Immunization Manual for Schools, Preschools, and Child Care Centers

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Immunization Manual

For Schools, Preschools, and Child Care Centers

Revised August 2024

Washington State Office of Immunization

P.O. Box 47843

Olympia, WA 98504-7843

360-236-3595

1-866-397-0337

oischools@doh.wa.gov

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Acknowledgements

Washington State Department of Health,

Office of Immunization staff:

Jamilia Sherls, DNP, MPH, RN, CPN, CDP

Director, Office of Immunization

Jéaux Rinedahl, RN, PhD

Clinical, Quality, and Schools Section Manager

Meghan Cichy, MPH, RDN, CD

Senior Policy Analyst

Chas DeBolt, RN, MPH

Vaccine-Preventable Disease Epidemiologist

Phillip Wiltzius, MS, CHES

Health Educator

Katherine Graff, RN, BSN

School and Child Care Immunization Nurse Consultant

                                            
                                                                                                      
 
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Table of Contents 
 
Manual Overview ..................................................................................................................................... 4 
Responsibilities......................................................................................................................................... 5 
Immunization Requirements .............................................................................................................. 9 
Vaccine Requirement Charts and Resources ...................................................................... 10 
Immunization Status ................................................................................................................... 11 
Excluding Children Out-of-Compliance with Immunization Requirements ............ 12 
Immunization Records ........................................................................................................................ 14 
Certificate of Immunization Status (CIS) ............................................................................ 14 
Certificate of Exemption (COE) ............................................................................................... 16 
Retaining Records ......................................................................................................................... 17 
Privacy of Immunization Records: HIPAA and FERPA .................................................... 18 
Requirements for Special Situations ............................................................................................. 20 
Required Parental Notification ......................................................................................................... 25 
Washington State Immunization Information System (IIS) ................................................ 26 
Disease Prevention and Control ...................................................................................................... 28 
Vaccines for Staff .................................................................................................................................. 29 
Additional Resources............................................................................................................................ 32 
List of Changes to this Manual ......................................................................................................... 34 
 
   

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2024

Manual Overview

The Immunization Manual for Schools, Preschools, and Child Cares

is a reference guide

for school and child care staff who process Certificate of Immunization Status and

Certificate of Exemption forms, complete immunization status reports, and answer

questions from parents and guardians about immunization requirements for children.

Many of you deal with immunizations every day and are expected to know a lot about

them. This manual will help you.

You can find the manual on the Department of Health’s Office of Immunization and Child

Profile Web site at: https://doh.wa.gov/SCCI. While you may want to print the manual and

place it in a three-ring binder, we suggest you access it electronically to get the most

up-to-date information.

The manual can help you:

• Understand Washington State immunization requirements for children attending

school, preschool, and child care.

• Work successfully with parents, school administrators, and healthcare providers

regarding immunization regulations.

• Answer questions about the immunizations a child needs for school, preschool and

child care.

• Prepare the required school and child care Annual Immunization Status Report.

• Report communicable diseases at your school, preschool, or child care to local public

health officials.

• Work with public health officials during a disease outbreak.

• Find immunization resources.

“Preschools and child cares” in this manual include; preschools and child care centers associated with public and

private schools, Head Start/ECEAP programs, licensed in-home child care, licensed child care centers, and

children’s group homes.

                                            
                                                                                                      
 
                                   
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Responsibilities 
Many organizations and individuals have responsibilities for immunizing children and students in 
Washington State. See below for specific responsibilities. 
Parents/Guardians 
Parents, foster parents, and guardians are responsible for their child meeting immunization 
requirements. Parents should keep accurate and up-to-date immunization records for their 
children. Parents must submit a complete and medically verified Certificate of Immunization 
Status (CIS) to their child’s school, preschool, or child care before the child can attend. See 
WAC 246-105-050 for more information.  
Health Care Providers 
These licensed health care providers can prescribe vaccines:  
•  Medical Doctors (MD) 
•  Doctors of Osteopathy (DO) 
•  Naturopathic Doctors (ND) 
•  Licensed Physician’s Assistants (PA) 
•  Nurse Practitioners (ARNP) with prescriptive authority 
•  Pharmacists (when working with a prescribing physician) 
 
Health care providers are encouraged to immunize patients according to the most current 
Centers for Disease Control (CDC) Advisory Committee on Immunization Practices (ACIP) 
recommended immunization schedules. Health care providers: 
 
•  Educate parents and guardians about communicable diseases and immunizations. This 
includes giving them a current Vaccine Information Statement (VIS) for each vaccine 
administered.  
•  Give information on the benefits and risks of immunization to parents or guardians 
wanting to exempt (excuse) their child from immunization requirements. See the 
Certificate of Exemption (COE) section of this document for more information. 
•  Must provide parents with a written record of immunizations administered, as noted in 
RCW 28A.210.100. Providers can print the Certificate of Immunization Status (CIS) 
with the child’s immunization history if they have access to the Washington State 
Immunization Information System (WAIIS).  
•  May sign a hardcopy CIS to verify that the immunization dates written on the CIS are 
accurate. Other providers such as a nurse, MA, or other profession listed in RCW 
18.130.040(2) may also sign to verify the accuracy of the CIS if administering 
vaccinations is within the profession's scope of practice. 
 
The Health Insurance Portability and Accountability Act (HIPAA) privacy rule permits providers to 
disclose proof of required immunizations to a school with agreement from the parent or 
guardian. The agreement may be obtained orally or in writing and need not be signed or contain 
the other elements required in a formal, written HIPAA authorization. More information about the 
HIPAA Privacy rule and student immunizations can be found at: www.hhs.gov/hipaa/for-
professionals/privacy/guidance/student-immunizations/index.html. 

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School, Preschool, and Child Care Staff

Administrators in these facilities have final responsibility when it comes to immunization

compliance. It is the duty of the administrator, by law, RCW 28A.210.120, to exclude children

from school, preschool, or child care if they do not meet immunization requirements.

Administrators may designate other staff to do immunization compliance tasks, such as

nurses, health assistants, secretaries, or volunteers. Schools, preschools, and child cares

should have policies to protect confidential information such as immunization records.

It is the responsibility of schools, preschools, and child cares to do the following

immunization compliance tasks:

• Ensure Certificate of Immunization Status (CIS) forms are medically verified.

• Have a school administrator, school nurse or their designee who can verify a hardcopy

CIS with attached medical immunization records and sign it to verify its accuracy.

• Review Certificate of Exemption (COE) forms to ensure they are completed correctly.

• Create a filing system for the required CIS and COE forms, such as alphabetizing by

grade level, name, or other system to make it easier to keep the immunization records

up to date.

• Identify students who are missing required immunizations and contact parents for

follow-up to maintain the conditional status timelines.

• Exclude children who do not meet the immunization requirements.

• Identify and keep a list of susceptible students (students with an exemption or missing

doses) to use in the event of a disease outbreak. This list must be transmitted to the local

health department within 24 hours upon request.

• Keep track of staff vaccinations or remind staff that they may need to provide their

immunization records in the event of an outbreak.

• Teach staff and parents about the importance of getting immunized.

• Follow state immunization laws regarding the requirements. Links to the applicable

RCW’s and WACs can be found at https://doh.wa.gov/SCCI.

Local Health Jurisdictions

Some local health jurisdictions (LHJs) administer immunizations. Some give out Certificates

of Immunization Status, other immunization forms, and materials about communicable

disease and immunization rules. Public health officials have the responsibility to work with

schools, preschools, and child cares to prevent and control outbreaks of vaccine preventable

diseases. They also work with health care providers to maintain or improve immunization

rates in their communities. In the event of a disease outbreak, the health officer of the LHJ

has the authority to exclude children and staff from school, preschool or child care. You can

find local health jurisdiction websites and contact information at

https://doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJurisdictions.

