immunization requirements for child care
TRANSCRIPT
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Office of Immunization
IMMUNIZATION REQUIREMENTSFOR CHILD CARE
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October 2021
Katherine Graff BSN, RN
School and Child Care Immunization Nurse Consultant
Office of Immunization
Immunization Requirements for Child Care
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Washington State Department of Health | 3
▪ Immunization Laws and Rules
▪ Vaccinations During COVID-19
▪ Immunization Requirements▪ Hib and PCV
▪ DTaP and Tdap
▪ Certificate of Immunization Status (CIS) Versions
▪ Conditional Status Attendance
▪ Certificate of Exemption (COE)
▪ Annual Immunization Status Report
▪ Resources
Today’s Presentation
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IMMUNIZATION LAW AND RULES
RCW & WAC
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Washington State Department of Health | 5
WA State Legislature passes legislation which is signed into law by the Governor
28A.210 RCW--Health - screening and requirements:
• 28A.210.060—through 28A.210.170
Revised Code of Washington (RCW)
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Washington State Department of Health | 6
The immunization laws give the WA State Board of Health the authority to determine the immunization rules
246-105 WAC Immunization of childcare and school children against certain vaccine-preventable diseases
• 246-105-010 - through 246-105-090
Washington Administrative Code (WAC)
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Washington State Department of Health | 7
ACIP Recommended WA State RequiredHepatitis BDTaPTdapIPVMMRVaricellaPCVHibHepatitis AHPVMeningococcalFluRotavirusCOVID-19 (age 12+)
Hepatitis BDTaPTdapIPVMMRVaricellaPCV (preschool/childcare)Hib (preschool/childcare)
Recommended vs. Required
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Washington State Department of Health | 8
The School and Child Care Immunization page: has links to the RCWs and WACs:
www.doh.wa.gov/SCCI
Links to the RCW and WAC
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IMMUNIZATION RATES AND COVID-19
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Washington State Department of Health | 10
Decline in Vaccines Administered
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IMMUNIZATION REQUIREMENTS CHARTS
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Washington State Department of Health | 12
Vaccines Required forPreschool/Child Care 2021-2022
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Washington State Department of Health | 13
Vaccines Required forPreschool/Child Care 2021-2022
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Washington State Department of Health | 14
Vaccines Required forPreschool/Child Care 2021-2022
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Washington State Department of Health | 15
Vaccines Required forPreschool/Child Care 2021-2022 Spanish
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Washington State Department of Health | 16
Vaccines Required forK-12 School 2021-2022
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Washington State Department of Health | 17
Vaccines Required forK-12 School 2021-2022
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Available on our website:
www.doh.wa.gov/SCCI
IVRS: Individual
Vaccine
Requirements
Summary
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Washington State Department of Health | 19
Number of doses needed depends on which vaccine (for Hib) is used and the age of the child when the vaccine was administered
o In some situations, only 1 dose is needed
Not routinely given to children 5 years and older unless they have certain medical conditions
HAEMOPHILUS INFLUENZAE TYPE B (Hib)and PNEUMOCOCCAL CONJUGATE (PCV)
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Available on our website:
www.doh.wa.gov/SCCI
IVRS: Hib Chart
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Available on our website:
www.doh.wa.gov/SCCI
IVRS: Hib Chart
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Available on our website:
www.doh.wa.gov/SCCI
IVRS: PCV Chart
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Washington State Department of Health | 23
DTaP age 0- 6 years Tdap age 7+years
• Contains more vaccine than Tdap
• Licensed for children though age 6 years
• Is not licensed to be given to children after they turn 7
• If primary DTaP series is incomplete, Tdap and Td are used to complete the series, Tdap must be included
• Tdap booster recommended for all at age 11
Diphtheria, Tetanus and Pertussis
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CERTIFICATE OF IMMUNIZATION STATUS (CIS)
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Washington State Department of Health | 25
A child care provider must have a new medically verified CIS form each year the child is in child care.
Medical Verification for Accuracy:
• CIS printed from the WA Immunization Information System (IIS). o A CIS printed from the IIS is medically verified by the IIS. No additional
parent or health care provider signature is needed to verify the accuracy of the information.
■ Validated CIS
■ CIS printed from MyIR
• Hardcopy Certificate of Immunization Status (CIS) completed by hand:o Verified as accurate with a health care provider signature. OR
o Verified as accurate by a school nurse, administrator, child care health consultant or their designee after comparing the information on the CIS with attached medical vaccination records
Only the hardcopy CIS needs to be medically verified by signature.
