General Immunization FAQs

Provides an overview of questions related to assessment, audits, exclusions, exemptions, timing, intervals/grace periods, NYSIIS/CIR Immunization Registries

This page has been updated to reflect changes in the 2018-2019 Immunization Requirements

Frequently Asked Questions for Public Health Law (PHL) §§ 2164 and 216810 N.Y.C.R.R. Subpart 66-1 School Immunization Requirements (NYSDOH 8/2015)

ASSESSMENT OF IMMUNIZATIONS

Do students who entered school prior to 2018-19 who met proof of immunity requirements under the prior regulations, have to meet the new requirements?

Yes, students in Pre-K through grade 9 will need to be compliant with current requirements. Depending on their status, some students may need to obtain additional vaccinations or serologic testing.

No, for students in grades 11 and 12. Children enrolling in grades 11 & 12 in the 2018-19 school year are deemed in compliance through graduation if they met the immunization requirements of regulations in effect prior to June 30, 2014. The Immunization Requirement Chart for the 2013-2014 School Year may be viewed on the A-Z Resource page, under “I” for Immunization. This may be used as a resource to determine what students in Grades 11 & 12 will need for 2018-2019.

Do intervals between doses of required vaccine series need to be reviewed for appropriate spacing?

Yes, they must be in accordance with the ACIP catch-up schedule in the 2018-19 school year.

• Pre-K, H grades 1-4 and grades 6-10 for Polio and Varicella

• Pre-K thru grade 10 for DTaP, Hepatitis B, and MMR

• Pre-K for Pneumococcal Conjugate (PCV) and Haemophilus Influenza type B (HIB)  

 

How can I calculate how old a student was on a particular date in the past? Where can I find old calendars to help me in my review?

The website: timeanddate.com has archived calendars and better yet can search for the time between two different dates. You can use this to determine if an immunization dose is valid or invalid based on the time between doses.

If a student repeats a grade, must they comply with the immunization requirements for that repeated grade?

Yes, students must comply with the grade level requirements for immunizations.

At what age does a student no longer need to provide proof of immunity?

All children between the ages of 2 months and 18 years must show proof of compliance with immunization requirements under Public Health Law Section 2164. Once a student reaches age 18, he/she is no longer required to show proof of immunity. Resource: NYSDOH Immunization Book FAQ

AUDITS

What can school staff expect if their school is selected for an immunization record audit?

NYSDOH staff conducting audits of school immunization records will provide support and assistance during this transition period for schools that are in the process of complying with the revised regulations.

What is the protocol for school immunization audits? 

Anyone auditing school records must understand the FERPA requirements. The protocol for school audits is that student records be redacted in accordance with FERPA.  This means removing or obscuring any personally identifiable information (PII). They cannot ask to see records that show student names or any other PII.

May a NYSDOH auditor require a school to release the student's name or any other personally identifiable information as any part of the audit process?

No. The only information which may be included is the date of birth to allow the auditor to assess timing validity of the immunization. If a NYSDOH auditor requests the nurse provide a record which includes personally identifiable information the nurse should refuse, inform the administrator and contact:

Karen Hollowood RN, BSN, MSEd, Associate in School Nursing
Office of Student Support Services, New York State Education Department
Student Support Services:
By phone: (518) 486-6090    By fax: (518) 474-8299
By email: StudentSupportServices@mail.nysed.gov

What is personally identifiable information?

The regulations define "personally identifiable information" so that it includes, but is not limited to:
a. The student's name
b. The name of the student's parent or other family member
c. The address of the student or student's family
d. A personal identifier, such as the student's social security number or student number
e. A list of personal characteristics that would make the student's identity easily traceable

What is required if my immunization records are selected to be audited? 

All personally identifiable information (PII) must be removed from the student records before auditors can review the records according to the Family Education Rights and Privacy Act (FERPA). Records will need to be photocopied with the personally identifiable information cut off or completely blacked out. This may require additional clerical assistance for the school nurse. For the purpose of immunization audits, the NYS Education Department has determined that the student’s birth date may remain on the record so that it can be determined if the immunizations were given at the appropriate ages.

