Immunization Documentation Form
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1
2Florida International University
Immunization Documentation Form
Immunization Policy:
As a prerequisite to registration, Florida International University requires all students born after December 31, 1956 to present documented
proof of immunity to measles (Rubeola) and German measles (Rubella).
Acceptable Proof of Immunity consists of:
1.
Proof of two (2) vaccinations (doses) of MMR (Measles/Mumps/Rubella) received at least 28 days apart or two doses of
measles and one Rubella
2.
Vaccinations must have been received after your first birthday
3.
Vaccinations must have been received in 1969 or later
4.
Proof of immunity by way of a blood test lab result (Measles and Rubella Titer)
5.
A written statement from a physician (M.D. or D.O. only) documenting a diagnosis of measles (Rubeola). Must include date of
diagnosis, be signed by the physician and be on his/her official stationery. This is acceptable for measles only and does not
apply to Rubella
Acceptable Forms of Documentation:
The following documents are acceptable proof of immunity to measles and rubella, provided that the dates are acceptable and the
documents are signed and stamped by the health care provider:
•
Health Department Records
•
Childhood Immunization Records
•
School Immunization Records
•
Military Service Records
•
Laboratory test results demonstrating immunity to the disease
Can’t Find Your Immunization Documents?
If you are certain that you have received two doses of measles vaccine and one dose of Rubella vaccine in the past but cannot obtain
written documentation of the actual dates, it is recommended that you have a blood antibody titer test performed to determine if indeed
you are immune to both viral diseases. If you must register and cannot wait for the test results, you can safely receive an MMR vaccine
prior to the registration process and a second dose after 30 days--assuming you have no medical contraindications to receiving the
vaccine(s) as determined by your physician.
Where can I get immunized?
Vaccines can be administered by FIU’s University Health Services either at the University Park or at the Biscayne Bay Campus. For further
information you may visit our website at
and click the Immunization link.
Exemptions:
You will be exempt from the pre-registration immunization requirement if you meet any one of the following three criteria:
1.
You were born before January 1, 1957.
2.
Medical Exemption: To claim a medical exemption, you must produce a letter from a doctor, signed on his/her stationery,
stating the medical reason(s) why you are not able to receive the measles and/or Rubella vaccine(s) and for how long – a
permanent or temporary medical condition warranting exemption.
3.
Religious Exemption: To claim a religious exemption, you must produce a letter from a minister, priest, rabbi or other religious
leader, signed on his/her stationery stating the reason for exemption based on religious grounds.
All of the above documents requesting medical or religious exemptions must be received by the University Health Services at least four
weeks prior to registration.
Temporary Deferments
:
Temporary deferments are acceptable for the following conditions:
1.
Documented pregnancy or fertility treatment
2.
Documentation of breastfeeding
3.
Documented illness
Deferment status requests must be submitted to the University Health Services at least four weeks prior to registration and the request
must be signed by a physician, nurse practitioner or registered nurse and be on his/her official stationery.
11/16/2004
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