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
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State Agencies 
Department of Health 
The Office of Immunization at the Washington State Department of Health tracks 
immunization levels in the state as part of a federal requirement. Staff respond to questions 
about the immunization requirements and are a resource for information about vaccines and 
vaccine-preventable diseases. The office has the responsibility to develop the Certificate of 
Immunization Status and Certificate of Exemption forms and align the ages and vaccination 
intervals specified in the national immunization guidelines with corresponding grade levels. 
They also have the responsibility to collect the immunization status of children attending 
school or child care in the annual immunization report. Public health staff may review school, 
preschool, and child care facility immunization records to ensure they comply with state 
regulations, per RCW 28A.210.110.  
 
State Board of Health 
The State Board of Health has the authority to write the immunization rules in the Washington 
Administrative Code. These rules include the immunizations children must have in order to enter 
school, preschool or child care, procedures for complying with a schedule to achieve full 
immunization, and the documentation required for proof of immunization. See RCW 28A.210.140 
for more information. 
 
State Board of Education 
The State Board of Education has the authority to establish the rules governing the exclusion of 
students from private schools for failure to comply with the immunization requirements. See 
Chapter 180-38 WAC for more information. 
 
Department of Children, Youth and Families 
The Department of Early Learning has the authority to establish rules governing the exclusion 
of children from child care for failure to comply with the immunization requirements. They 
enforce immunization rules for licensed preschools and child cares. See Chapter 110-300 
WAC for more information. 
 
Office of the Superintendent of Public Instruction 
The Office of the Superintendent of Public Instruction (OSPI), in consultation with the State 
Board of Health, has the authority to establish the rules governing the exclusion of students 
from public schools for failure to comply with the immunization requirements. See WAC 392-380-
050 for more information.  
They also: 
 
•  Provide information to public schools about immunization requirements and how to 
properly contain contagious diseases at schools.  
•  Adopt rules regarding immunization records of transferring students. See WAC 392-
182-020 for more information. 
•  Consult with the Department of Health (DOH) to prepare information for schools to 
comply with the law. For example, OSPI consults with DOH for information on 
meningococcal and human papillomavirus. Schools are required by law to send this 
information to parents or guardians. 
•  Consult with school districts on immunization issues.  
 
 

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The network of partners involved in childhood immunization is shown below.

Child/Student

gets immunized

Parents/Guardians must:

▪ Comply with immunization

regulations.

Healthcare Providers must:

▪ Administer vaccines according to the Recommended

Immunization Schedules

▪ Provide a record of administered vaccines.

Administrators of

Schools, Preschools,

and Child Cares must:

▪ Check compliance

and exclude non-

compliant children

and students.

Staff at Schools,

Preschools, and Child

Cares must:

▪ Communicate

required

immunization

information to

parents.

▪ Collect and assess

immunization

information.

▪ Follow-up with

parents if needed.

▪ File Certificates of

Immunization

Status.

▪ Complete annual

status report.

Local Health Jurisdictions

may:

▪ Administer vaccines.

▪ Distribute Certificates of

Immunization Status and

other immunization

information.

▪ Prevent, investigate, and

contain disease outbreaks.

State Agencies

Department of Health

must:

▪ Create immunization

forms and requirement

charts.

▪ Collect annual status

reports.

▪ Act as a resource for

immunization

information.

State Board of Health

must:

Adopt state rules for

immunization

requirements.

Department of Children,

Youth and Families

must:

▪ Develop regulations for

exclusion of children in

Child Care.

Office of the

Superintendent of

Public Instruction must:

▪ Provide information

about the requirements

▪ Develop regulations for

immunization record

transfer and exclusion of

students in public

school.

State Board of

Education must:

▪ Develop regulations for

exclusion of students in

private school.

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Immunization Requirements

School, preschool, and child care staff can help to protect children against serious diseases

by encouraging full and timely immunization. Help parents understand that:

• Each child must have a record of their immunizations on a medically verified

Certificate of Immunization Status (CIS) or have a completed Certificate of

Exemption on file for each of the diseases for which full immunization is required.

• Immunizing on time gives children the best protection.

• Immunization requirements in schools, preschools, and child cares have been shown

to increase immunization coverage.

• Communicable diseases still exist, and international travel can bring diseases

common in other parts of the world to our communities.

• Keeping up-to-date records at home and at school is important.

• All children under the age of 19 can get immunizations at no cost in our state from

clinics participating in the Childhood Vaccine Program (CVP) program. Providers may

charge an administration fee, but they must waive the fee if asked by the parent.

Find CVP clinics by using this vaccine map at

https://fortress.wa.gov/doh/vaccinemap.

Recommended Versus Required Immunizations

Not all of the immunizations recommended for children are required for school or child care entry

in Washington. These definitions can help:

• Recommendations: The Centers for Disease Control and Prevention (CDC) Advisory

Committee on Immunization Practices (ACIP) makes vaccine recommendations that

providers follow as the “best practice” to get the best protection from vaccine preventable

diseases. The ACIP updates the recommended immunization schedule annually.

• Requirements: State law requires children to have documentation of full immunity to

certain diseases to enter school, preschool, and child care, RCW 28A.210.080.

o The law directs the State Board of Health (SBOH) to determine which diseases

children must have immunity against. The SBOH writes the rules in the

Washington Administrative Code (WAC). The rule says a child documenting

immunity though vaccination must be vaccinated according to the ages and

vaccine intervals set forth in the ACIP recommended immunization schedule

published in a specific year. The WAC may not always reference the most recently

published ACIP schedule. See Chapter 246-105 WAC for the currently referenced

schedule.

o The SBOH directs the State Department of Health to align the ages and

intervals specified in the ACIP schedule with corresponding school grade levels.

Required Immunizations

According to the Washington Administrative Code WAC 246-105-030, any child attending

school, preschool, or child care in Washington State is required by law to be fully immunized

against the following diseases:

Chickenpox (Varicella)

Mumps

Diphtheria

Pneumococcal disease*

German measles (Rubella)

Polio (Poliomyelitis)

Haemophilus influenzae type b disease (Hib)*

Tetanus

Hepatitis B

Whooping cough (Pertussis)

Measles (Rubeola)

*Required only until 5 years of age

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Vaccine Requirement Charts and Resources

The Washington State vaccine requirements charts, and the Individual Vaccine Requirements

Summary (IVRS) are updated each school year and are available at https://doh.wa.gov/SCCI.

To document immunity by vaccination, children must have the vaccine doses required in the

applicable school or child care chart. The vaccine doses must be given at the appropriate ages

and intervals. Documentation of vaccination given to schools or child care centers must be

medically verified.

• Vaccines Requirement Charts for School Attendance, Grades Preschool-12

There are vaccine requirement charts for school attendance in grades Preschool-12. There is

an English and Spanish version for school staff, and parent versions in multiple languages.

• To find the doses required in the chart, look at the row that includes the student’s

grade and match it with the column for the required vaccine. For example, a student

entering Kindergarten needs two doses of MMR vaccine. The requirements and rules

vary depending on the student’s grade and for preschool/TK the age of the child on

September 1st.

• Vaccines Required Charts for Child Care Attendance

There are vaccine requirement charts for child care. There is an English and Spanish version

for staff, and parent versions in multiple languages.

• To read the chart, find the child’s age range and follow the row across to find the

number of vaccine doses required by that age. For example, if a child is 6 ½ months

old (not yet 7 months old), look at the row “By 5 months”. A 6 ½ month old child

needs a total of 2 doses of DTaP vaccine. By the time the child reaches 7 months,

they will need 3 total doses.

• Individual Vaccine Requirements Summary (IVRS)

The Individual Vaccine Requirements Summary (IVRS) is a companion to the vaccine

requirement charts. It provides detailed information about the number of doses needed, the

minimum age and intervals of the doses, exceptions to these rules, and the catch-up

schedules.