Are there any tips to be proactive in preparing for Immunization Audits?  To proactively prepare records which may be needed in the event your district is chosen for an audit, you may consider creating the following folder system:  

    • Create a separate immunization folder system for each grade in your school.
    • Make a copy of the immunization record before filing it in the student's cumulative health folder.
    • Place this copy of the immunization record for each student in the appropriate grade -immunization folder in alphabetical order. This will allow you to easily locate these records upon notification that you will be audited. You will not have to search the main health folder.
    • Make a copy of each requested immunization record and remove personally identifiable information except for the birth date. Place the unaltered original record back into the folder so that the folder can be advanced to the next grade level at the end of the year. Updated immunization records received should replace older ones. Once you have this in place it can be used throughout the student’s tenure in the district.

What might the auditor ask to view?

    • Whether the records were signed and stamped
    • Whether the student has a NYSIIS record
    • A copy of the school board policy regarding immunizations
    • A list of susceptible students  (only redacted information may be shared - DOB only)
    • A list of the students in progress 
    • Upcoming appointment cards/notes

If a student has a medical or religious exemption in place of an immunization record, how would the auditor know that there is an exemption on file?

The document verifying the exemption should have the student’s name and all other personally identifiable information (except the DOB) redacted so the auditor can see that an exemption is on file. 

If the auditor requests personally identifiable information, who can I contact?

NYSDOH, Bureau of Immunization, School Assessment Unit at 518-474-1944
NYSED, School Health - Karen Hollowood or Martha Morrissey 518-486-6090
NYSCSH 585-617-2380 

DOCUMENTATION / PROOF OF IMMUNIZATIONS/RECORD REVIEW

If a parent does not produce an immunization record, may the school nurse ask the private provider directly for the record?

No.  Under HIPAA, a private provider may not release a health record or immunizations without parent permission.  Permission may be in writing or verbally to the provider. Click here to view the new regulatory change which allows the parent to make a verbal request.

A health care practitioner must sign the certificate of immunization. What persons are included in this category?

Health practitioners are persons authorized by law to administer an immunization to a child under 18. This includes a physician, nurse practitioner, physician assistant, nurse-midwife caring for a pregnant student, registered professional nurse (RN), and licensed practical nurse (LPN) under the direction of an RN [10NYCRR 66-1.1(e)]. Ideally, the signature would be by the administering health care practitioner, but if this is impractical/impossible, such as an immunization registry record from another state, then it would be acceptable to be signed by a NYS health care practitioner.

What is considered acceptable proof of immunizations?
The following documents are proof of compliance:

  • Original signed certificate of immunization
  • New York State Immunization Information System (NYSIIS)
  • New York Citywide Immunization Registry (CIR) immunization record
  • Immunization records from a previous school
  • An out of state immunization registry specifying the dates and products administered
  • An official record from a foreign nation may be accepted without a health practitioner’s signature or a physician, physician assistant, or nurse practitioner diagnosed history of varicella.
  • An electronic health record 
    • A copy of immunization records from a previous school which includes who administered the immunization agents, the products administered (products administered can mean either the vaccine or its brand name) and dates of administration.
  • Serologic proof of immunity can be accepted in place of vaccination only for the following diseases: measles, mumps, rubella, varicella, hepatitis B and all 3 serotypes of poliomyelitis found in the polio vaccines (in early 2017, the US stopped testing for serotype 2, therefore, unless all 3 serotypes were tested prior to 2017, there will not be evidence of immunity for polio with all 3 serotypes and will not be accepted).

What documents, considered official Certificates of Immunization, must have a signature?

Health care practitioner record which is signed by a practitioner licensed in New York State.  Under the revised regulations, an immunization record must be signed, either by handwritten signature, electronic signature, or signature stamp.

What documents, considered official Certificates of Immunization, are acceptable without a signature?

The following records are acceptable without a signature: under the revised regulations: Records acceptable without a signature
• NYSIIS or CIR record
• Official registry record from another state
• Electronic health record
• Official record from a foreign nation
• Official school health record (paper or electronic) which includes the name of immunization, date given, and name of the health care practitioner who administered the immunization agents as required in Immunization Law 66.1.6

If the student has unsigned paper record and has all required does of vaccines at the correct intervals, then he/she may continue to attend school, but the student's parent or guardian should be advised to obtain a healthcare provider's signature on the immunization record as soon as possible. 

