Ensuring children are immunized before attending school, preschool, child care, or home daycare is a cornerstone of public health policy in Oregon. The Oregon Health Authority, Immunization Program, mandates the use of the Oregon 53 05A form, known as the Certificate of Immunization Status. This critical document serves as a record of a child's immunizations, detailing every dose administered, in the order received, alongside exemptions where applicable. To foster compliance, the form collects comprehensive information, including the child's name, birthdate, mailing address, and the names and telephone number of the parents or guardians. It addresses a suite of required vaccines such as Diphtheria/Tetanus/Pertussis (DTaP, Tdap, Td), Polio, Varicella (Chickenpox), Measles/Mumps/Rubella (MMR), and more. The form is designed not only to log vaccinations but also to document exemptions, whether for medical reasons, through a physician-signed letter specifying the medical contraindications to vaccinations, or for nonmedical reasons, where a parent or guardian attests to having reviewed educational material on the benefits and risks of immunizations. Thus, it plays a pivotal role in safeguarding public health by ensuring children are appropriately vaccinated or exempted according to state laws before participating in group educational or care settings.
| Question | Answer |
|---|---|
| Form Name | Oregon Form 53 05A |
| Form Length | 4 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 1 min |
| Other names | oregon certificate of immunization status, oregon immunization form, or certificate immunization, oregon immunization records |