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Immunization Status  
Definitions can be found in WAC 246-105-020. 
•  Complete or Fully Immunized 
Children have an immunization status of “complete” if they have documentation of full 
immunity against each of the vaccine–preventable diseases listed in WAC 246-105-030. 
Immunity can be documented in the following ways: 
•  By having the vaccination doses required for the child’s age (child care) or grade 
(preschool-12
th
) administered at the appropriate ages and intervals as described in WAC 
246-105-040; or 
•  By blood antibody titer levels sufficient to document immunity confirmed by a health 
care provider acting within their scope of practice (immunity by antibody titer is not 
acceptable for pertussis or pneumococcal diseases, immunity to polio disease by 
antibody titer must demonstrate immunity to all 3 polioviruses); or 
•  For varicella (chickenpox) only: history of disease verified by a health care provider 
acting within their scope of practice.  
•  Conditional  
Children who are actively catching up on their vaccines can start and remain in school with 
a “conditional” immunization status. Vaccine series doses are spread out among minimum 
intervals, so some children may have to wait a period of time before finishing their 
vaccinations. To attend school or child care in Conditional Status the following conditions 
must be met (WAC 246-105-050): 
•  The parent/guardian must sign the conditional status statement on the Certificate 
of Immunization Status form. The parent acknowledges their child is attending 
school or child care in conditional status with the associated timelines.  
•  Children must be up to date on their immunizations, having received all of the 
vaccine doses they are eligible to receive before they can start school or child care.  
•  When the next catch-up vaccine dose comes due, the parent or guardian must turn 
in documentation within 30 days of the vaccination due date.  Valid documentation 
includes medical records showing vaccination, evidence of immunity to the 
disease/s , or a completed Certificate of Exemption (COE) form.  
 
After a child has caught up on all missing required immunizations, their “conditional” status 
changes to “complete.” If documentation is not received by the required date then the 
“conditional” status changes to “out of compliance” and the child must, by law, be excluded 
from further attendance, as listed in RCW 28A.210.120.  
More information about conditional status can be found in Frequently Asked Questions 
about Conditional Status on https://doh.wa.gov/SCCI.  
•  Exempt 
Children have an immunization status of “exempt” if they: 
•  Have a completed Certificate of Exemption form on file for any one or more of 
the required immunizations, and 
•  Are not out of compliance for any other of the immunization requirements. 
A child may be exempted from the immunization requirements for medical, 
personal/philosophical, or religious reasons. Personal/philosophical exemptions may 
not be used to exempt a student from the measles, mumps, and rubella 
immunization requirements. For more information about exemptions, please see the 
Certificate of Exemption section in this document. 
 

                                            Immunization Manual for Schools, 
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•  Out of Compliance 
Children have an immunization status of “out of compliance” if they:  
•  Are not fully immunized as required for their age (child care) or grade (preschool-
12
th
 grades) against each of the vaccine–preventable diseases listed in WAC 
246-105-030, and 
•  Are not in a temporary conditional status for the missing required 
immunization, and 
•  Do not have a Certificate of Exemption on file for the missing required 
immunization. 
 
With the exception of students considered homeless or in foster care (see Requirements 
for Special Situations), any child with a status of “out of compliance” must, by law, be 
excluded from attending school, preschool, or child care until they come into compliance 
with the immunization requirements. See RCW 28A.210.120 for details on the law. 
 
Excluding Children Out-of-Compliance with Immunization 
Requirements 
By law, RCW 28A.210.120, it is the duty of the administrator of every public and private 
school and day care center to exclude children who are out of compliance with the 
immunization requirements. Administrators must continue to prohibit the child's presence 
until documentation of immunization, a certification of exemption, or documentation of 
initiation of a schedule towards full immunization has been provided. 
  
School or child care staff must follow these rules when excluding a child: 
 
Public Schools WAC 392-380-050   
Schools must provide written notice to parents, in a language the parents understand, prior 
to excluding students from school for failure to comply with WAC 392-380-045. The written 
notice may be delivered in person, mail, or by email.  
It must include: 
•  The school's decision to exclude the student from school, effective immediately upon the 
parents' receipt of the notice.  
•  The duration and conditions of the exclusion including that the exclusion will continue 
until the school receives necessary proof of immunization in accordance with RCW 
28A.210.080 
•  Information about, and a copy of, the applicable laws and rules.  
•  Information regarding immunization services available through the local health 
department and other public agencies. 
•  Describe the rights of the parents and student to a hearing and describe the hearing 
process. See WAC 392-380-080 for more information. 
Private Schools WAC 180-38-050 
Private schools must provide written notice to parents prior to excluding students from school 
for failure to comply with WAC 180-38-045. The written notice must include: 
•  Information about and a copy of the applicable laws and implementing rules. 
•  Information regarding immunization services that are available through the local health 
department or other public agencies. 
•  Order the exclusion of the student from school and state that such order is effective upon 
receipt of the notice. 

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Child Care Chapter 110-300 WAC

The exclusion of a child from a day care center shall be accomplished in accordance with

rules of the Department of Children, Youth and Families.

Sample Letters

Staff can find sample exclusion letters on the Department of Health webpage.

www.doh.wa.gov/SCCI. The sample letters include:

• Notice of Child’s Conditional Immunization Status (Public & Private Schools)

• Notice of Exclusion for Immunization Noncompliance (Public Schools)

• Notice of Exclusion for Immunization Noncompliance (Private Schools)

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Immunization Records

Certificate of Immunization Status (CIS)

Before a child may attend a school or child care center, a parent must provide proof of the required

immunizations on a department-approved Certificate of Immunization Status (CIS) form, WAC 246-

105-050. School, preschool, and child care staff must review the immunizations listed on the CIS and

determine if the child has met the immunization requirements.

A new CIS must be submitted annually for continued enrollment in a child care center. Child care

administrators will determine when their annual immunization documents are due from

parents/guardians each year.

In lieu of a CIS, a school or child care center using the WAIIS School Module may accept verification

by school staff that the child is fully immunized as recorded in the WAIIS.

A department approved CIS means:

• A hardcopy CIS form, or

• A CIS produced from the WA Immunization Information System which is either:

o A validated CIS printed from the Washington State Immunization Information System,

o A CIS printed from MyIR

The hardcopy CIS, available in several languages, and instructions on how to print a CIS from the

Immunization Information System, is available on www.doh.wa.gov/SCCI.

An unapproved or alternate certificate is not acceptable. A CIS printed from a health care provider’s

electronic health record system is not approved or acceptable.

The CIS must be filled out completely and include:

• Name of child or student

• Birth date of child or student

• Type of vaccine(s) received

• Month, day, and year of each dose of vaccine received

For all children starting at a new child care center, school district or private school

after August 1, 2020, the CIS must be medically verified for accuracy by one of the

following methods:

• Print a CIS from the WA Immunization Information System (IIS) which contains only

medically verified vaccination dates. A CIS printed from the IIS does not require a health

care provider signature. A CIS printed from the IIS can be:

o The Validated CIS; or

o The CIS printed from MyIR

• Verify a hardcopy CIS as accurate by signature. The signature can be from:

o A health care provider signature certifying the vaccination information on the CIS

accurate. The health care provider must be licensed as a doctor, a nurse, or other

profession listed in RCW 18.130.040(2) and administering vaccinations is in their

profession’s scope of practice.; or

o A school nurse or their designee, child care health consultant or their designee, or

the chief administrator of the school or child care. They must review the CIS and

attached medical immunization records and sign and date the CIS to certify the

vaccination dates on the CIS are accurate.

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How Parents and Guardians Can Get Help with a Certificate of 
Immunization Status (CIS) 
The law requires parents/guardians to submit a completed CIS to document their child’s immunity. 
Here are some ways parents/guardians can get help completing a CIS: 
 
•  Ask if the health care provider, school, or Head Start/ECEAP program can print a validated CIS 
from the Washington State Immunization Information System (IIS) with the child’s 
immunizations already filled in. For more information, see the Immunization Information System 
section of this manual. 
•  Sign up with MyIR which allows parents to view and print their child’s immunizations online. MyIR 
prints pre-populated CIS forms which are valid for school or child care entry. 
•  Get a printed vaccination record from the provider and ask for help to fill out the CIS by hand. 
•  Some schools may choose to help parents fill out the CIS using medical vaccination records. 
 