If an immunization record from a health care provider's office has a stamp on it, is it considered acceptable proof of immunity for school immunization requirements?

Yes. Under the revised regulations, an immunization record must be signed, either by handwritten signature, electronic signature, or signature stamp. If the student has all required doses of vaccines at the correct intervals, then he or she may continue to attend school, but the student’s parent or guardian should be advised to obtain a health care provider’s signature on the immunization record as soon as possible. 

If a medication order with a printed statement on the bottom stating “ Signed Electronically by ( Dr.’s Name, title, date and time), is that acceptable?

Yes, this is acceptable. The only responsibility of the nurse is that if she believes the document to not be authentic to verify. This can be done once by calling the office and verifying one record as signed in that manner then placing a copy of that record- with a notation verified by (name of caller)  on (date)  in a binder for future reference from that office. It would not be acceptable if the name was not someone licensed to give immunizations (like a secretary)

If the student's immunization record does not include the actual dates of administration, is the record acceptable?

No. The school immunization regulations state that the certificate of immunization must specify the vaccines administered and the dates of administration.  A record that only lists that child’s age when the vaccines were given is not acceptable for school entry or attendance.  If possible, the parent or guardian should work with the child’s provider from the country of origin to obtain a record documenting the dates the vaccines were given.  If the dates cannot be obtained, then the child will need to be re-vaccinated.  Serologic testing would be acceptable as proof of immunity for measles, mumps, rubella, hepatitis B, varicella, and polio (if all 3 poliovirus serotypes are positive), but they would need to be re-vaccinated for all other vaccines if dates cannot be obtained.

If a student is enrolled in a BOCES program, who is responsible for obtaining immunization records and enforcing compliance, the district or the BOCES?

According to the NY State Education Department, both are responsible. When the student enrolls in the public district, it is the district's responsibility to obtain proof of immunization. When the student is transferred to the BOCES program, authorities at the center should require proof of immunization from the sending school as part of the placement process. NOTE:  The student records should be kept at the education site that the student attends full time.  For students attending a part-time program, the home school retains responsibility for the cumulative health record.

If a student is enrolled in a partial day BOCES program, who is responsible for including the student in the mandated annual immunization school survey form?

The home school district is responsible for counting the student on the form. If the student attends BOCES for the full day, then BOCES and the home school district should decide which one will submit the survey data on the student. Most BOCES do send a separate form, but the DOH reports that a number of local school districts send the information. It's important that the school nurse be sure that the student is counted on one survey or the other.

Are homeless students required to present proof of immunization in order to be admitted to school?

No.  Under the Federal Law, The McKinney-Vento Act, homeless children and youth are to have equal access to a free, appropriate, public education. Such students are entitled to enrollment in school even if they lack the documents normally needed, including proof of immunization. Every school district, BOCES, and charter school is required to have a liaison for homeless students whose duties include making eligibility determinations on a case-by-case basis and to help the student obtain the immunization records or immunizations.

If a foster child cannot provide immunization records may we admit them?

If it is determined to be in the best interest of the foster child to leave the school in which the child was enrolled when placed into foster care or the school most recently attended, the new school, or the school district where the foster placement is located should immediately enroll the child, even if the child does not have the documents normally required for enrollment, such as immunization records, birth certificate, and educational records.

Do home-schooled students who wish to participate in testing or other activities on school premises of a public or nonpublic school have to present proof of immunization? 

No.  Public Health Law §2164 which require parents to submit proof of immunization prior to admission of their children to a school does not apply to students being educated at home. However, in the event of the outbreak of a disease for which immunization is required, parents of children on home instruction must produce proof of immunization or the children must be denied access to the school building.

Do home-tutored students have to present proof of immunizations?

Yes, if the student is being tutored in the home – it is because for some reason (medical –psychological – physical) the child cannot attend school.  However, to be eligible for home tutoring, the child would need to be enrolled and therefore need immunizations (unless they have a valid religious or medical exemption). 

If a parent provides the facility with the immunization card received when a child was born, and it has an administrator signature on it, can this be used as proof of vaccines?  

