Free Oregon 53 05A PDF Template

Instructions on Writing Oregon 53 05A

Completing the Oregon 53 05A form is an important step in ensuring that your child meets the immunization requirements for school or childcare. This form collects essential information about your child's vaccination history and allows for exemptions if applicable. Follow these steps carefully to fill out the form correctly.

1. Gather necessary information about your child, including their full name, birthdate, and current mailing address.
2. Provide the names of the parents or guardians and a home telephone number for contact purposes.
3. List the required vaccines on the front side of the form. Enter the date (month/day/year) for each dose your child received, in the order they were given.
4. If your child received any vaccines that are not routinely given, write the date in the shaded boxes provided.
5. Check with your child's school or daycare to confirm which vaccines are required for their age or grade.
6. On the back side of the form, fill in the recommended vaccines your child has received, again listing the dates in order.
7. Sign the form to certify that the information provided is accurate. A parent, guardian, or an eligible student can sign.
8. If applicable, indicate any exemptions by checking the appropriate boxes. For nonmedical exemptions, attach the required documentation.
9. For medical exemptions, include a letter from your child's physician with the necessary details about the medical condition and contraindicated vaccines.
10. Make sure to complete both sides of the form before submitting it to the school or childcare facility.

What is the purpose of the Oregon 53 05A form?

The Oregon 53 05A form, also known as the Certificate of Immunization Status, is required by Oregon law to ensure that children have received the necessary vaccinations before attending school, preschool, child care, or home day care. This form collects essential immunization information, which may be shared with the Oregon Health Authority or local public health departments upon request.

What information do I need to provide on the form?

You will need to provide your child's full name, birthdate, mailing address, and the names and contact information of parents or guardians. Additionally, you must list each vaccine received by your child in the order they were administered, including the dates for each dose. If your child has any exemptions from required vaccinations, you will also need to indicate those on the form.

How do I handle exemptions on the Oregon 53 05A form?

Oregon allows both medical and nonmedical exemptions. For a medical exemption, you must submit a letter from a licensed physician stating your child's name, birthdate, medical condition, and the vaccines contraindicated. For a nonmedical exemption, you need to check the appropriate box on the form and provide documentation from a healthcare practitioner or proof of completion of an approved vaccine educational module.

What should I do if my child has not received all required vaccinations?

If your child has not received all required vaccinations, you can still submit the form, indicating which vaccines your child has received. It is important to consult with your child's school or daycare to understand which vaccines are necessary for their age or grade. If you choose to exempt your child from any required vaccinations, ensure that you complete the exemption section of the form.

Who can sign the Oregon 53 05A form?

The form must be signed by a parent, guardian, the student (if they are at least 15 years old), a medical provider, or a county health department staff member. This signature certifies that the information provided is accurate. If you add new vaccination information, you will need to resign the form to confirm the updates.

• Misconception 1: The Oregon 53 05A form is only for children attending public schools.

This form is required for any child attending school, preschool, child care, or home day care in Oregon, regardless of whether the institution is public or private.

• Misconception 2: Parents do not need to provide proof of immunization if they have an exemption.

Even if a parent opts for an exemption, they must still complete the form and submit the appropriate documentation to verify the exemption status.

• Misconception 3: The form does not need to be updated once submitted.

Parents must update the form whenever their child receives additional vaccinations. A new signature is required each time the form is modified.

• Misconception 4: Only a physician can sign the Oregon 53 05A form.

The form can be signed by a parent, guardian, or even the student if they are at least 15 years old. A physician's signature is not mandatory but is acceptable.

• Misconception 5: The form is only for documenting required vaccinations.

While the form primarily focuses on required vaccines, it also includes a section for recommended vaccines. Parents can document these as well, even though they are not legally required.

The Oregon Certificate of Immunization Status (Form 53 05A) is similar to the California Immunization Record. Both documents serve to track and verify a child's vaccination history, ensuring compliance with state laws regarding school attendance. The California form requires similar information, including the child's name, birth date, and vaccination dates. It also allows for exemptions, whether medical or personal, and mandates that parents or guardians provide accurate information about their child's immunization status.

Another comparable document is the Texas Immunization Record. This form is used to document vaccinations for children in Texas and is essential for school enrollment. Like the Oregon form, it collects data on the child's name, date of birth, and vaccination history. The Texas form also provides space for medical exemptions and requires a parent or guardian's signature to confirm the accuracy of the information provided.

The Florida Certificate of Immunization is another document that parallels the Oregon 53 05A form. This certificate is necessary for children attending school in Florida. It includes sections for required and recommended vaccinations, much like the Oregon form. Parents must fill out the child's personal information and vaccination dates, and they can also indicate any exemptions, ensuring that the school has a complete record of the child's immunization status.

To effectively safeguard your business information, consider utilizing a comprehensive Non-disclosure Agreement template, which clarifies the terms and responsibilities involved in maintaining confidentiality. You can find a useful resource at this link.

In New York, the Immunization Record serves a similar purpose. This form collects essential information about a child's vaccinations and is required for school entry. It shares features with the Oregon form, such as sections for listing immunizations in chronological order and the need for a parent or guardian's signature. Additionally, it allows for medical exemptions, aligning with the approach taken in Oregon.

The Michigan Immunization Record is another document akin to the Oregon Certificate. It is used to maintain a child's vaccination history and is required for school attendance. This form collects similar data, including the child's name, birth date, and vaccination details. Like the Oregon form, it provides options for exemptions and requires a signature from a parent or guardian to validate the information.

The Illinois Certificate of Child Health Examination shares similarities with the Oregon 53 05A form. This document not only records immunizations but also includes a health examination section. It is mandatory for children entering school in Illinois. The form requires detailed information about the child's vaccinations and allows for medical exemptions, ensuring that schools have the necessary health information for each student.

The Pennsylvania Immunization Record also aligns with the Oregon form. This document is required for school attendance and collects comprehensive data on a child's immunization history. Parents must provide the child's name, date of birth, and vaccination dates, similar to the Oregon form. It also allows for exemptions and requires a parent's signature to confirm the accuracy of the information provided.

Lastly, the Washington Certificate of Immunization Status is comparable to the Oregon 53 05A form. This document serves to verify a child's vaccination history for school enrollment. It includes sections for both required and recommended vaccines and allows for exemptions. Parents must complete the child's information and provide a signature to ensure the accuracy of the immunization record, reflecting the same requirements found in Oregon.

When filling out the Oregon 53 05A form, it's important to ensure accuracy and completeness. Here are some guidelines to follow:

• Do provide complete information: Make sure to include your child’s full name, birthdate, mailing address, and your contact details. This information is essential for any follow-up questions.
• Do list immunizations in order: Record each vaccine dose in the order received, including the exact dates. This helps maintain a clear and accurate immunization history.
• Do check for required vaccines: Confirm which vaccines are necessary for your child’s age or grade by consulting with their school or daycare.
• Do sign the form: Your signature certifies that the information provided is accurate. If you add more information later, be sure to sign again.

• Don’t leave fields blank: Incomplete information can lead to delays or issues with your child’s enrollment in school or daycare.
• Don’t forget to complete both sides: Ensure that all sections of the form, including the back, are filled out before submission.
• Don’t ignore exemption requirements: If you are applying for a medical or nonmedical exemption, make sure to include the necessary documentation.
• Don’t use outdated information: Always provide the most current immunization history and contact details to avoid complications.