Note: it is not acceptable to attach a medical vaccination record to a blank CIS. The CIS must be 
filled out with the dates of vaccination. 
 
Making Changes to an Existing Certificate of Immunization Status (CIS) 
School, preschool, and child care staff can update an existing CIS by: 
o  Receiving updated medical vaccination records. If staff get an updated medical 
vaccination record (such as Tdap immunization required for 7
th
 grade) that needs to be 
added to the CIS, staff can add the vaccination date and initial the change. The medical 
vaccination record should be attached to the CIS.  
o  Viewing the WA Immunization Information System. If staff find additional vaccination 
dates in the Immunization Information System (IIS), they can add the vaccination dates to 
the CIS, initial the change, and note that the information came from the IIS. Alternately, 
they can print a new CIS from the IIS. 
 
Parent approval is not required for staff to update a CIS or a student information system with 
additional immunizations from the IIS or another immunization record. 
Certificate of Immunization Status (CIS) Resources 
 
•  Print a blank CIS. The blank CIS is available in English, Spanish, and several other languages: 
www.doh.wa.gov/SCCI and www.doh.wa.gov/vaxtoschool. 
 
•  Print a Validated CIS with preprinted immunization dates from the Immunization 
Information System. 
English only instructions:  
www.doh.wa.gov/Portals/1/Documents/Pubs/348-389-CIS-PrintingInstructions.pdf  
 
•  Sign up for MyIR. Parents and guardians can view their children’s immunizations online and 
print a pre-populated CIS. Access your Family's Immunization Information | Washington State 
Department of Health  
 
•  Frequently Asked Questions and other resources: available in the Certificate of 
Immunization Status (CIS) section of the webpage www.doh.wa.gov/SCCI.  
 
 

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Certificate of Exemption (COE)

A child may be exempted from one or more required immunizations, RCW 28A.210.090.

To request an exemption, a parent/guardian must complete and sign the applicable section of the

WA Certificate of Exemption (COE). An unapproved or alternate certificate is not acceptable. A COE

printed from an electronic health record system, or another state is not approved or acceptable.

With the exception of a Religious Membership exemption, all COE forms presented on or after July

22, 2011 must be signed by a health care practitioner (HCP) saying they have given the parent or

guardian information about the benefits and risks of immunizations. A healthcare practitioner is

defined as a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), Naturopathic Doctor

(ND), Physician Assistant (PA), or Advanced Registered Nurse Practitioner (ARNP) licensed in

Washington State. The form may be signed by the HCP at any time prior to the enrollment of the

child. Photocopies of the signed form or a letter from the HCP referencing the child's name can be

accepted in lieu of the original form. Such a letter should be attached to the COE signed by the

parent or legal guardian. A health care practitioner who, in good faith, signs the statement that

they have provided the parent with information about the benefits and risks of immunization for

the child is immune from civil liability for providing their signature. See RCW 28A.210.090 and

WAC 246-105-020 for more information.

Only one type of exemption is allowed per disease immunization requirement. If a parent or guardian

turns in an improperly filled out COE form, return it to the parent or guardian and let them know a

properly completed COE is needed for the exemption to be valid.

If a child with a COE subsequently receives a dose of vaccine for which they were exempt and more

doses are needed to complete the series, school, preschool or child care staff should contact the

parent or guardian to determine if an exemption is no longer needed.

If a child with an exemption has received all of the doses of a vaccine needed to document full

immunity, see definitions of immunization status on page 11, staff should remove the exemption that

is no longer needed from their immunization tracking system.

There are four different types of exemptions:

Medical Exemption: A health care practitioner may grant a medical exemption to a vaccine

required by rule of the state board of health if, in his or her judgment, the vaccine is not advisable

for the child. When it is determined that this particular vaccine is no longer contraindicated, the child

will be required to have the vaccine (RCW 28A.210.090). Providers can find guidance on medical

exemptions by reviewing Advisory Committee on Immunization Practices (ACIP) recommendations

via the Centers for Disease Control and Prevention publication, “Guide to Vaccine Contraindications

and Precautions,” or the manufacturer’s package insert. The ACIP guide can be found at

https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/contraindications.html. Medical

exemptions may be permanent or temporary.

• Permanent medical exemption: To be used when a health care practitioner determines

that the vaccine is not advisable for the child on a permanent basis.

• Temporary medical exemption: To be used when a health care practitioner determines

that the vaccine is not advisable for the child on a temporary basis. Healthcare

practitioners must put the date that the temporary exemption ends on the Certificate of

Exemption. School, preschool, or child care staff should monitor temporary exemptions.

When the temporary exemption ends, the child can be in conditional status for up to 30

days in order to get the missing vaccinations, other documentation of immunity or another

exemption.

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
                                                                                                     Page 17 
 
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Philosophical/Personal Exemption:  The philosophical or personal exemption is used when the 
parent/guardian has a personal or philosophical objection to the immunization of the child. A 
philosophical/personal exemption may not be used to exempt a child from the measles, mumps, or 
rubella immunization requirements.  
 
Religious Exemption: This exemption is used when the parent/guardian has a religious belief that 
is contrary to the required immunization.  
 
Religious Membership Exemption: This exemption is used when the parent/guardian affirms 
membership in a church or religious body that does not allow medical treatment by a health care 
practitioner. If the parent/guardian requests a religious membership exemption, no healthcare 
practitioner signature is required. Parents/guardians who have a religious objection to vaccination 
but whose children do obtain care from a health care practitioner need to use the Religious 
Exemption area of the Certificate of Exemption which requires a healthcare practitioner signature. 
 
Parents/guardians of exempt children or students MUST receive notification that if there is 
an outbreak of a disease that the child is not fully immunized against, the child may be excluded 
from school, preschool, or child care for the duration of the outbreak. This information is included in 
the parent signature section of the Certificate of Exemption form. 
 
Certificate of Exemption (COE) Resources 
•  Print a COE The COE is available in English, Spanish and several other languages: 
www.doh.wa.gov/SCCI and www.doh.wa.gov/vaxtoschool.  
 
•  Other resources are available in the Exemptions from Immunization Requirements - Certificate 
of Exemption (COE) section of the webpage www.doh.wa.gov/SCCI:  
o  Quick Reference Guide and Instructions 
o  Frequently asked questions 
o  Immunization Exemption Toolkit for Health Care Providers 
 
Retaining Records 
Schools and child care centers must maintain immunization records per Washington State law (RCW 
28A.210.110 and WAC 246-105-060). The law states schools and child care centers must: 
•  Keep the Certificate of Immunization Status (CIS) and/or, if applicable, the Certificate of 
Exemption (COE) for as long as the child attends the school, preschool, or child care. These 
documents may be kept electronically in a student information system or other database. 
o  Schools, preschool and child care centers using the WA Immunization Information 
System (IIS) School Module are not required to keep a CIS on file if the child’s 
immunizations are verified as complete in the IIS. A CIS, parent permission, and 
medical immunization records used to complete information in the IIS should be kept 
as long as the child is in attendance. 
•  Return the CIS, applicable COE, or a legible copy to the parent if the child has been 
withdrawn or transferred from a school or child care center. A school or child care center may 
not withhold a child's CIS or COE for any reason, including nonpayment of fees. 
•  Keep information about each child excluded due to a lack of immunization. Keep the child’s 
name, address, and date of exclusion for at least three years from the date of exclusion. 
•  Allow agents of state and local health jurisdictions access to the records during business 
hours for the purposes of inspection and copying. 
•  Keep or produce a list within twenty-four hours that identifies children who are not fully 
immunized. This list must be transmitted to the local health department upon request. 

