Ensuring that children are vaccinated according to state laws is a paramount responsibility for parents and guardians, a task where the Georgia Department of Public Health Form 3231 plays a crucial role. This Certificate of Immunization is a comprehensive document that records a child's vaccination history, a requirement for enrollment in any school or childcare facility across Georgia. Not only does it list mandatory vaccines such as DTP, DTaP, DT, Td Polio, Hepatitis B, Tdap, MCV4, among others for school or childcare attendance, but it also mentions vaccines recommended for optimal health. Form 3231, last revised in July 2014, mandates inclusion of the child's name, birthdate, and the parent or guardian's name, alongside the vaccination dates, making it a personalized immunization record. It stipulates requirements for children entering K through 6th grade and those in 7th grade or higher, reflecting the state's commitment to public health through vaccination. The form also accommodates medical exemptions, should they exist, with specific sections for diagnosed serology plus history, and details any medical exemptions, thereby enshrining in policy understanding and flexibility for individual health needs and considerations. Compliance is not merely encouraged but required under Georgia law (O.C.G.A. § 20-2-771), with penalties for failure to comply, emphasizing the seriousness with which the state regards this aspect of public health. The logistical aspects of maintaining, updating, and transferring these records are also outlined, ensuring that each child's vaccination record is current, accessible, and within legal compliance at all times. Thus, Form 3231 serves not only as a record but also as a critical checkpoint in the safeguarding of public health in educational and childcare settings across Georgia.
| Question | Answer |
|---|---|
| Form Name | Form 3231 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | ga form 3231 printable, ga form 3231, form 3231 pdf, form 3231 georgia |
Rev. 07/2014 |
Georgia Department of Public Health |
Form 3231 |
CERTIFICATE OF IMMUNIZATION
Child's Name (Last name first) |
Birthdate |
(Optional) Parent/Guardian Name (Last name first)
Date of Expiration
(Next required immunization or review of medical exemption due.)
(Fill in X)
Complete For K through 6th Grade
Child must be ≥ 4 years and have met all requirements for school attendance.
(Fill in X)
Complete For 7th Grade or higher
Fulfills requirements K through 6th grade AND must have Tdap and MCV4 documented
Unless specifically exempted by law, Georgia law (O.C.G.A. §
VACCINE
DATE |
DATE |
DATE |
DATE |
DATE |
MM DD YY MM DD YY MM DD YY MM DD YY MM DD YY MM
DATE
DD YY
Total Doses
Diagnosed
Serology +
History
Med. Exemption
Required Vaccines for School or Child Care Attendance
DTP,DTaP, DT,Td |
Polio |
Hepatitis B |
Tdap |
MCV4 |
HIB |
(Under Age 5) |
PCV |
(Under Age 5) |
Measles |
Mumps |
Rubella |
Hepatitis A |
(Born on/after 1/1/06) |
Varicella |
Recommended Vaccines (For Information Only)
Rotavirus
HPV (3 doses)
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Influenza |
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Td (booster) |
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Notes: |
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Printed, Typed or |
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A licensed Georgia physician, Advanced Practice Registered Nurse, Physician Assistant or |
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Stamped Name, |
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qualified employee of a local Board of Health or the State Immunization Office is responsible for the |
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content of this certificate. All dates must include month, day and year. In cases of natural immunity or |
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Address and |
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Medical Exemption, the 4 digit year of infection, test or exemption must be filled in the appropriate |
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box(es). The certificate is NOT valid without name and birthdate of the child, date of expiration |
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Telephone # of |
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OR "X" in Complete for School Attendance box, legible name and address of the physician, |
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Advanced Practice Registered Nurse, Physician Assistant or health department, certified by |
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Licensed |
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signature and a date of issue. A school or facility official is responsible for keeping a current valid |
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Physician |
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certificate on file for each child in attendance. A certificate must be replaced within 30 days after |
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or Health Dept. |
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expiration. When a child leaves or transfers to another facility, the Certificate of Immunization |
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should be given to a parent/guardian or sent to the new facility. |
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Certified by (Signature/Signature Stamp) |
Date of Issue |