Childcare Imms Record Management Toolkit
This guide will help childcare providers keep their immunization records up-to-date and makes the State-required annual immunization report easier to submit. This toolkit is specifically for Washington State childcares. The information contained in this toolkit is intended to assist both medical and non-medical staff at childcares in establishing immunization record-keeping and documentation workflow processes, or modifying existing processes.
Toolkit Background
The record management toolkit was funded through a generous grant from the Momentum Fund of the Group Health Foundation that built off of an immunization record review project with Spokane County schools and childcares. Spokane Regional Health District (SRHD) Immunization Outreach staff created and facilitated a statewide workgroup that included the Washington State Department of Health Office of Immunization, the Tacoma-Pierce County Health Department (TPCHD), Education Service Districts (ESDs) and School Nurse Organization of Washington (SNOW) members, and the Office of Superintendent of Public Instruction (OSPI). This toolkit was piloted at two childcares in the Spokane County region between October 2012 and February 2013. SRHD staff continue, in partnership with OICP, to ensure the content is current and up-to-date.
Immunization Requirements
Washington Immunization Law – The Nuts & Bolts to Know
Refer to Chapter 246-105 WAC Immunization of Childcare and School Children Against Certain Vaccine-Preventable Diseases for additional information about any of the bullet points below.
- Students have the right to attend school without the threat of exposure to certain vaccine-preventable diseases.
- Students are required to be vaccinated and submit a completed Certificate of Immunization Status (CIS), or Certificate of Exemption (COE), before attending school. Refer to WAC 246-105-030.
- State law requires early learning programs to report immunization status by November 1 of every year. Refer to RCW 28A.210.110.
- Find information about yearly reporting here: Department of Health Childcare Status Reporting. A paper copy can be completed and mailed to the Washington State Department of Health, or Skyward/other Student Information Systems may be used.
- Students not fully immunized, or students attending school under conditional status who fail to make satisfactory progress, must be excluded. Refer to WAC 246-105-080.
- Schools must maintain immunization records and keep a list of students with exemptions on file. Refer to WAC 246-105-060.
Required Vaccines for Washington Childcare Attendance
For guidelines on immunizations required for childcare/preschool entry in Washington State for School Year 2018-19, click the Individual Vaccine Requirements Summary to view.
This summary enables staff and those working with student information systems to understand the detailed immunization requirements as well as the immunization schedule based on the recommendations of the Advisory Committee on Immunization Practices (ACIP). You will find detailed information about the immunization schedule and the exceptions to the schedule that may happen when medical errors occur or when ACIP recommendations are not followed.
Mandatory Immunization Reporting for Childcares
State law requires that childcares annually report their immunization status by November 1. This guide will help childcare providers keep immunization records up-to-date and makes the yearly report easier to submit. It is recommended that immunizations are evaluated every three months on children who are 0-12 months old, and every six months for children 12-30 months old. Click here for information on Early Learning Program Immunization Status Reporting.
State Law Information:
- Childcares must submit an immunization status report as required by 28A.210 RCW (Revised Code of Washington), either electronically on the internet, or on a form provided by the Washington State Department of Health (DOH). The report must be submitted to DOH by November 1 of each year. Refer to WAC (Washington Administrative Code) Chapter 246-105-060 Duties of Schools and Childcare Centers.
- Childcares are required to keep a list of children with exemptions on file. Refer to WAC Chapter 246-105-060 Duties of Schools and Childcare Centers.
- Required vaccines for childcare entry include the following: Please refer to WAC Chapter 246-105 Immunization of Childcare and School Children Against Certain Vaccine-Preventable Diseases.
- Diphtheria
- Tetanus
- Pertussis (whooping cough)
- Poliomyelitis
- Measles (rubeola)
- Mumps
- Rubella
- Hepatitis B
- Haemophilus influenzae type B disease
- Varicella (chickenpox)
- Pneumococcal
- Excluding a child from childcare is required when a parent or guardian does not provide a complete Certificate of Immunization (CIS), including all age-appropriate immunization dates, or parent or guardian does not provide Certificate of Exemption (COE). Refer to WAC 246-105-080 Criteria for Excluding Children From Schools or Childcare Centers.
