Promoting Student Health For Student Success

School nurse and student


MDH New Immunization Form

April 2019

The Minnesota Department of Health has introduced a new Immunization Form to help parents document their child’s immunization history or medical/non-medical exemption. The new form will also assist schools in collecting the immunization information they need to comply with the School Immunization Law and complete the Annual Immunization Status Report (AISR). There have been no changes to the law or requirements, only improvements to the form.

The new form can be found on Vaccines for Infants, Children, and Adolescents ( The new form is meant to be distributed with our Are Your Kids Ready? And When to Get Vaccines, Birth to 16 Years document that is also available on that web page.

Improvements to the immunization form include:
▪ Consolidation to a single form for school, child care, and early childhood education.
▪ Clearer instructions for parents.
▪ Formatting changes to make the form more readable.
▪ Creation of a table for exemptions so parents can select the specific vaccine for which they are requesting an exemption.
▪ Removed certain signature requirements. Signatures and notarization are still required for non-medical exemptions, and a health care practitioner signature is still required for disease history and medical exemptions.

Transitioning steps:
▪ In the 2019-2020 school year
▪ The new Immunization Form is available to all schools wanting to use it.
▪ Schools can still use the previous Student Immunization Form, so if you already sent it out, no need to send the new form.
▪ Reporting the meningococcal booster dose for 12th grade students will be optional.
▪ In the 2020-2021 school year
▪ All schools should use the new form.
▪ Every school will be required to report the meningococcal booster dose on all 12th grade students.

In the works:
▪ Translations in other languages: Amharic, Hmong, Karen, Russian, Spanish, Somali, and Vietnamese.
▪ We will post these on Vaccines for Infants, Children, and Adolescents ( when they are completed.

Lisa Harris
School & Childcare Reporting Outreach &Coordination | Education &Partnership Unit
Minnesota Department of Health
Office: 651-201-3523