Yes. If the card was prepared and signed by the health practitioner who administered the immunizing agents and specifies the products administered and the dates of administration, then it would meet the requirements for a certificate of immunization stated in Section 66-1.6.  
(NYSED Guidelines)

Is a school health record from a previous school acceptable proof of immunity?

Yes, under Section 66-1.5, a school health record from a previous school which contains all of the information specified in subdivision (a) of Section 66-1.3 is acceptable proof of immunity. It must include who administered the immunization agents (name of provider or office), the products administered (either the vaccine or its brand name) and dates of administration. This must be sent directly from the school.

What records are acceptable proof of immunizations for transferring students?

When a student transfers from one school to another, it is incumbent upon the school that is accepting the transferee to request from the school the student last attended, a copy of the student’s cumulative immunization record and a copy of the health care providers immunization record of such student. If the school that the student last attended does not have a copy of the health care provider’s immunization record, then the accepting school should document this. A record from the Immunization Registry is a valid original record.

Is a physician, physician assistant or nurse practitioner's diagnosis of disease acceptable proof of immunization for school enrollment?

The only disease for which proof of immunity can be met through provider diagnosis is varicella

Is an electronic signature or a print out from the provider's office, with the provider's name, address on it and their name printed on the bottom with the date acceptable?

The current regulations state that NYSIIS, CIR, official registry record from another state, electronic health record (acceptable only if sent directly from the provider to verify contents) and an official record from a foreign nation do not require a signature. New York City rules differ so please check with them what they will or will not accept.

If the dates in the NYSIIS record are incorrect may we contact the provider to clarify? 

Yes.  Examples of clarification would include contacting the provider if the record indicated:
• Date of administration errors where the immunization was recorded before the student was born or transposed month-day-year.
• Duplicate immunizations administered on the same day.

EXCLUSION / IN PROCESS

If a child is not in compliance with immunization requirements for school entrance or does not present acceptable evidence of compliance, should we refuse to admit the child to school?

Yes. The principal or other person in charge of any school is required to do this. However, when a child/family has shown a good faith effort to obtain the necessary documentation, Public Health Law (PHL), Section 2164.7 allows for the provision of a limited period of attendance. The basic “grace period” is 14 days. However, when the child is transferring from another state or country, the grace period may be extended to not more than 30 days. The Questions and Answers from the Immunization Survey Booklet address many questions school nurses raise.

What should be provided to parents/guardians of students who do not meet the immunization requirements and cannot be admitted to school, or permitted continued attendance?

They should receive a verbal explanation and a written copy of the school policy; written documentation specifying the immunizations their child is missing, and information on where to obtain the missing immunizations.

What should schools do if a child is refused admittance or continued attendance due to lack of immunizations?

Schools must notify the local health department and must provide the local health department with the name and address of the child and the immunizations that he/she lacks. The school must also provide, with the cooperation of the local health department, for a time and place at which the required immunizations may be administered within 2 weeks. If the local DOH cannot provide the shots in a timely manner, please notify the state DOH and the Student Support Services at NYSED.

If a teacher has no immunizations and there is an outbreak of a vaccine preventable disease, is that teacher excluded from school?

The control of communicable disease in the community is a public health function and under the local health department jurisdiction.  Guidance for control is based on CDC and NYSDOH recommendations.  The guidance is available at: http://www.health.ny.gov/prevention/immunization/providers/outbreak_control_guidelines.htm

Can a school deny school entry/attendance if a student if he or she has not received at least the first vaccination in a series?

For school entrance and attendance, a student must provide proof of immunity or a valid medical or religious exemption or meet the definition of in process. Schools are required to exclude students who do not meet the requirements of one of those four categories.

Can a school exclude a child who has an appointment for a vaccination?

If a student meets the definition of "in process" as set forth in Section 66-1.1(j), a school may not exclude the student. “In process” is now defined as a child that has received at least the first dose of each required vaccine series and has age appropriate appointments to complete the series according to the ACIP catch-up schedule. The previous immunization regulations did not define the acceptable intervals between required doses of vaccine.

Do we need to get proof of "In Process" for immunizations which are part of a series and have a range of which the child has not yet exceeded?