Before You Begin...
- Please consult with your childcare organization before initiating this process- there may be necessary paperwork for you to complete, including HIPAA and associated confidentiality/record retention agreements
- Be familiar with general computer software programs, including the Internet and Microsoft Office programs (Word)
- Determine the scope of your roles and responsibilities related to immunization recordkeeping and documentation (are you responsible for establishing a brand new process, including a filing system? Or, are you assisting with following up with parents to obtain missing immunization information?) The complexity of your involvement will help guide you to the resources and tools to use within this toolkit.
- Determine which recordkeeping/ documentation systems your organization currently uses (computer database? paper records?) and what is available to you for use
- Ensure that you or someone within your organization can access the Washington State Immunization Information System (IIS) (click here for more information)
Suggested Trainings Before You Begin
- Familiarize yourself with the basic tenets outlined in the Washington State Department of Health Immunization Manual
- View the Washington State Department of Health requirements webinars (previously recorded)
- Fully review the required vaccine charts for childcare and the individual vaccine requirements for the current year
Out-of-Compliance Review Checklist
| Step | Description |
|---|---|
1.Find children who are out-of-compliance. |
“Out-of-compliance” can be defined as those children who do not meet the requirements for attending childcare due to inadequate immunization records. This group of children does NOT include those with exemptions on file or those children that are conditional (cannot obtain immunizations at this time due to minimum age or intervals of vaccine schedule). You can find the current requirements to attend childcare by clicking here. |
2. Determine the best way to contact parents. |
Two examples of ways to contact parents are listed below. Calling parents may not be the best option when they are working. Once the best contact method is determined, contact each parent.
Hi (Parent Name), |
3. Determine best way to track progress. |
Once a childcare provider knows who will be contacting the parent, it is important to track their progress and attempts. Example tracking sheet for children needing follow up can be found here. Example tracking sheet for children who are exempt can be found here. |
4. Gather immunization data from parents. |
As parents provide completed records back to the childcare, ensure updates are added to current immunization record-keeping system. |
5. Make a new list of children needing follow-up. |
Repeat steps 2-5 until data is accurate. Waiting too long for parents to get back to the childcare provider can decrease the momentum of the childcare provider’s immunization record review. After first contact with parents, it is recommended to remind them every few days to get the needed information. Keep trying. Although a childcare provider may feel like a pest, many times parents are just busy and need reminders. Sample conversations with parents can be found here. |
6. Determine end of follow-up and send out certified exclusion letters. |
Be sure to give ample time for the follow-up process. Although it is tedious, it is the backbone to ensuring success of a childcare provider’s records review process. Allow three to four weeks to follow-up with parents after the initial contact. From the updated tracking sheet, a childcare provider should be able to count the number of newly-compliant children. According to Washington Administrative Code (WAC), the childcare center is obligated to exclude these children until a completed Certificate of Immunization Status (CIS) or Certificate of Exemption (COE) is provided to the childcare. Parents are notified that their child will be excluded by sending an Exclusion Letter, which must be sent by certified mail, or hand-delivering the exclusion letter to the parent or caregiver. Many childcares hand-deliver letters during child drop-off or pick-up, or parent-teacher events. The child is excluded upon receiving the certified letter until the child is compliant. If a parent wishes to file a Certificate of Exemption, they will need to visit their health care provider, who will review their reasons for exemption and must sign the form. |
7. Send yearly immunization status report by November 1. |
State law requires childcares to report their center’s immunization status by November 1 of each year. Although a childcare provider will not need to submit this report every time he/she performs an immunizations record review, it is important to have records up-to-date before submitting a yearly status report. There are two ways to submit a status report: 1) online or 2) through a faxable paper form. The Immunization Status Report form can be found by clicking here. |
Exemption Review Checklist
| Step | Description |
|---|---|
1.Gather a list of children who are exempt from 1 or more vaccines. |
Children who are exempt from one or more vaccines must have a current Certificate of Exemption on file. There are a couple different ways to track exempt children depending on how a child care provider stores immunization information. If a childcare provider uses paper files, they will need to manually go through and determine which children have Certificates of Exemption on file and make a separate list of these children. Sometimes it is helpful to put them in categories by age. It will also be important to determine which vaccines they have exempted, which will help other steps go faster. This can also be done by a childcare’s tracking software. There are then different ways to group children. A center may find it easier to group children by age or classroom. Some centers may find it easier to alphabetize all the children with exemptions by name. A childcare provider should find the method of grouping children that works best for them and their center. |
2. Determine the best way to contact parents. |
The purpose of contacting these parents is to ensure the information a childcare provider has is accurate. Although these children are non-compliant according to the law, there are many times parents change their mind and get their children vaccinated. To ensure a childcare provider has the most up-to-date information during an outbreak, it is best to ask parents if the Certificate of Exemption they signed is still accurate. Here are two examples of ways to contact parents that can be modified to meet your needs. Calling parents may not be the best option. Once the contact method is determined, contact each parent.
