School Immunization Record Management Toolkit
The steps outlined in the School Immunization Record Management Toolkit will help keep students’ immunization records up-to-date and make required annual immunization reports easier to submit. This toolkit is specifically for Washington State schools. The information contained within this toolkit is intended to assist both medical and non-medical staff at schools in establishing immunization record keeping and documentation workflow processes, or modifying existing processes.
Toolkit Background
This 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 five schools 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
Immunization Law – The Nuts & Bolts to Know
Refer to Chapter 246-105 WAC Immunization of Child Care and School Children Against Certain Vaccine-Preventable Diseases for additional information about any of the bulleted 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 schools to report immunization status by November 1 of every year. Refer to RCW 28A.210.110.
- All schools are encouraged to submit annual data online via the Washington State Immunization Information System (WAIIS) as a preferred method.
- Find information about yearly reporting here: Department of Health School Status Reporting.
- 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 State School Attendance
For guidelines on immunizations required for school entry in Washington State, 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.
2020-21 Grades K-12 Required Vaccine Chart English (PDF)
Before you Begin...
- 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)
- Consider getting access to the IIS School Module for your school or district. The School Module allows schools to track and manage immunization information for their students by linking patients in the IIS to their school. School Module users can access existing immunization records entered by healthcare providers, add missing immunizations, and manage student immunization compliance work in the 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 schools.
Immunization Review Checklist
Step | Description |
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1.Train school and childcare support staff. |
Staff training is important to ensure all immunization information is collected and maintained in the same way. Staff should be trained on the number of doses required of each type of vaccine for childcare/pre-school/school entry. Intervals can be complicated, but it will save follow-up hours with parents later if staff know immunization intervals and invalid doses information. Immunization schedules and easy to read vaccine requirement charts from the Washington State Department of Health can help aid in training. The Certificate of Immunization Status (CIS) overlay can help with training. This document can be printed on a transparency sheet and then laid over a CIS to ensure dates are provided in the highlighted areas – the transparency file can be found here. Entry requirements can be found here. |
2. Educate parents who are already in your district. |
Kindergarten entry – A district may have groups that will automatically be entering into kindergarten such as Head Start/Early Childhood Education and Assistance Program (ECEAP) or pre-school groups. Talking with these parents prior to school helps ensure you are collecting and maintaining immunizations consistently. Cover the topics below with these parents through an in-person meeting.
Before 6th grade – Before school is out every year, send letters home to current parents of 5th grade students letting them know about the Tdap vaccination required for 6th grade school entry. Most staff utilize this mailing to inform parents of the meningococcal and human papillomavirus (HPV) vaccine recommendations, as required by law. Example letters can be found here. It is also beneficial for staff/volunteers to attend 6th grade orientation and remind parents about the requirement. Some school districts find it helpful to not assign the student a class schedule until the immunization record is updated. All grades – Before school is out every year, send letters home to parents that include a back-to-school list that includes immunization information, including required immunizations for school entry. Have registration packets available for parents prior to school registration. This will help some parents fill out the CIS in advance of attending a registration event—saving you (and the parent) time. |
3. Verify immunization at registration event and cross-reference the Washington State Immunization Information System (WAIIS). |
Whether you have a registration event or not, the best time to ensure immunizations are current and accurate is while you have the parent in front of you. Although it may seem time consuming, it is an important step to ensuring childcare attendees and students have the appropriate immunizations prior to starting. As indicated in step 1, having staff trained to interpret if the child or student has the needed immunizations is critical. Refer to step 1 for training resources. During any kind of registration event, make a computer and printing station available and print completed CIS forms out of the Washington Immunization Information System (WAIIS) for parents to sign and turn in with registration documents. This will allow the parent to add any immunization that may not be on the CIS from the WAIIS and can minimize mistakes when copying dates onto the CIS. Another practice found to be beneficial for school districts during the registration process is to hold immunization clinics to enable same-day student vaccinations. School districts that have done this successfully worked with partners in the community such as local health departments and/or their Medical Reserve Corps to offer free or low-cost immunizations. See the Imms-To-Go toolkit for more information. |
4. Create student profile in Student Information System (SIS). |
In many school districts there is a time delay between when the student registers and when they are entered into the Student Information System (SIS). In order to run reports to find students who registered and are not compliant, the initial data entry is required. The sooner this data is entered the more time school staff have to get students up-to-date before school starts. |
5. Call parents of students with missing immunization information. |
Before school starts, school staff should generate an out-of-compliance report or refer to their tracking sheet, and start calling parents to get updated immunization information—some school districts allow school nurses or secretarial staff to start half-days before school begins. These staff can then take a full day off during the year by combining it with a naturally-occurring school half day. Other possibilities are to recruit other staff to help, such as detention staff, parent advocates and health clerks, who may not be as busy before school starts. Keep trying parents. Many times parents are just busy and need reminders. Find sample phone call scripts here. As records are provided to the school from parents, ensure these updates are added to the SIS. |
Out-of-Compliance Checklist
For those that use computer systems, there should be an option to print out-of-compliance data. It is important to verify that these students are truly out-of-compliance, as computers are not perfect.
