Proof of Immunity Requirements and Examples

Summer Program Requirements

All medical records must: 

1. Be legible and in English (original documentation may be in a foreign language with translation attached).
2. Show patient name and date of birth consistent with an official government ID (i.e. passport or driver’s license). 
3. Show medical clinic, pharmacy, or laboratory contact information. 
   1. The Figure 1vaccine record below meets documented proof of immunity requirements. 
   2. The Figure 2 vaccine record below does not meet documented proof of immunity requirements. 
4. Lab results must be on an official report indicating that the result shows immunity to measles (rubeola). 
5. Vaccine records must show: 
   1. The vaccine provided. 
   2. The number of doses (at least one is required, two recommended). 
   3. The date(s) provided. 

Figure 1

Following is an example of a vaccine record that meets documented proof of immunity requirements:

Figure 2 

Following is an example of a vaccine record that does not meet documented proof of immunity requirements: