Form H.2.5 - Delinquent Immunizations, Notice Of

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DELINQUENT IMMUNIZATIONS, NOTICE OF
H-2-5 Revised Feb. 2012
Office of the School Nurse
DATE: _____________________
MEMORANDUM FOR: Parents/Sponsor of _______________________________________________________
SUBJECT: Delinquent Immunizations and/or Immunizations due
1. DoDEA Manual 2942.0, March 2004 states that students enrolled in DoDEA Schools shall meet specific
immunization requirements.
2. Our records indicate that your child needs additional immunizations to meet the meet the DoDEA minimum
requirements for continued enrollment. The following immunizations are missing:
_____ Diphtheria/Tetanus/Pertussis:
after fourth birthday or dose # _____
_____ Hepatitis A: dose # 1 _____ #2 _____
_____ Hepatitis B: dose # 1 _____ #2 _____ #3 _____
_____ Measles/Mumps/Rubella: dose # 1 _____ #2 _____
_____ Meningococcal Conjugate Vaccine dose # 1 _____ (at age 11 years)
dose # 2 _____ (at age 16 years)
_____ Polio Vaccine
after the fourth birthday or dose # _____
_____ Tetanus/Diphtheria/Pertussis-Booster (at age 11 years old)
_____ Varicella (Chicken Pox): _____ reliable history or dose # 1 _____ #2 _____
_____ Other: ______________________________________________________________________________
_____ A copy of your child’s up-to-date immunization record.
3. Tuberculosis Testing: The frequency of PPD (TB) testing is directed by the local medical command. A PPD is
required every _____ years in this community. Annual TB questionnaire missing: _____
PPD due: _________________________
PPD results needed: _________________________
4. Annual Influenza vaccination requirement is determined by local medical authority. If required in your
community, proof of vaccination is to be presented to school officials NLT 30 days after the local medical
authority notifies school administration that the vaccine is available.
Date available: _________________________
5. As of July 2010, DoDEA adopted the Interstate Compact on Educational Opportunity for Military Children.
The compact language reads that “compacting states shall give thirty (30) calendar days from the date of
enrollment for students to obtain any immunization(s) required by the receiving state. For a series of
immunizations, initial vaccinations must be obtained within thirty (30) days.”
6. For an immunization that requires a series of vaccinations to complete immunity, the next in the series is due
NLT 10 days after the due date as determined by the Advisory Committee on Immunization Practices (ACIP)
series spacing requirements.
7. DoDEA Manual 2942.0, March 2004 requires parents of currently enrolled students to provide the school with
documentation satisfying immunization requirements. To avoid disenrollment of your child from school, your
child’s records need to be reviewed by their health care provider and proof of required immunizations received
presented to school officials.
8. Bring your child's updated immunization record to school as soon as possible, but no later than
_________________________.
9. If you have any questions, please call
.
___________________________________

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