Required Health Forms
Medically verified records must have:
- Your child’s name
- Your child’s date of birth
AND
- A unique health care provider or clinic stamp or another form of written healthcare provider documentation, such as a provider signature
Please provide a medically verified Certificate of Immunization Status (CIS) form
OR one of the following:
- Official immigration immunization records
- The immunization record printed from a healthcare provider, clinic, or hospital’s Electronic Health Record
- A written immunization record from a healthcare provider or clinic
- The immunization record printed from the Washington State Immunization Information System or the Immunization Information System of another state
Bellevue School District nurses track immunization status through the Washington State Immunization Information System. Please sign the Certificate of Immunization Status form to give us permission to update the state system, and turn it in to your child’s school with their medically verified immunization records.
For information on how to access your child’s Washington State vaccination records, please visit our Health Resources webpage.
For more information on School and Child Care immunizations, please visit the Washington State Department of Health’s webpage.
Certificate of Immunization Status:
Other languages are available on the Washington State Department of Health website.
Confidential School Nurse Information
Please complete this document when you register your student for school, or if there are any medical updates you would like us to know about at. Once completed, deliver this form to your school nurse.