CIS Medical Verification
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VALIDATED CIS
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Washington State Department of Health | 27
Validated CIS
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Washington State Department of Health | 28
Validation is:
• Complete
• Not Complete
• Conditional
Validated CIS
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Washington State Department of Health | 29
Validation is:
• Complete
• Not Complete
• Conditional
For series selected
• Age for Child Care
• Preschool
• Grade K-6
• Grade 7-8
• Grade 9-12
Validated CIS
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Washington State Department of Health | 30
Shows date CIS was printed and validated
No provider or parent validation signature is needed
Validated CIS
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Washington State Department of Health | 31
Place for parent/guardian to give permission to add info to the IIS
Needed if using the IIS School Module IF info is missing in the IIS
Signature is optional
Validated CIS
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Washington State Department of Health | 32
Place for parent/guardian to acknowledge child’s conditional status entry
Signature is required if the child will be attending in conditional status
Validated CIS
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Washington State Department of Health | 33
Immunity:
Lab evidence of immunity entered in the IIS will display on the Positive Titer column.
This is considered provider verification of immunity.
Validated CIS
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Washington State Department of Health | 34
History of Chickenpox Disease:
Checks the box on Varicella line if history of chickenpox disease is entered in the IIS.
This is considered provider verification.
Validated CIS
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Washington State Department of Health | 35
Validated CIS – Page 2 Action Report
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Washington State Department of Health | 36
Lists:
• Missing required vaccinations
Validated CIS – Page 2 Action Report
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Washington State Department of Health | 37
Lists:
• Recommended but not required vaccinations
Validated CIS – Page 2 Action Report
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Washington State Department of Health | 38
Lists:
• Invalid doses with reason invalid
• Invalid doses not print on the CIS page 1
• If a repeat dose is needed it will be in the required or recommended boxes
Validated CIS – Page 2 Action Report
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MYIR CIS
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Washington State Department of Health | 40
Currently using the previous version of the WAIIS CIS.
Can still accept this as a valid medically verified CIS form
Prints valid and invalid dates. Check date for age and interval
MyIR CIS
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Washington State Department of Health | 41
History of Chickenpox Disease:
Checks the box in section 1 of chickenpox disease section if history of chickenpox disease is entered in the IIS.
This is considered provider verification.
MyIR CIS
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Washington State Department of Health | 42
Parents can register to use MyIR to view immunization records and print a CIS:
How to Register
• Consumers can self-register: https://myirmobile.com/, or
• Contact our office for help with registration, a release form is required: [email protected]
Flyer for parents:
• https://www.doh.wa.gov/Portals/1/Documents/Pubs/348-519-WA-MyIR-card.pdf
• Order by sending an email to: [email protected]
MyIR CIS
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HARDCOPY CIS
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Washington State Department of Health | 44
Hardcopy CIS
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Washington State Department of Health | 45
Hardcopy CIS
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Washington State Department of Health | 46
Hardcopy CIS
Must be medically verified for accuracy by:
• A health care provider • Licensed, certified or registered in a profession listed in RCW 18.130.040(2), if
administering vaccinations is within the profession's scope of practice. • If signed by a health care provider, no medical immunization records need to be
attached to the CIS.OR• A school nurse, administrator, child care health consultant or their designee.
• Before signing they must determine the information on the CIS is accurate after comparing it with the attached medical vaccination records.
• If not signed by a health care provider must have medical vaccination records attached before they can be turned in to the school or child care.
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Washington State Department of Health | 47
Medical Vaccination Records Include:o Provider records
o Another state registry: https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fprograms%2Fiis%2Fcontacts-registry-staff.html
o Lifetime Immunization record completed by provider
More examples in the Acceptable Versions of a Certificate of Immunization Status (PDF)
Medical Vaccination Records
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Medically Verified Immunization Records
Immunization Record printed from a healthcare provider, clinic or hospital’s Electronic Health Record
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Washington State Department of Health | 49
Medical Vaccination Records Include:o Provider records
o Another state registry: https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fprograms%2Fiis%2Fcontacts-registry-staff.html
o Lifetime Immunization record completed by provider
More examples in the Acceptable Versions of a Certificate of Immunization Status (PDF)
Medical Vaccination Records
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Medically Verified Immunization Records
Immunization Record printed from the WA IIS or the IIS of another state
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Washington State Department of Health | 51
Medical Vaccination Records Include:o Provider records
o Another state registry: https://www.cdc.gov/vaccines/programs/iis/contacts-locate-records.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fvaccines%2Fprograms%2Fiis%2Fcontacts-registry-staff.html
o Lifetime Immunization record completed by provider
More examples in the Acceptable Versions of a Certificate of Immunization Status (PDF)
Medical Vaccination Records
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Medically Verified Immunization Records
Official lifetime immunization record from WA or another state with a unique healthcare provider or clinic stamp, or another form of written healthcare provider documentation, such as a provider signature.
