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Student Immunization - Insurance Record (only for non-FSU students enrolled in IP Program and transient students)
Student Immunization Record
- The Student Immunization Record KEEP A COPY OF THIS DOCUMENT FOR YOUR RECORDS.
- Must be signed and dated by medical personnel OR custodian of records.
- The signer’s printed name is required.
- An official seal OR office stamp is required.
- Contraindications to receiving immunizations may be entered on the Student Immunization Record or attached on provider’s letterhead.
- Contraindications must be dated and signed by the provider.
- A statement of whether the contraindication is permanent or temporary must be included.
- Temporary contraindications must have an end date included.
- Corrections to immunization dates must be initialed and dated by the person authorizing the records. White out on the record is not acceptable.
- The document must be legible and in English. Illegible documents will not be processed.
- For international students, the Student Immunization Record can be completed in your home country.
Students born before January 1, 1957
Students born before January 1, 1957 are exempt from showing proof of vaccination against measles, mumps and rubella. Proof of vaccination or waiver of receiving the vaccine(s) against meningococcal meningitis and/or hepatitis B must be submitted on the Student Immunization Record.
Exempt Students: Students with the following student group designations in their Student Central accounts are exempt from the requirement to show proof of immunizations:
- ROP (Republic of Panama)
- Distance Learning (DL)
- Simply taking courses on line or by correspondence does not automatically make one a distance learning student.
- Check with your department if you think you should have the DL student group designation.
- As long as the DL designation remains active, the exempt status will apply.
- When either the ROP or DL student group is inactivated, the student must comply with immunization requirements.
All other students must show proof of the following:
- MMR (measles, mumps, rubella)
- Two vaccinations are required. The first immunization must have been given on or after the first birthday and after January 1, 1968. Immunizations given more than 4 days before the first birthday DO NOT count toward the two MMR requirement.
- The second immunization must have been given at least 28 days following the first MMR immunization.
- IgG titers showing proof of positive immunity to measles, mumps AND rubella may be submitted in place of the two MMR requirement.
- Lab slips showing POSITIVE immunity to each of the three diseases must be submitted with the Student Immunization Record.
- An equivocal or negative titer on any of the three tests will require the student to receive the MMR series.
- Meningococcal meningitis
- Proof of one immunization is sufficient. The CDC recommends a second immunization if the first was administered before the student was 15 years of age.
- This immunization may be waived on the Student Immunization Record. The student must hand write his/her initials, the date and signature in the spaces provided for the waiver. Electronically generated entries are not acceptable. All undated waivers will not be processed either.
- There is currently no titer to prove immunity to meningococcal meningitis.
- Hepatitis B
- Proof of the completed two- or three-shot vaccination series. If the records being submitted do not show the completed series, we recommend completing the series or waiving receiving the vaccine.
- This immunization series may be waived on the Student Immunization Record. . The student must hand write his/her initials, the date and signature in the spaces provided for the waiver. Electronically generated entries are not acceptable. All undated waivers will not be processed either.
- A titer showing immunity to hepatitis B may be submitted in place of proof of the vaccination. The lab document must be submitted with the Student Immunization Record.