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
                                                                                                     Page 18 
 
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Privacy of Immunization Records: HIPAA and FERPA 
This is intended only as information. It is not legal advice.  
 
HIPAA www.hhs.gov/ocr/privacy/ 
The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule (Section 
164.512(b)(1)(i)) recognizes the legitimate need for public health authorities and others responsible 
for ensuring public health and safety to have access to protected health information to carry out their 
public health mission.  
 
The privacy rule permits a covered entity (such as a health care provider) to disclose proof of a 
student’s immunizations directly to a school with the parent or guardian’s agreement. The agreement 
may be orally or in writing. Read more here: https://www.hhs.gov/hipaa/for-
professionals/faq/1507/is-a-health-care-provider-permitted-to-disclose-proof-of-a-childs-
immunizations/index.html.  
 
HIPAA also permits a covered entity (i.e. a school nurse) to disclose protected health information for 
public health activities and purposes (i.e. looking up immunization information in the WA 
Immunization Information System and printing a Certificate of Immunization Status form) without 
individual authorization (Section 164.512(b)(1)(i)).  
 
FERPA www.ed.gov/policy/gen/guid/fpco/ferpa/index.html   
The Family Educational Rights and Privacy Act (FERPA) law protects the privacy of student education 
records, including immunization records, submitted to the school. This law applies to educational 
agencies or institutions that get funding from the United States Department of Education. HIPAA 
rules do not apply to education records. Once a CIS or an immunization record is provided to the 
school, preschool, or child care, it becomes a part of the student education record and is covered 
under FERPA laws. 
 
FERPA requires parent or guardian consent for disclosure of immunization records. The consent must 
be signed and dated, specify the records that may be disclosed, state the purpose of the disclosure, 
and identify the party or class of parties to whom the disclosure may be made, as noted in 34 CFR § 
99.30. Signed and dated written consent may include a record and signature in electronic form that 
– (1) Identifies and authenticates a particular person as the source of the electronic consent; and (2) 
Indicates such person’s approval of the information contained in the electronic consent, See § 
99.30(d) for more information. 
 
Schools, preschools, and child cares using the WA Immunization Information (IIS) School Module 
must obtain parent or guardian permission before using immunization records covered under FERPA 
to update the immunization information in the IIS. The Certificate of Immunization Status (CIS) form 
has a place to capture this permission. School, preschools, and child cares can also gather this 
permission in other ways such as a health enrollment form or stand-alone consent form. For more 
information, please see the School Module section of this document or the School Module website: 
www.doh.wa.gov/SchoolModule.  
 
 
 
 
 
 
 
 

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Records from School-Based Clinics

School-based clinics may need to follow either HIPAA or FERPA rules. School-based clinics not

receiving funding from the United States Department of Education (US DOE) must follow HIPAA

rules. School-based clinics that do receive funding from the US DOE are covered under FERPA.

For example, if a public health clinic provides an on-site school immunization clinic, the records

belong to the public health clinic and must follow HIPAA rules. On the other hand, if a school

contracts privately with an agency or individual healthcare provider to provide a school-based clinic,

the records from that clinic belong to the school education record and must follow FERPA rules.

Exceptions

Exceptions to sharing immunization information without a proper release may include:

 Compliance with a lawfully issued subpoena.

 A significant health or safety emergency, if it is necessary to protect the health or safety of

students or other individuals. The exception in this case would be:

 Limited to the period of the emergency

 A specific release - not a blanket release

 Only for “need to know” and “appropriate parties”

 A designated emergency by a public health authority. Note that:

 An emergency can exist with or without a public health authority designation, and

 A federal designation of an emergency means a current outbreak or safety issue in the

school or school district.

If immunization records are shared because of an exception, school staff must write this in the

student’s education record within a reasonable period of time and include a description of why the

exception happened. Schools must retain the record of each request for access to the educational

record and each disclosure made from the record.

References

 Read the joint guidance on the application of FERPA and HIPAA to student health records

here: www.k12.wa.us/HealthServices/pubdocs/ferpa-hipaa-guidance.pdf

 Read more about Frequently Asked Questions on FERPA here:

https://studentprivacy.ed.gov/frequently-asked-questions

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Requirements for Special Situations

Alternative School Programs

Home-School, Vocational Technical, Running Start, and Virtual School Students

Students enrolled at a public or private school participating in alternative school programs must

follow the same immunization rules as all other students. They need a completed Certificate of

Immunization Status (CIS) and/or Certificate of Exemption (COE) on file at the school or district

program.

Children in Foster Care

Children in foster care must follow the same rules as all other children and have a completed CIS on

file at the school or child care they attend. However, the ‘Every Student Succeeds Act’ states: “If it’s not

in the child’s best interest to stay in his or her school of origin, the student must be immediately enrolled

in the new school, even if the child is unable to produce records normally required for enrollment. The

enrolling school shall immediately contact the school last attended to obtain relevant academic and other

records”. https://www.ed.gov/esea

Foster children in WA State are required to be immunized according to the national Advisory

Committee on Immunization Practices (ACIP) Recommended Immunization Schedule. Every

child/youth in out-of-home placement should receive an EPSDT/Well-Child examination, which

includes immunizations if needed, within 30 days of entering any foster or relative placement. If the

child is missing immunizations the foster parent must take the child to a health care provider as soon

as medically possible for catch-up immunizations according to the ACIP/CDC catch-up schedule.

https://www.dcyf.wa.gov/services/health-for-youth/epsdt

WAC 110-148-1555.

The WA State Department of Children, Youth and Families is the legal guardian of children in foster

care. DCYF does not allow foster parents to exempt their foster children from the immunization

requirements for personal or religious reasons. Foster children may have a medical exemption if

there is medical contraindication to receiving the vaccine. Check with the foster child’s case worker

regarding personal or religious exemptions signed by the child’s biological parents. For all

exemptions a Certificate of Exemption must be completed and submitted to the school or child care.

Children of Active-Duty Military Parents

Children of active-duty military parents or guardians must turn in documentation of immunization

status on or before the first day of attendance. If they need additional vaccine doses to meet state

requirements, they have 30 days from enrollment to do so. See RCW 28A.705.010 for more

information.

Graduating Students

Colleges and some employers may require immunization records. The most recent and accurate

Certificate of Immunization Status (CIS) should be returned to the student or parent upon

graduation. Schools may want to keep a copy on file, but it is not required.

We recommend schools include a letter with the CIS that includes information about additional

adolescent vaccine recommendations as well as information about how to sign up for MyIR when

they are 18 years old. A sample graduating senior letter is available here: www.doh.wa.gov/SCCI

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
                                                                                                     Page 21 
 