Step | Description |
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1.Identify out-of-compliance students. |
“Out-of-compliance” can be defined as those children who do not meet the requirements for attending school 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 school by checking here. |
2. Develop a tracking system. |
Once school staff know who to contact, it is important to track progress and attempts at contacting parents. Find sample tracking sheet here. Developing a system to keep track of who and when a parent is contacted is critical to the follow-up process. TIP: Some school nurses use their Outlook calendars to remind themselves who they need to follow-up with that day. For districts that have computerized records, the system may allow you to put notes on a student’s record. |
3. Cross-reference the Washington State Immunization Information System (WAIIS). |
If a school has access to the Washington State Immunization Information System (WAIIS), staff can cross-reference a child’s school immunization record with immunization data in this database (FYI– The WAIIS was also formerly referred to as Child Profile). |
4. Send letters or emails to parents of out-of-compliance students. |
Below is a list of current letters that can be modified to meet your needs, including organization or district logo and contact information. You can find any of these sample letters in Microsoft Word Format in the “School Sample Letter” section here.
Once the letter is developed, a separate letter for each student will need to be printed out and
If funds are available, it may help to include a self-addressed stamped envelope for parents to return updated information, as well as updated contact information. Mailing and calling parents are the most effective methods of contacting parents. TIP: If a school has parent names and addresses in an exportable form, or if a school has them typed into Excel, they may find Microsoft Word’s mail merge tool useful. The functionality allows staff to create letters and envelopes that are pre-populated with names and address. Click here for more information about Microsoft Mail Merge. |
5. Start calling parents. |
Start calling parents right away. Even though staff know the parents have not received a letter yet, staff can let them know the letter is on its way. Staff have only 30 days to get the needed immunization information before the child is excluded from school, so it is important to start the follow-up as soon as a student is identified as out-of-compliance. Keep trying parents. Many times parents are just busy and need reminders. Sample phone scripts to call parents can be found in here. As records are provided to the school from the parents, ensure these updates are added to the current system of immunization record keeping. |
6. Mail or hand-deliver exclusion letters. |
Within 30 days, complete the phone follow-up and update tracking sheet. According to the WAC, schools are obligated to exclude these children until a completed Certificate of Immunization Status (CIS) or a completed Certificate of Exemption (COE) is provided. Parents are notified that their child will be excluded by mailing an Exclusion Letter, which must be sent by Certified Mail, or hand-delivering an Exclusion Letter. The child is excluded upon receipt of the letter, until the child is compliant. Many school districts will utilize resource officers to hand-deliver letters, or even distribute them during parent-teacher conferences. If a parent requests a Certificate of Exemption, there are two ways this form can be completed:
|
Exemption Review Checklist
Immunization Exemptions
A parent or guardian may choose to exempt their child from one or more of the immunization requirements for school. However, the child may be
at risk for disease.
Children with exemptions have contributed to disease outbreaks of vaccine-preventable diseases throughout the state of Washington as well as the nation. These outbreaks put children, their family members, and community members (sometimes too young or unable to be vaccinated) at risk.
