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In South Carolina, ensuring that children are vaccinated according to state regulations is a critical step before they can attend daycare or school. This requirement is fulfilled through the South Carolina Certificate of Immunization (DHEC 2740), a form designed to document a child's immunization status comprehensively. The form is structured to capture all necessary information, including the child's identification details, vaccination dates, and any medical exemptions that may apply. Special sections on the form denote whether a child meets the immunization requirements for daycare, school, or both, based on their current vaccinations. This document also outlines procedures for noting temporary or permanent medical exemptions, which must be approved by a licensed physician or an authorized representative. Additionally, the form includes space for the physician or authorized representative's information, ensuring that the document is validated by a medical professional. The completion of this form is essential for compliance with South Carolina's school and daycare attendance requirements, highlighting its importance in the public health framework of the state.

Document Example

South Carolina Certificate of Immunization (DHEC 2740)

INSTRUCTIONS FOR COMPLETING

Purpose

To provide valid documentation of immunizations for daycare and school attendance in SC.

(*) Asterisk denotes items that cannot be completed by school nurses.

Certification

NOTE: The Vaccination Date (Section 2) and Medical Exemption (Section 3) information must be completed first to determine the Certification Status.

Check only ONE box in the Certification Status section after reviewing the child’s vaccination/ titer documentation, medical exemption section and South Carolina School and Day Care attendance requirements.

•Certificate Expires*: Check this box if child has not received complete immunizations for daycare or school and does not have any medical exemptions.

“Date next immunization is due” section MUST be completed. The child may attend day care or school for no more than one month from the date listed.

The date written should correspond to the date the next immunization is due and written as mm/dd/yy.

Applies ONLY to immunizations required for day care or school in South Carolina

•Meets Day Care Requirements: Check this box if child meets all of the immunization requirements for day care as of the date of certificate being issued.

•Meets Day Care & School Requirements: Check this box if child meets all of the immunization requirements for day care AND the requirements for 5K – 6th grade.

Example: A child is in a 4K program and receives age appropriate vaccines at age 4. These vaccines complete the requirement for 5K-6thgrade. So this child does not have to have a duplicate certificate printed when entering 5K from day care, this box can be checked.

•Meets School Requirements: Check the applicable box for which the child meets all of the immunization requirements for school as of the date of certificate being issued.

Select the appropriate box based on the child’s current immunizations (not on current grade)

Example: A child in the 3rd grade is up-to-date on all immunizations including having received a valid Tdap dose. This child meets current requirements for 7th – 12th grade as of date of issue and this box should be selected.

If the DHEC 2740 is being completed to document Tdap requirement only, the form is then supplemental to the child’s primary immunization certificate which should have all other required vaccines documented.

•Medical Exemption*: Check this box if child has a temporary or permanent medical exemption.

Section 1: Identification/ Name

Name

Enter child’s full name. Date of Birth

Enter child’s date of birth. MCI/Chart#

Record child’s assigned MCI or chart number, if applicable.

Section 2: Vaccination Date

Vaccine Date: Document month/day/year (e.g. 12/23/2002) for each immunization administered that corresponds to the appropriate vaccine.

•Varicella (“Chickenpox”): If child has a reliable history of Varicella disease, check box in this section.

Reliable history of Varicella is defined as: (1) Healthcare provider diagnosis or verification of Varicella disease or (2) laboratory evidence of immunity or laboratory confirmation of disease.

•If a child has documentation of a positive titer, record month/day/year (e.g. 12/23/2002) and the “Positive Titer” on the line corresponding to the vaccine. If a child has a positive titer for a vaccine with multiple antigens, the disease for which there is a positive titer must also be included on the line (e.g. positive titer for mumps only – write “Positive Titer – Mumps 12/23/2002” on the MMR line).

Section 3: Medical Exemption*

If applicable, document the name of the vaccine(s) if there is a permanent or temporary medical reason for exclusion. This section must be approved by the licensed Physician (MD or DO) or his/her authorized representative (e.g. Physician’s Assistant or Advanced Practice Registered Nurse).

•Temporary Exemption: This section should only be used if the vaccine(s) listed is/are temporarily exempt. A date must be documented indicating when the temporary exemption for the vaccine(s) expires.

•Permanent Exemption: This section should only be used if the vaccine listed is permanently exempt. A check mark should be placed in the box indicating this is permanent and does not have an expiration period.

Section 4: Physician/ Authorized Representative Information

Print Physician’s Name: The physician is the licensed Practitioner of Medicine, Surgery, or Osteopathy. The physician’s name area must be completed to be valid.

DHEC staff: Print the following - “DHEC Director of Clinical Services”

School Nurses: Print the following - “DHEC Director of Clinical Services”

Private Practices: Print name of specific physician certifying certificate

Authorized Representative: The physician authorizes this individual to complete the certificate. The Authorized Representative’s name must be printed if someone other than the certifying physician is issuing the certificate.

Example – The physician authorizes his/her nurse to complete the certificate. The physician’s name and the nurse’s name (as authorized representative) must be printed. The nurse’s signature is required as the authorized representative for that physician.

Facility Telephone Number/ Name/ Address:

DHEC staff: Regional Health Department telephone number, name and address

School Nurses: School telephone number, name and address

Private Practices: Office telephone number, name and address

Signature: The person completing the certificate must sign the form (either physician or authorized representative)

Date Certificate Issued: Certificate cannot be issued if immunization dates in the Vaccination Date (Section 2) are after the date the certificate is issued.

Office Mechanics: Provide the parent, legal guardian or person in loco parentis with the certificate of immunization.

