and the parent has given you a vaccine education certificate of completion if both of these criteria are met Marc ME for non-medical exemption in the corresponding empty boxes if the child is either up to date or has valid exemptions for all required vaccines then note that on the CIS form but what if there are still empty boxes this looks like a job for the primary review table here's how to use the table start by finding the vaccine in question then look for the number of doses the child already has now read each statement in order in that section until you find the first true statement then check if the shot is required if it is mark the empty box incomplete if there are any in completes on the CIS form you'll mark I and C at the top if the primary review table indicates that a shot is not required leave yourself a note that the child is up to date for that vaccine now repeat this process for each child's record once you've finished assessing you'll have all the data you need to fill out the first report so count up how many CIS forms are marked up to date how many are up to date with non-medical exemptions and how many are incomplete with and without non-medical exemptions every CIS form should fall into one of these four categories thank you for your work

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How do I transfer my out of state immunization records to Florida?

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What is CA CDPH 8608P IMM-542P?

CA CDPH 8608P IMM-542P is a form used in California for reporting immunization records and related data to the California Department of Public Health.

Who is required to file CA CDPH 8608P IMM-542P?

Health care providers, facilities, and schools that administer vaccinations and hold immunization records are required to file CA CDPH 8608P IMM-542P.

How to fill out CA CDPH 8608P IMM-542P?

To fill out the CA CDPH 8608P IMM-542P, individuals must enter patient information, vaccination details, and the signature of the authorized provider.

What is the purpose of CA CDPH 8608P IMM-542P?

The purpose of CA CDPH 8608P IMM-542P is to ensure accurate tracking of immunization records and compliance with public health requirements.

What information must be reported on CA CDPH 8608P IMM-542P?

Information that must be reported includes patient demographics, vaccination details such as type and date of immunization, and provider information.