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Washington State Department of Health | 53
Hardcopy CIS
Has a place for provider to• Verify history of chickenpox
disease• Verify lab evidence of
immunity
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Washington State Department of Health | 54
Hardcopy CIS
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Washington State Department of Health | 55
Hardcopy CIS
Cat Sparky M 02/01/2019
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Washington State Department of Health | 56
Hardcopy CIS
Cat Sparky M 02/01/2019
4/1/19 6/1/19 8/1/19 8/1/20
2/1/19 4/1/19 8/1/194/1/19 6/1/19 2/1/204/1/19 6/1/19 8/1/19
2/1/203/1/21
2/1/20
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Washington State Department of Health | 57
Hardcopy CIS
Cat Sparky M 02/01/2019
4/1/19 6/1/19 8/1/19 8/1/20
2/1/19 4/1/19 8/1/194/1/19 6/1/19 2/1/204/1/19 6/1/19 8/1/19
2/1/203/1/21
2/1/20
Katherine Graff Katherine Graff 9/1/21
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Medically Verified Immunization Records
Attached Immunization Record printed from a healthcare provider, clinic or hospital’s Electronic Health Record
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Washington State Department of Health | 59
Hardcopy CIS
Cat Sparky M 02/01/2019
4/1/19 6/1/19 8/1/19 8/1/20
2/1/19 4/1/19 8/1/194/1/19 6/1/19 2/1/204/1/19 6/1/19 8/1/19
2/1/203/1/21
2/1/20
Katherine Graff Katherine Graff 9/1/21
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Washington State Department of Health | 60
Hardcopy CIS
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CONDITIONAL STATUS
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Washington State Department of Health | 62
New WAC language clarifies “Conditional Status”
In the past:
• Parents/Guardians had 30 days from 1st day of attendance to turn in their child’s immunization documentation.
Starting 08/01/2020:
• Immunization documentation must be turned in before the can start child care or school.
• There is no longer an automatic 30-day conditional period from the first day.
• Children must have all vaccinations they are eligible to receive on or before the first day of attendance
Conditional Status
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Washington State Department of Health | 63
A 19 month old child with history of chickenpox disease entering child care has all of their infant vaccinations but is missing their age 12 month and older vaccines
• they must get the missing DTaP, MMR, varicella, Hib and PCV13 before starting child care.
All of the Doses - Examples
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Washington State Department of Health | 64
Lists:
• Missing required vaccinations
Validated CIS – Page 2 Action Report
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Washington State Department of Health | 65
If more doses needed after having all the doses they are eligible to receive:
• Child can attend child care in “Conditional Status”
• Parent/guardian must acknowledge conditional status entry and timelines on the CIS
Conditional Status
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Washington State Department of Health | 66
A 3 year old child starting child care only has 1 dose of Hepatitis B vaccine. Dose 1 was administered one day before starting child care:
• They can start in conditional status until the dose 2 recommended date plus an additional 30 days in which to get the dose.
Conditional Status - Example
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Validated CIS
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Lists:
• Missing required vaccinations
Validated CIS – Page 2 Action Report
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Student stays in child care until next dose is due.
Dates follow the recommended dates of the ACIP Catch-Up Schedules.
Conditional Status
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Validated CIS
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Parent has 30 days from due date to turn in paperwork.
Conditional Status continues until all of the series are complete.
Conditional Status
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If the 30 days expires without documentation of immunization or an exemption the child is out of compliance
Children out of compliance must be excluded. RCW 28A.210.120
Conditional Status
X
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EXEMPTIONS FROM THE SCHOOL AND CHILDCARE IMMUNIZATION REQUIREMENTS
AND THE CERTIFICATE OF EXEMPTION (COE)
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A child may be exempted from one or more required immunizations, RCW 28A.210.090.
To request an exemption, a parent/guardian must turn in a completed and signed Certificate of Exemption (COE) to the school or childcare.
The COE is created by the Department of Health.
It can be downloaded from this website: https://www.doh.wa.gov/SCCI
Certificate of Exemption (COE)
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• Personal or philosophical exemption • not allowed for measles, mumps or rubella immunization
requirements
• Religious
• Religious membership
• Medical
Types of Exemptions for Children
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Personal or Philosophical Exemption:
• To be used when the parent/guardian has a personal or philosophical objection to the immunization of the child.
• Cannot be used for the measles, mumps and rubella immunization requirements.
Religious Exemption:
• To be used when the parent/guardian has a religious belief that is contrary to the required immunization.