No, this requirement only applies to students who are not up to date and therefore on the catch up schedule. Students who have the age appropriate dose for their grade level need no further documentation.

Must partially immunized students who are in process be allowed to attend school?

Yes, if they are in process which is defined as:

    • Having received at least the first dose in each immunization series required by PHL §2164
    • Having age appropriate appointments to complete the immunization series according to the catch-up schedule of the Advisory Committee on Immunization Practices (ACIP
    • Are obtaining serological test(s) within 30 days of notification to the parent/guardian of the need for such tests.
      • If a child is obtaining serologic tests, he/she has a total of 30 days to provide test results and if necessary (based on negative test results), appointment dates to begin or complete the vaccine series within 30 days. 
      • Parents/guardians are required to present proof of future appointments such as an appointment card, receipt, or other statement from the provider’s office that includes the date(s) of appointments with a specified health care provider or facility for completion of the required immunizations or serological test(s). 
      • The school should follow and track such student’s immunization status and follow through on appointments.

Is a student with NO record of any immunizations considered to be "in process"?   

To be "in process" a child must have "received at least the first dose of all required immunization series required by section 2164 of the Public health law and has age appropriate appointments to complete the immunization series." If a child has not had at least the first dose, he/she would not be considered "in process" and would be required to get the shot in 14 days.

EXEMPTIONS TO IMMUNIZATIONS

Does NYS allow exemptions to immunizations?

Yes.  The following exemptions are allowed with proper documentation:
• A medical exemption for a valid contraindication to vaccination exists. The medical exemption must be certified by a physician licensed to practice in the State of New York and must specify which immunizations are contraindicated and why.
• A religious exemption is a written and signed statement from the parent or guardian stating that they object to their child's immunization due to sincere and genuine religious beliefs which prohibit the immunization. The principal or person in charge of the school may require supporting documents. The school decides whether to accept or reject the request for a religious exemption.

Where can I find forms and information on requesting medical or religious exemptions?

    • Medical Exemption for Required Immunization Form-Provides two sample forms which may be used by the private medical providers to document request for exemption from immunizations due to medical contraindication. 
    • Religious Exemption Request Form for Parent/Guardian-This form may be used by a parent or guardian when applying for a religious exemption to Public Health Law. Religious exemptions are handled by the building principal.
    • How to Handle Requests for Medical Exemptions to Vaccines-Provides an overview of the NYS Immunization Law and guidance for medical directors in reviewing and responding to requests in accordance with national medical standards and best practice. It is available on the Medical Directors Resource Page.

What should school nurses do if a child has a religious or medical exemption from immunization?

A list should be immediately available and include all children with exemptions from immunizations. Best practice would indicate parents be informed in writing of possible complications of the disease and the district's policy of exclusion of unimmunized students during an outbreak.

Must a medical exemption be renewed annually for immunizations?

Yes, a medical exemption must be renewed annually under the NYSDOH Immunization Requirements. This allows a physician to re-evaluate the need for an exemption based on student’s current health status. The principal or person in charge of the school may require additional information supporting the exemption. This applies to all schools in NYS.

Must a medical exemption be written by a physician?

Yes.  A medical exemption must be certified by a physician licensed to practice in NYS per PHL 2164(8) and DOH 66-1.3. A physician who is licensed in a bordering state and who resides near a border of New York State, provided their practice is limited in this state to the vicinity of that border and the physician does not maintain an office or place to meet patients or receive calls within New York State may also submit the Medical Exemption.

Has NYSDOH created a standardized medical exemption form?

Yes. NYSDOH has created a standardized medical exemption form which can be found at the following NYSDOH web page: http://www.health.ny.gov/forms/doh-5077.pdf.

What is a religious exemption? 

A religious exemption is a written and signed statement from the parent, parents or guardian of such child, stating that the parent, parents or guardian objects to their child's immunization because of sincere and genuine religious beliefs which prohibit the immunization of their child. The principal or person in charge of the school may require supporting documents. The school decides whether to accept or reject the request for a religious exemption.

Can a child be admitted to school if the parents are claiming a religious exemption?

Yes.  A child can be admitted to school if a parent or guardian has submitted a religious exemption statement and it has been accepted by the School. The student may remain in school until the decision is made - there is no time frame.

