Measles Immunization Documentation Form

Form Template

In order to protect the health and safety of all members of a school campus, a college or university may adopt immunization requirements for infectious diseases such as measles and rubella as recommended by the Centers for Disease Control or a local health department.

5,000 Companies save time and money with GoCanvas

Lumen Logo Post Consumer Brands Logo Saluda Hill Landscapes Logo Te3co Logo Two Men and a Truck Logo VIP Lighting Logo

To meet health requirements, college students will be required to submit the immunization record before attending school. The Measles Immunization Documentation Form app provides students with a form to report measles-rubella immunization records or immunity. With the app, students can select from four different options. The first three options indicate the student's protection against the illness including that student was vaccinated with the required dose of MMR or Rubeola Vaccine in two immunizations, a healthcare provider confirms that student had the Rubeola Measles vaccine or a confirmation that the student had a blood test that indicated measles immunity. These options should include the signature of the primary physician or health care provider who administered the vaccine. The fourth option is a measles immunization waiver for those declining to be vaccinated. The student signing the waiver acknowledges exposure risks and understanding of protocol if a case of measles should arise on the school campus.

  • Signature Capture
  • GPS
  • Image Capture
  • Submission Editing
Read More
  • iPhone
  • iPad
  • Android
  • Windows
Read More
  • Quickbooks
  • Salesforce
  • Google Docs
  • Dropbox
Read More
*The Capterra SoftwareAdvice ​and GetApp logos are a service mark of Gartner, Inc. and/or its affiliates and is used herein with permission.*

Don't take our word for it...

“I’m not a tech guy and I was able to pick this thing up in probably an hour, and actually start to build apps. I’ve done them over lunch when I’ve gotten frustrated with a process that didn’t exist in our company. So for non tech people who’ve got a problem, the support here is awesome and I’d recommend it to anybody, not just in our industry.”

Dave Kramer, PennLine Service

Connect with one of our experts today.

We’ll help you put together the right solution for your needs.

Contact Us