Hi Parent, |
3. Determine the best way to track progress. |
Once a childcare provider knows who will be contacting parents, it is important to track progress and attempts at contacting parents. A sample tracking sheet for children that need follow up can be found here. A sample tracking sheet for children that are exempt can be found here. |
4. Gather immunization data from parents. |
As records are provided to the childcare center from parents, ensure these updates are added to current immunization record keeping system. |
5. Make a new list of children still needing follow-up. |
Repeat Steps 2-5 until data is accurate. Waiting too long for parents to communicate back can decrease the momentum of a record review. After first contact with parents, continue encouraging them every few days to provide the needed information back to the childcare center. Keep talking with parents. Although a child care provider may feel like a pest, many times parents are just busy and need reminders. Sample conversations with parents can be found here. |
Resources
- Washington State Department of Health Resources
- Updated changes on exemptions
- Regulations surrounding vaccines, including the Revised Code of Washington (RCW) and Washington Administrative Code (WAC)
- The Office of Immunization and Child Profile has public health nurse consultants on staff to answer clinical questions about immunizations. They can be emailed at immunenurses@doh.wa.gov. Emails are confidential and will be answered within three business days.
- Washington State Department of Health Immunization Manual
- A reference guide designed for staff members who process Certificates of Immunization Status (CIS), complete immunization status reports, and answer questions from parents and guardians about immunization requirements for children in preschools, childcares, and schools.
- Washington Department of Health Vaccine Requirements
- Includes easy-reference childcare and preschool vaccine requirement charts for parents and childcare providers in multiple languages.
- Provides detailed clinical guidance information for individual vaccine requirements.
- Links to the most current immunization schedules on the Centers for Disease Control & Prevention (CDC) website.
- Washington State Department of Health Forms & Letters in multiple languages
- Certificate of Exemption (COE)
- Certificate of Immunization Status (CIS)
- CIS Overlay for childcare/preschool entry
- CIS Overlay for Kindergarten entry
- FAQs about CIS and COE
- Childcare susceptible tracking lists to document exemptions and conditional/noncompliant children that require follow-up
Glossary
- Certificate of Immunization Status (CIS): Washington State form used by parent/guardian to report immunization information on their student.
- Compliant: Student has required immunizations for school entry or parent has signed a Certificate of Exemption that is on file.
- Conditional: Does not have required immunizations and is in the process of completing a series of shots.
- Early Childhood Education and Assistance Program (ECEAP): Comprehensive preschool program that provides free services and support to eligible children and their families, run by the Washington State Department of Early Learning.
- Exemption: Parent chose to not obtain one or more of the required immunizations for school entry and has a healthcare provider-signed Certificate of Exemption.
- Out-of-Compliance (OOC): Does not have required immunizations, does not have a signed Certificate of Exemption, and is not considered conditional.
- Student Information System (SIS): A software system used statewide for student and fiscal data.
- Washington Immunization Information System (WAIIS or IIS): Formerly known as Child Profile, a lifetime registry that keeps track of immunization records for people of all ages.