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Refugee Students 
Children starting school or child care who have entered the U.S. as a refugee must follow the same 
immunization rules as all other students. They need a completed Certificate of Immunization Status 
(CIS) and/or Certificate of Exemption (COE) on file at the school or district program.  
In some cases, newly arriving students may be eligible for services under the McKinney-Vento 
Homeless Assistance Act. See the section on homeless students below. 
If possible, schools should ensure newly arriving children are connected to a local primary care 
provider. Note, children are potentially eligible for Apple Health. ParentHelp123 can assist families 
with health insurance connection and can be reached by phone at 1-800-322-2588 or online 
at http://www.parenthelp123.org/benefit-finder/, language assistance is available. Clinics in the 
Childhood Vaccine Program (CVP) program provide childhood vaccines to all persons through age 18 
at no cost in the state of Washington, regardless of insurance or immigration status. Clinics may 
charge an administration fee, but they must waive it if asked because of inability to pay. Clinics 
providing CVP vaccine can be found on this vaccine map: https://fortress.wa.gov/doh/vaccinemap. 
Children arriving as refugees may have limited access to copies of medical records, including 
immunization information.  According to CDC guidance, clinicians should review all available vaccine 
records, perform any testing, and update or revaccinate, as appropriate. Written records of vaccine 
doses administered outside the United States should be accepted as valid, if the schedule for ages 
and intervals is compatible with ACIP recommendations. Checking for laboratory evidence of 
immunity (i.e., antibody levels) is an acceptable alternative to vaccination for some diseases, when 
previous vaccinations or disease exposure are likely.  CDC/ACIP General Best Practice 
Guidelines: Persons Vaccinated Outside the United States and Unknown or Uncertain Vaccination 
Status. The school immunization requirements can be met with positive antibody titers for 
Diphtheria, Tetanus, Hepatitis B, Measles, Mumps, Rubella, Varicella, Haemophilus influenzae type b, 
and Polio (must have evidence of immunity to all three polioviruses). Antibody titers to type 2 
poliovirus are no longer available so documenting immunity to polio by titer is no longer an option. 
There is no acceptable titer for Pertussis or Pneumococcal. 
It is suggested that school districts work with parents and providers to get students into compliance 
with the CDC immunization catch-up schedule as soon as possible. If attending in Conditional Status, 
they must follow the Conditional Status Attendance rules. The Individual Vaccine Requirements 
Summary (IVRS) document is a good reference for the vaccine schedule rules, exceptions to the 
rules and the catch-up schedules. We update it every school year. You can find the IVRS in 
the Immunization Requirements section of the School and Child Care Immunization 
page www.doh.wa.gov/SCCI.  
Additional Resources 
•  Immunization Action Coalition - Ask the Experts: Documenting Vaccination  
•  Immunization Action Coalition - Quick Chart of Vaccine Preventable Disease Terms in Multiple 
Languages  
•  CDC Pink Book – Appendix B  
•  Immunization Action Coalition – Vaccine Manufacturers: Contact and Product Information  
•  CDC - Guidance for Evaluating and Updating Immunizations during the Domestic Medical 
Examination for Newly Arrived Refugees  
•  https://www.chop.edu/news/news-views-interpreting-foreign-immunization-records-and-
immunizing-newly-immigrated  

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Homeless Students Experiencing Homelessness

Students experiencing homelessness are protected by the federal McKinney-Vento Act, which

requires public schools and preschools to allow students experiencing homelessness to enroll, attend

classes, and participate fully in school activities even if they are missing immunization or other

records. Schools cannot delay enrollment or keep students experiencing homelessness out of school

because they lack immunization records. School districts should have policies and procedures in

place to help students get immunization records as quickly as possible. If a student needs to get

immunizations or immunization records, the enrolling school must immediately refer the parent or

guardian to the local school district homeless liaison, who should help the student get immunizations,

their immunization records, or if applicable, an exemption. Students experiencing homelessness

cannot be excluded from school for being out of compliance with the immunization requirements.

A student is homeless if he or she meets the definition as explained in the McKinney-Vento law.

Who is homeless (Sec. 725 McKinney-Vento Act; USC 11432)

(2) The term homeless children and youths' —

(A) Means individuals who lack a fixed, regular, and adequate nighttime residence (within the

meaning of section 103(a)(1)); and

(B) Includes —

(i) children and youths who are sharing the housing of other persons due to loss of housing,

economic hardship, or a similar reason; are living in motels, hotels, trailer parks, or camping

grounds due to the lack of alternative adequate accommodations; are living in emergency or

transitional shelters; or are abandoned in hospitals.

(ii) children and youths who have a primary nighttime residence that is a public or private

place not designed for or ordinarily used as a regular sleeping accommodation for human

beings (within the meaning of section 103(a)(2)(C).

(iii) children and youths who are living in cars, parks, public spaces, abandoned buildings,

substandard housing, bus or train stations, or similar settings.

(iv) migratory children (as such term is defined in section 1309 of the Elementary and

Secondary Education Act of 1965) who qualify as homeless for the purposes of this subtitle

because the children are living in circumstances described in clauses (i) through (iii): An

individual that is not older than 21 years of age, who:

• Is entitled to a free public education (through grade 12) under State law, or the child is

not yet at a grade level at which the LEA provides a free public education; and

• Made a qualifying move in the preceding 36 months as a migratory agricultural worker

or a migratory fisher, or did so with, or to join a parent/guardian or spouse who is a

migratory agricultural worker or a migratory fisher; and

• Moved due to economic necessity from one residence to another residence, and from

one school district to another; or from one administrative area to another within such

district; or resides in a school district of more than 15,000 square miles and migrates a

distance of 20 miles or more to a temporary residence.

International Students

International or foreign exchange students must follow the same rules as all other students. They

need a completed Certificate of Immunization Status (CIS) and/or Certificate of Exemption (COE) on

file at the school they attend. This includes short-term visitors. The school must have the CIS and/or

COE before the student’s first day of school. Host parents of international students who act as legal

guardians and may sign a CIS or COE. DOH strongly recommends the CIS be filled out as part of

pre-registration for all international students. Schools can help agencies that sponsor international

students by sharing information about the immunization requirements and resources available at

www.doh.wa.gov/SCCI. Completing the CIS should become a regular part of the application process

for international students.

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Student Requirements by Grade

Students should follow immunization requirements for their grade. For example, a student who is 10 years

old but is held back a grade should follow the immunization requirements for the grade they are in. If a

student is not associated with a specific grade, they should follow the grade requirements for students

who are about the same age. For example, students 19 years of age and older should follow the

requirements for 12

grade. Students who are 12 years of age should follow the 7

grade requirements

since most 7

grade students are 12 years old.

Summer School Students

All students enrolled in a Washington State public or private summer school must have a

completed and signed Certificate of Immunization Status (CIS) on file. It is allowable for a

student’s CIS to be on file in a different building than where they attend summer school as long

as the CIS is in the same district. This also applies to vocational technical skill centers and off

campus and alternative schools. However, the information on the CIS must be accessible to the

summer school, skills center, or alternative school staff.

Transfer Students

When a student transfers to another school district, the parent can take the original or a copy of

the Certificate of Immunization Status (CIS) and/or Certificate of Exemption (COE) to the new

school.

Note: A former school cannot withhold the student's CIS or COE for any reason, including non-

payment of fees.

In-State Transfer Students

If a student transfers to a new school district within the state, they are considered ‘new’ and must have

a completed medically verified CIS and/or COE on file at the new school. Acceptable records include a

copy of the medically verified CIS and/or COE from the former school.

Out-of-State Transfer Students

If a student transfers from another state, they must have a completed medically verified

Washington state CIS and/or a Washington state COE on file at the new school. Forms from other

states are not an acceptable substitute for the WA State CIS or COE.

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Required Annual Immunization Reporting

Schools, preschools, and child cares must submit an immunization status report in a manner

provided by the Washington State Department of Health. The report must be submitted to the

department by December 1 of each year. WAC 246-105-060

The chart below shows schools, preschools, and child cares required to comply with immunization

requirements and reporting:

Comply with State Board

of Health immunization

requirements

Required to report to DOH

Public and private school

√

Licensed child care or preschool

√

Preschool located at a public or

private school

√

Head Start, ECEAP

√

Licensed child care for school

age children

√

Licensed family home child care

with 12 or fewer children

Comply with DCYF rules

Private preschools not located at

a public or private school

Coop preschool

Each child’s immunization status must be determined for the annual status report. Use the student’s

Certificate of Immunization Status (CIS) and any Certificate of Exemption (COE) to determine the

child’s overall status.

How to Report

The most current reporting information is available on the DOH reporting websites. These websites

include detailed instructions on how to report and the report form.

Public and Private Schools

https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/SchoolStatusReporting

Preschools and Child Care Centers

https://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/ChildCareStatusReporti

Questions About Reporting

Send any questions about reporting to oich[email protected].gov.

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Required Parental Notification

The notification rules state that schools, preschools, and child cares must notify parents or guardians

of certain immunization-related information.