Does a religious exemption written by a parent have to be notarized? 

No. The district may require notarization, but it is not mandated.

If a student receives a religious exemption from their home school but then is placed at a BOCES school, do they need to re-do the religious exemption?

The home school decides if the religious exemption is in place if it is a part-time BOCES placement. If it is a full-time placement, the BOCES decides.  If going from a full-time BOCES to a new BOCES (different BOCES, not just different program within the same BOCES), the student would need to reapply.

Does a religious exemption need to be reviewed annually?

No.  Religious exemptions are not required to be reviewed annually. If the student leaves the district for another school in New York State, the process would need to be repeated.

Where can a parent find information on filing an appeal if a religious exemption is denied?

Education Law §310 allows those who disagree with an action taken at a school district meeting or by school authorities to appeal to the Commissioner of Education for a review of such action. This link to the NYSED appeals page tells how to file an appeal.

GRACE PERIOD

Is there a 14 day grace period for a child to be in compliance with immunization requirements?

Yes.  Public Health Law 2164 and Section 66-1.4 of the regulations require that a child shall not continue to attend school for more than 14 days (30 days may be granted for children from out of the state or out of the country) unless the school has received a certificate of immunization, documentation that the child is "in process," or a medical or religious exemption.

If a "grace period" is granted, are these calendar days or school days?

They are calendar days.

What is the “4 Day Grace Period" and how does it apply?

Immunizations are considered valid if the date of administration is within 4 calendar days of the recommended minimum age or interval. This is defined in PH Section 2164 Rules and Regulations 66-1:1 here.  This is the CDC document which explains this.  See Grace Period below.

IMMUNIZATION STATUS (Fully Immunized and In-Process)

What does it mean to be "fully immunized" in the updated immunization regulations?

"Fully-immunized" is defined as appropriate doses of vaccine received as determined by the ACIP schedule for those immunizations required by PHL § 2164

What does “in process” mean? 

“In process” is defined as a child that has received at least the first dose of each required immunization vaccine series and has age appropriate appointments to complete the series. The ACIP catch-up schedule is used to determine appropriate appointment spacing. There is a 30 day allowance for serologic testing results. If results are negative, appointment dates for vaccine administration must be provided with 30 days from serology results.

Can a child remain in school if they are “in process?”

Students whose immunization records show invalid intervals between doses of vaccine as specified by the Advisory Committee on Immunization Practices (ACIP) catch-up schedule can be considered "in process". Children who are not fully immunized can continue to attend school if they are in the process of completing the ACIP catch-up schedule.  A school may not refuse to admit a child based on immunization requirements if that child is “in process.”
 

NYSIIS

If a dose of vaccine was administered consistently with the ACIP schedule, but NYSIIS indicates it is "Not Valid", should the school accept the dose as valid?

Yes, even if NYSIIS indicates it is “Not Valid” or that additional doses are needed, the school immunization requirements are based on the ACIP schedules, not NYSIIS. In addition, please note that although NYSIIS is a valuable tool to assist schools in determining if doses of vaccine are valid, NYSIIS is only as good as the data that is reported into it, and there can be data entry errors, typos, and computer glitches that lead to doses being incorrectly identified as “Not Valid” or requiring additional doses when in fact they were given correctly according to the ACIP schedule.  Schools should continue to provide NYSDOH feedback to identify glitches and programming errors in NYSIIS, so they can be corrected. 

 

SEROLOGY

Is serological evidence of immunity acceptable proof of immunization for school enrollment?

A positive serologic test can be accepted as proof of immunity for school enrollment only for the following diseases: measles, mumps, rubella, varicella (chickenpox), hepatitis B and all three serotypes of poliomyelitis found in the polio vaccines. NEW Polio serologic tests that do not report all three serotypes cannot be accepted in place of vaccination. In addition, polio antibody tests which only report a combined antibody titer but do not provide results for each individual serotype will not satisfy the regulatory requirements. However, previous serologic testing, which was obtained when testing for poliovirus type 2 was still available in the United States, can still be accepted if the test documents a separate positive result for each of the three serotypes.

Updated 7/27/18