CA CDPH 8608P IMM-542P 2017-2025 free printable template
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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...
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How to fill out CA CDPH 8608P IMM-542P
01
Begin by downloading the CA CDPH 8608P IMM-542P form from the California Department of Public Health website.
02
Read the instructions carefully to understand the purpose of the form and required information.
03
Fill out your personal information including name, address, and contact details in the designated sections.
04
Provide accurate details regarding the type of service for which you are applying, including the applicable codes.
05
Complete any additional sections as required, such as medical history or declarations.
06
Review all the information for accuracy and completeness.
07
Sign and date the form, confirming that the information provided is true.
08
Submit the completed form as per the submission guidelines provided in the instructions.
Who needs CA CDPH 8608P IMM-542P?
01
Individuals or organizations applying for a public health permit or license related to medical services.
02
Healthcare providers seeking to comply with California state regulations.
03
Entities involved in the management of health-related facilities that require documentation to operate.
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People Also Ask about california immunization record history form
What is the SF 601 immunization record?
The SF 601 contains specified blocks for various immunizations, such as yellow fever vaccine, typhoid vaccine, and influenza vaccine. Preparing and Maintaining SF 601 An immunization record is prepared and main- tained for each person with an HREC. Information on the SF 601 is recorded in designated blocks.
What is the past history of vaccines?
Dr Edward Jenner created the world's first successful vaccine. He found out that people infected with cowpox were immune to smallpox. In May 1796, English physician Edward Jenner expands on this discovery and inoculates 8-year-old James Phipps with matter collected from a cowpox sore on the hand of a milkmaid.
What is immunization history?
Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.
Does Florida have a state immunization registry?
The Florida SHOTS™ (State Health Online Tracking System) is a free, statewide, centralized online immunization registry that assists health care providers, schools, and parents with keeping track of immunization records.
Is hepatitis B vaccine for life?
Most people who are vaccinated with hepatitis B vaccine are immune for life.
How do I transfer my out of state immunization records to Florida?
Transferring Immunization Records from Another State to Florida. The Florida Certification of Immunization, also known as the “Blue Card” or “DH 680 form,” is required for each child entering a Florida school for the first time. This form must be completed by a physician or a Florida county health department.
How long does Hep B vaccine last?
How long does protection from hepatitis B vaccine last? Studies indicate that immunologic memory remains intact for at least 30 years among healthy people who initiated hepatitis B vaccination at less than 6 months of age (15).
How often do you need to be vaccinated for hepatitis B?
Adults. All adults aged 19 through 59 years, and 60 years and older with risk factors for hepatitis B should get the hepatitis B vaccine. The vaccine is given in 3 doses. The second dose is given 1 month after the first dose, followed by a third dose 6 months after the second dose.
What is Tdap vaccine called?
Tdap (Adacel® and Boostrix®) provides protection against tetanus, diphtheria, and whooping cough.
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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.
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