Exclusion Notification- Student Exemption During an Outbreak

WAC 246-105-050

Parents or guardians of students with an exemption must be notified that their child may be excluded

from school, preschool, or child care in the event of an outbreak of a vaccine-preventable disease for

which their child has an exemption. This exclusion lasts for the duration of the outbreak. This

information is included on the parent declaration section of the Certificate of Exemption.

Exclusion Notification- Failure to Follow Immunization Requirements

Schools must provide written notice to parents of their child’s exclusion from school for failing to

follow WA immunization requirements, per the following state laws:

• WAC 392-380-050 regarding parents/guardians of children in public school

• WAC 180-38 050 regarding parents/guardians of children in private school

Meningococcal & HPV Disease and Vaccine – Required Notification

RCW 28A-210-080

• Public Schools: At the beginning of each school year starting with sixth grade, every public

school shall provide parents and guardians with information about meningococcal and human

papillomavirus (HPV) diseases and their vaccines.

• Private Schools: At the beginning of each school year starting with sixth grade, every

private school shall provide parents and guardians with information about meningococcal

disease and its vaccine and that information about human papillomavirus disease prepared by

the department of health is available.

Sample Letters

The Department of Health website for school and child care immunizations has a variety of sample

letters for notifying parents. View the page at www.doh.wa.gov/SCCI.

• Notice of Missing Immunization Documentation

• Notice of Child’s Conditional Immunization Status

• Notice of Exclusion for Immunization Noncompliance (Public Schools)

• Notice of Exclusion for Immunization Noncompliance (Private Schools)

• Meningococcal Disease (Public & Private Schools)

• Human Papillomavirus (HPV) (Public Schools)

• Human Papillomavirus (HPV) (Private Schools)

• Meningococcal & HPV (combination)

Immunization Manual for Schools,

Preschools and Child Care Centers

Page 26

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Washington State Immunization Information

System (IIS)

The Washington State Immunization Information System (IIS)

www.waiis.wa.gov is a lifetime registry that keeps track of

immunization records for people of all ages. The system is a

secure, web-based tool for healthcare providers and schools.

The IIS connects people who receive, administer, record, view

and order vaccines in Washington.

School Module

The School Module is a portal to the IIS that schools may use for immunization tracking and

reporting. School nurses and staff use it to access their students’ existing immunization records and

enter medically verified historical immunizations that are missing in the IIS.

The School Module allows the user to see school-specific information and reports. It reduces the

need for school staff to spend time entering immunization dates into a student information system

that is separate from the IIS. It provides tools to determine immunization compliance and identify

vulnerable students during a disease outbreak quickly and accurately. If immunization dates are

missing in the IIS, a school nurse can enter medically verified immunization dates into the School

Module, providing students with a complete immunization record that they can access throughout

their lifetime.

There are many reasons why the School Module is beneficial for schools and public health. More

information, including how to sign up free of charge is available on the School Module web page at

www.doh.wa.gov/schoolmodule.

Patient Privacy and the Immunization Information System

The Immunization Information System must follow the Washington State Health Care Information

Act (RCW 70.02) as well as other state and federal laws that govern the use and sharing of health

information. RCW 70.02 allows licensed healthcare professionals to exchange patient-specific

healthcare information without patient or parental consent for these reasons:

• Providing, coordinating, or facilitating healthcare, and

• Preventing and controlling disease.

Accessing the IIS

School Districts, Private Schools, Head Start, ECEAP Programs and Child Care Centers may

access the Immunization Information System in three different ways:

 View Only: allows user to view immunization records and print a CIS.

 Exchange - School Module: allows user to view and enter any missing immunization records in

the system. This Module also provides tools to track compliance with immunization

requirements.

 Limited Exchange - School Module: allows user, who do not have access to a licensed health

professional, to track compliance of the immunization requirements but limits their ability to

add immunization information to the IIS.

Information about the School Module is available at: https://doh.wa.gov/SchoolModule.

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
                                                                                                     Page 27 
 
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 please call 711 (Washington Relay) or email doh.information@doh.wa.gov.                                                                  DOH 348-124 September 2024  
 
Getting Access to the IIS 
  Complete an Information Sharing Agreement (ISA). The school district superintendent, head 
of school or child care provider must sign the agreement. The View Only and Exchange ISAs 
also require the signature of a licensed healthcare professional (usually a nurse).  
  Each person using the IIS must sign a Confidentiality Agreement. A sample is included in the 
Information Sharing Agreement. The signed Confidentiality Agreement should be kept at the 
school, district office, or child care center; do not send them to the Immunization Information 
System staff. 
  Nurses can allow non-licensed staff to use the Immunization Information System to view 
immunization information and print a Certificate of Immunization Status (CIS). These staff 
members must also sign the Confidentiality Agreement.  
                                             
More information including links to the Information Sharing Agreements can be found at: 
https://doh.wa.gov/public-health-provider-resources/healthcare-professions-and-facilities/data-
exchange/immunization-information-system.  
 
MyIR (My Immunization Record) 
MyIR is a consumer access portal that parents and guardians can use to view their child's 
immunization records securely online. Once registered for MyIR, parents or guardians can access 
their child’s immunization records any time they are needed. They can also print the Certificate of 
Immunization Status for school and child care entry.  
 
How to Sign Up 
Parents can visit https://doh.wa.gov/immsrecords for detailed information about how to get access 
to MyIR Mobile.  
 
Questions can be directed to 360-236-3595, 1-866-397-0337 or [email protected]. 
 
Resources for the IIS 
The IIS Training Portal has many helpful resources for using the IIS: https://doh.wa.gov/TrainingIIS  
 
Information about the School Module can be found here: https://doh.wa.gov/SchoolModule  
 
For technical questions and account set-up if an Information Sharing Agreement is already in place, 
contact the IIS Helpdesk email: WAIISHelpDesk@doh.wa.gov or call 1-800-325-5599.   

Immunization Manual for Schools,

Preschools and Child Care Centers

Page 28

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Disease Prevention and Control

Reporting Notifiable Conditions

School and child day care facilities are legally required to notify

public health authorities at their local health jurisdiction of

suspected or confirmed cases of selected diseases or conditions.

These are referred to as notifiable conditions. See WAC 246-101

for details. For more information about notifiable conditions,

including a list of conditions and local health contact information

see:

https://doh.wa.gov/ForPublicHealthandHealthcareProviders/NotifiableConditions

https://doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJurisdictions

Disease Outbreaks

The Health Officer of a local health jurisdiction has the authority to take all appropriate actions

deemed to be necessary to control or eliminate the spread of the disease WAC 246-110-020. School

and child care staff must follow the directives of the local health officer.

If an outbreak is declared:

• Cooperate with the local health department’s directives.

• Identify students and staff exposed to the disease.

• Review immunization records to identify susceptible students and staff.

• Take action as directed to protect those who cannot be immunized against the disease.

• Communicate the information provided from and as directed by the local health department

with parents, students, and staff.

• Contact your local health department to determine if susceptible students should be excluded

until the danger of the outbreak passes. Find contact information here:

https://doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJurisdictions

• Review the Infectious Disease Control Guide for information about specific diseases:

https://ospi.k12.wa.us/sites/default/files/2024-06/guidance_health_420-503-

infectiousdiseasescontrolschoolguidedoh.pdf

Immunization Manual for Schools,

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Vaccines for Staff

Child Care Center Staff and Volunteers

Staff and volunteers at a Child Care Center (including ECEAP and Head Start preschools) are required

to provide specific immunization documentation to their facility (Chapter 43.216 RCW). They will

need one of the following:

• An immunization record showing they received the MMR vaccine.

• Proof of immunity from measles through documentation of lab evidence of antibody titer.

• A health care provider’s attestation of the person’s history of measles sufficient to provide

immunity against measles. The provider may consider CDC guidance regarding evidence of

immunity including for those born before 1957.