There is no requirement for a parent to validate or prove their personal or religious beliefs.
Philosophical/Personal and Religious
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Personal or Religious Exemption
Use for parent-requested exemptions or alternate schedules
Needs parent and health care practitioner signatures
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Philosophical/Personal and Religious Exemptions must have the signature of a health care practitioner that he or she
“provided the signator with information about the benefits and risks of immunization to the child.”
Health care practitioner is a physician (MD, DO), Naturopath (ND), Physician Assistant (PA) or Advanced Registered Nurse Practitioner (ARNP) licensed in WA State
RCW28A.210.090
Clinician and child care or school staff have no role in assessing parents’ personal or religious beliefs.
Education Requirement
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To be used when the parent/guardian affirms membership in a church or religious body that does not allow their child to get medical treatment by a health care practitioner.
• No health care practitioner signature is required.
• If the parent or guardian takes their child to see a health care practitioner for things like illness, and injury care they cannot use this exemption. They need to use the Religious or Personal Exemption area of the COE which must have a health care practitioner signature.
Religious Membership Exemption
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Religious Membership Exemption
Parent affirms they belongs to a church or religion that does not allow ANY medical treatment by a health care practitioner
Child Care or school does NOT need to verify the religious beliefs.
Needs parent signature but does not need health care practitioner signature
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Granted by a health care practitioner when in their judgement the vaccine is not advisable for the child.
Guidance about contraindications to vaccination:
• Recommendations of the Advisory Committee on Immunization Practices: www.cdc.gov/vaccines/recs/vac-admin/contraindications.htm
• Vaccine manufacturer’s package insert
Permanent or Temporary:
• Both require health care practitioner and parent/guardian signatures.
• When a temporary exemption ends the child has 30 days to get the vaccine or another exemption.
Medical Exemption
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Medical Exemption Exemption
Indicates for each disease whether the child is not exempt, permanently exempt or temporarily exempt.
If temporarily exempt it must have an expiration date.
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• New form should be used for all NEW exemptions
• Children with existing exemptions DO NOT need to resubmit a new COE
• Incomplete or improperly completed forms should be returned to the parent or HCP to complete
• If an exemption is no longer needed because the child has received the needed immunizations remove the exemption from your tracking system
• Additional exemption information including a fact sheet and FAQs: www.doh.wa.gov/SCCI
Exemption Considerations
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ANNUAL SCHOOL REPORTING
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Childcare centers, preschools and K-2 public/private schools are required to report the immunization status of their students each year; RCW 28A.210.110and WAC 246-105-060 .
Reporting is required for:• Licensed child care center with 13 or more children • Preschool located at a public or private school • Head Start, ECEAP programs
Reporting is optional for:• Licensed family home child care with 12 or fewer children • Private preschools not located at a public or private school • Co-Op preschool
The Department of Health (DOH) collects the reports and processes the data.
OVERVIEW OF IMMUNIZATION REPORTING
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For the 2021-22 school year
• Reporting opens on 11/01/2021
• Reports are due by 12/01/2021
Report in one of the following ways
• School Module
• Complete online survey
IMMUNIZATION REPORTING FOR 2021-22
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Reporting: School Module
A preschool or child care center with an active School Module doesn’t have to report. DOH can pull the report from the module itself
A School Module is considered active if:
• the roster is kept up to date,
• missing immunization dates and exemptions are entered.
More info about the School Module: https://www.doh.wa.gov/SchoolModule
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Reporting: Online Survey
By Nov 1, 2021 DOH will:
• Add the online survey link, training guide and the instructions/worksheet to the preschool/child care reporting website: https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/ChildCareStatusReporting
• Email info to those on Listerv: http://public.govdelivery.com/accounts/WADOH/subscriber/new?preferences=true#tab1
Person reporting:
1. Reviews the Report Training Guide
2. Gathers information needed on the Reporting Instructions/Worksheet
3. Clicks on survey link on the website and completes the survey
4. Check survey for error messages and corrects as needed
5. Submits
6. Receives a confirmation email with a copy of the report submitted
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Resources
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Website:
www.doh.wa.gov/SCCI
Questions?
Feedback!
Email us at:
School and Child Care Immunization Page
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Child Care Immunization Resource Flyer (PDF)
Resources
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http://bit.ly/2HybXYS
1. Sign in with email and name
2. Click Add Subscriptions button
3. Click the + to open Immunization
4. Check School Nurses and/or Childcare and Preschool
5. Click Submit
School and Child Care Listserve
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For persons with disabilities, this document is available in other formats.Please call 711 Washington Relay Service or email [email protected].