The Washington State Administrative Code 246-110 allows a health officer to exclude children from school or childcare during an outbreak of vaccine-preventable disease if the child has not been fully immunized due to a medical, religious, philosophical, or personal exemption.
Immunization Exemption Law
On May 10, 2011, Governor Gregoire signed a bill that requires a licensed health care provider to sign the Certificate of Exemption, for a parent or guardian to exempt their child from school and child care immunization requirements.
The signature verifies that the provider gave the parent or guardian information about the benefits and risks of immunization.
A health care provider doesn’t need to sign the form for parents or guardians who demonstrate membership in a church or religious group that does not allow a health care provider to provide medical treatment to a child. (Please note: this is different than a religious exemption). Additionally, Certificates of Exemption signed by a parent prior to July 22, 2011 – the date when the law officially took effect – will be honored.
Step | Description |
---|---|
1.Gather a list of students who are exempt from one or more vaccines. |
Students who are exempt from one or more vaccines must have a current Certificate of Exemption on file. There are several ways to gather a list of students depending on how a school stores immunization information. For schools that are using paper, staff will need to manually go through and determine those exempt. According to Washington state law, a school must keep a current list of exempted students. Sometimes it is helpful to put them in categories by grade or school. Determine from which vaccines a student has an exemption- this step is especially critical for case management and notification during a potential vaccine-preventable disease outbreak (i.e measles or chickenpox). For schools that use a computer system, there should be a report that can be printed to show students who are exempt for one or more vaccines. It is still important for you to verify the accuracy of this information, as computers are not perfect. |
2. Develop a tracking system. |
Once you know who to contact, it is important to track progress and attempts at contacting parents. Find Sample Tracking Sheet here. Developing a system to keep track of who and when in terms of contacting parents is critical to the follow-up process. TIPS: Some school nurses use their Outlook calendars to remind them who they need to follow-up with that day. For districts that have computerized records, there may be a place to put notes on a student’s record. In Skyward, some schools use the “office visit section” to make notes and run reports. |
3. Cross-reference the Washington State Immunization Information System (WAIIS). |
If a school has access to the Washington State Immunization Information System (WAIIS), staff can cross-reference a child’s school exemption with immunization data in the WAIIS (formerly known as Child Profile). |
4. Start calling parents. |
The purpose of these calls is to see if the information a school has on file is correct. Having an exemption for one or more vaccines is within the law to attend school; however, many times students eventually receive vaccines after an exemption was signed. Sample phone scripts to call parents can be found here. |
5. Determine end date. |
Give ample time to the follow-up process. Although it may be tedious, it is the backbone to ensuring success of this process. Allow 3-4 weeks to follow-up with parents by phone to inquire about the accuracy of exemptions on files. Please note that a school cannot exclude students who have a current and correctly-signed Certificate of Exemption. These students are permitted to attend school with this signed document except as directed by the local health officer during an outbreak. |
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 school vaccine requirement charts for school staff and parents.
- 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 Documentation Resources in Multiple Languages
- Certificate of Exemption (COE)
- Certificate of Immunization Status (CIS)
- CIS Overlay for Kindergarten Entry
- CIS Overlay for Middle School
- CIS Overlay for High School
- Frequently Asked Questions (FAQ) about the CIS and COE
- School susceptible tracking lists to document exemptions and conditional/non-compliant children that require follow-up
- Washington State Department of Health Sample Letters for Parents (all are in Microsoft Word and can be modified to include school district logo/associated contact info)
- Graduating Senior Letter
- HPV Letter for Private Schools
- HPV Letter for Public Schools
- HPV and Meningococcal Letter (combination)
- Meningococcal Letter
- Notice of Child’s Conditional Immunization Status (Public and Private Schools)
- Notice of Exclusion for Immunization Non-Compliance (Private Schools)
- Notice of Exclusion for Immunization Non-Compliance (Public Schools)
- Tdap Letter for 6th-12th grade
- Tdap/Varicella Letter (combination)
- Varicella Requirement Letter for 9th-12th grade
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.
- 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.