• Written certification, signed by a health care practitioner, that the MMR vaccine is not

advisable for the person.

School Staff

While immunizations are not required for school staff, knowing a staff’s immunization status can

prepare schools in advance of a disease outbreak. Cases or outbreaks of diseases associated with the

school must be reported to the local health department (RCW 28A.210.010 and WAC 246-101-420).

All susceptible staff not completely immunized or immune may be excluded from school at the

direction of the local health officer.

Schools, preschools, and child cares must try to prevent the spread of disease for both children

and staff. To do this, they should:

• Keep track of staff vaccinations or remind staff that they may need to provide their

immunization records in the event of an outbreak.

• Promote vaccination for staff members in an effort to safeguard the school, preschool, and

child care community.

• If directed by the local Health Officer, exclude susceptible staff members during an

outbreak. Refer to your school or agency policies about whether staff can take sick leave

when excluded.

Immunization Manual for Schools,

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The following immunizations are recommended for school and child care staff:

Recommended Immunizations for School and Child Care Staff

Vaccine

MMR

(Measles,

Mumps,

Rubella)

Required for

child care

center staff

and

volunteers

Persons Born Before 1957

Persons Born in or After 1957

• High risk: 2 doses of vaccine

are recommended for health

care personnel including school

nurses.

• Those not at high risk are

generally considered immune

(US or foreign born). Vaccine is

not routinely recommended, but

1 dose may be given.

• Testing is NOT necessary.

However, if testing occurred

and the result is negative, 1 or

2 doses of MMR vaccine is

recommended depending on

risk level.

• Staff should receive 1 dose of vaccine if

not at high risk

• Staff should receive 2 doses of vaccine

if they are high risk. This includes

health care personnel, school nurses,

international travelers, and students

attending college.

• Vaccine is needed even with a history

of prior disease diagnosed by a

provider.

• No vaccine is needed if documentation

of blood test shows positive immunity.

• No vaccination or testing is needed if

there is documentation of 1-2 doses of

MMR vaccine (based on risk level).

Varicella

(chickenpox)

• 2 doses of vaccine.

• If there is other evidence of immunity, no vaccine is needed. This includes:

o Healthcare provider verification of chickenpox disease or herpes zoster

(shingles).

o Persons born before 1980 (does NOT apply to healthcare personnel, pregnant

women, and immunosuppressed persons).

o Blood test showing positive immunity.

Hepatitis B

Staff should receive 2 or 3 doses depending on which vaccine is used.

For more information about Labor and Industries rules about the hepatitis B

vaccine and potential occupational exposure to blood-borne pathogens, go to:

https://lni.wa.gov/safety-health/safety-rules/rules-by-chapter/?chapter=823

Tdap/Td

Staff should receive 1 dose of Tdap, then a Td booster every 10 years.

Pregnant women should get Tdap during EACH pregnancy, regardless of when the

last dose was received.

Influenza

(Flu)

Annual influenza vaccine is recommended for everyone 6 months of age and older.

COVID-19

Up to Date: one dose of the current formulation as recommended by the Centers

for Disease Control and Prevention.

The national Recommended Adult Immunization Schedule includes additional vaccines. For more

information, recommendations, and correct immunization schedules, visit the Department of

Health at https://doh.wa.gov/you-and-your-family/immunization/adult

Resources

• Recommended Adult Immunization Schedule

English only https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html

• Recommended Immunization Schedule for Health-Care Personnel

Immunization Manual for Schools,

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https://www.cdc.gov/mmwr/preview/mmwrhtml/rr6007a1.htm

• Sample Staff Immunization History Form

https://doh.wa.gov/SCCI

• Washington State School Directors’ Association (WSSDA) Infection Control Policy and

Procedure:

https://doh.wa.gov/sites/default/files/2024-06/420-503-

InfectiousDiseasesControlSchoolGuide.pdf

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
                                                                                                     Page 32 
 
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Additional Resources 
 
Laws and Rules 
 
•  Preschool and Child Care  
https://doh.wa.gov/YouandYourFamily/Immunization/SchoolandChildCare/ChildCareImmunizatio
nLaws  
•  School 
https://doh.wa.gov/YouandYourFamily/Immunization/SchoolandChildCare/SchoolImmunizationL
aws 
 
Department of Health - Office of Immunization 
 
•  School and Child Care Immunization, including CIS, COE, Conditional status 
FAQs and Sample Letters etc. 
      https://doh.wa.gov/SCCI  
 
•  Family Friendly Immunization Page 
https://doh.wa.gov/YouandYourFamily/Immunization/FormsandPublications.aspx 
 
•  Access Your Immunization Records and MyIR  
https://doh.wa.gov/immsrecords 
 
•  WAIIS School Module  
https://doh.wa.goc/SchoolModule 
 
•  Free Educational Materials  
https://doh.wa.gov/YouandYourFamily/Immunization/FormsandPublications.aspx 
   
•  Local Health Jurisdiction Contact List  
https://doh.wa.gov/AboutUs/PublicHealthSystem/LocalHealthJurisdictions  
 
Office of Superintendent of Public Instruction 
 
•  Health Services - Immunizations  
https://ospi.k12.wa.us/student-success/health-safety/school-health-nursing-
services/immunizations  
 
Vaccine  
 
•  Recommended Immunization Schedules 
o  Adults Aged 19 Years and Older: 
https://www.cdc.gov/vaccines/hcp/imz-schedules/adult-age.html  
o  Children and Adolescents Aged 18 Years or Younger: 
https://www.cdc.gov/vaccines/hcp/imz-schedules/child-adolescent-age.html    
 
 
•  Vaccine (continued) 

                                            Immunization Manual for Schools, 
                                            Preschools and Child Care Centers 
                                                                                                     Page 33 
 
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•  CDC: ACIP Best Practice Guidelines 
https://www.cdc.gov/vaccines/hcp/acip-recs/general-recs/ 
 
•  Foreign Language Terms: Aids to translating foreign immunization records 
www.cdc.gov/vaccines/pubs/pinkbook/downloads/appendices/B/foreign-products-tables.pdf 
 
•  Vaccine Abbreviations 
https://www.cdc.gov/vaccines/hcp/vaccines-us/abbreviations.html 
 
•  Vaccine Trade Names in the United States 
https://www.cdc.gov/vaccines/hcp/vaccines-us/index.html  
 
•  Vaccine-Preventable Diseases 
https://doh.wa.gov/YouandYourFamily/Immunization/Diseases.aspx 
 
•  Vaccine Terms in Multiple Languages 
www.immunize.org/catg.d/p5122.pdf 
 
•  Glossary of Immunization and Public Health Terms  
English only https://doh.wa.gov/Portals/1/Documents/Pubs/348-269-
GlossaryImmunizationPublicHealthTerms.pdf  
 
•  Pink Book: Epidemiology and Prevention of Vaccine-Preventable Diseases 
https://www.cdc.gov/pinkbook/hcp/table-of-contents/  
 
•  Immunization Action Coalition – Ask the Experts 
www.immunize.org/askexperts/  
 
•  Find a Vaccine Clinic and Immunization Toolkits for School and Childcare 
https://immunitycommunitywa.org/levels-of-engagement/  
 
 
 
 

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List of Changes to this Manual

Date

Page(s)

Content

July 2024

Entire

Document

Minor formatting and language changes

August 2024

Updated section on Students Experiencing Homelessness.

Changed name from “homeless students” to “students

experiencing homelessness” and removed “those awaiting

foster care placement” to align with updated definition of

homeless in the McKinney-Vento Act.

July 2024

Added language about the Limited Exchange ISA

July 2024

Added additional DOH resources

September

2024

Entire

Document

All web links have been updated. CDC’s new web page design,

OSPI’s new web addresses broke many of the existing links.

Corrected DOH links from www.doh.wa.gov to

https://doh.wa.gov.