DHEC-2740

➤ South Carolina Immunization Certificate PDF Form

Form Properties

Fact Detail
Purpose The South Carolina Certificate of Immunization (DHEC 2740) is designed to document valid immunization records for children attending daycare and school in South Carolina.
Key Sections to Be Completed First The Vaccination Date (Section 2) and Medical Exemption (Section 3) must be filled out initially to determine the child's Certification Status.
Expiry and Requirements Compliance The certificate indicates whether a child's immunizations are up-to-date for day care, both day care and school (5K – 6th grade), or school, including the Tdap requirement, with specific boxes to check based on the child’s status. A temporary certificate can be issued, allowing attendance for no more than one month if next immunizations are due.
Medical Exemptions A child can be temporarily or permanently medically exempt from certain vaccines, as documented by a licensed physician, DO, physician's assistant, or advanced practice registered nurse.
Validation The form must be signed by the physician or an authorized representative to be valid. It also distinguishes the role of DHEC staff, school nurses, and private practice representatives in its completion and signature requirements.

Guide to Writing South Carolina Immunization Certificate

Ensuring the health and safety of children attending daycare and schools in South Carolina requires valid documentation of immunization, as outlined in the South Carolina Certificate of Immunization (DHEC 2740) form. This document is crucial for verifying that a child meets the state's immunization requirements, a fundamental step before they are allowed to attend any educational institution within the state. Here are the steps to properly fill out this form, making sure each section is completed accurately and entirely according to the provided instructions.

  1. Start with the Certification Note: Before filling out other sections, review the Vaccination Date (Section 2) and the Medical Exemption (Section 3) to determine the child's Certification Status.
  2. Check the appropriate Certification Status: Based on the reviewed documentation, select only ONE box that accurately represents the child's current immunization status in relation to daycare and school requirements in South Carolina. Consider whether the next immunization date is known for those not fully immunized.
  3. Section 1 - Identification/Name:
    • Enter the child's full name as it appears on official documents.
    • Fill in the child's date of birth in the format mm/dd/yyyy.
    • If applicable, record the child’s MCI or chart number.
  4. Section 2 - Vaccination Date: For each required immunization, document the date administered in the format mm/dd/yyyy. If the child has a historical instance of Varicella (Chickenpox) confirmed by a healthcare provider or has a documentation of a positive titer, check the appropriate box and provide the documentation date alongside the mentioned titer.
  5. Section 3 - Medical Exemption*: If there is a valid medical reason for one or more vaccines to be exempt, list the vaccine(s) and specify if the exemption is temporary or permanent. This section requires authorization from a licensed Physician (MD or DO), Physician’s Assistant, or Advanced Practice Registered Nurse. Always indicate the expiry date for temporary exemptions.
  6. Section 4 - Physician/Authorized Representative Information:
    • Print the full name of the authorizing physician or if applicable, the "DHEC Director of Clinical Services" for DHEC staff or school nurses.
    • If an authorized representative is completing the form on behalf of the certifying physician, print both the physician’s name and the representative’s name.
    • Provide the contact information of the facility issuing the certificate, aligned with whether it’s a DHEC staff, school nurse, or private practice submission.
    • The form must be signed by the physician or authorized representative issuing the certificate to be valid. Indicate the signature and the date the certificate is issued.
  7. Finalise the Process: Once completed, the certificate must be provided to the parent, guardian, or person acting in loco parentis for the child. Ensure that all sections are filled out correctly to avoid delays or issues with school or daycare admissions.

By closely following these steps, you can ensure the South Carolina Certificate of Immunization (DHEC 2740) form is filled out accurately and comprehensively. This not only complies with state laws but also plays a critical part in safeguarding the health of children in educational environments.

Understanding South Carolina Immunization Certificate

What is the purpose of the South Carolina Certificate of Immunization (DHEC 2740)?

The South Carolina Certificate of Immunization (DHEC 2740) serves as official documentation of a child's immunizations. It is required for daycare and school attendance in South Carolina. The form verifies that a child has received the necessary vaccinations or has a valid medical exemption.

How is the Certification Status determined on the form?

The Certification Status is determined after completing sections on the Vaccination Date and Medical Exemption information. These sections must be filled out first. Based on the child's documentation and adherence to South Carolina School and Day Care attendance requirements, only one box in the Certification Status should be checked to reflect the child's current immunization status.

Can school nurses complete the entire form?

No, there are items marked with an asterisk (*) on the form that cannot be completed by school nurses. These items include determining if the Certificate Expires, Medical Exemption documentation, and the Certification Status. A licensed Physician (MD or DO) or their authorized representative must complete these sections.

What is required if a child has a medical exemption?

If a child has a medical exemption, either temporary or permanent, the specific vaccine(s) exempted must be documented in Section 3 of the form. This section requires approval and must be signed by a licensed Practitioner of Medicine, Surgery, or Osteopathy (MD or DO), or their authorized representative, such as a Physician's Assistant or Advanced Practice Registered Nurse.

Who can certify the South Carolina Certificate of Immunization?

The form can be certified by a licensed physician, or their authorized representative. School nurses can print "DHEC Director of Clinical Services" for their section, while private practices will include the name of the certifying physician. The actual name and signature of the person completing the certificate, either the physician or authorized representative, are required for the form to be valid.

What should be done if the certificate cannot be issued on the same day as the vaccine date?

The certificate cannot be issued if the dates of vaccination listed in Section 2 are after the date the certificate is issued. It is crucial to ensure that all immunization dates are correct and prior to the issuance of the certificate. Once complete, the certificate should be provided to the parent, legal guardian, or person in loco parentis.

Common mistakes

The South Carolina Certificate of Immunization form, or DHEC 2740, serves an essential role in verifying the immunization status of children for day care and school attendance within the state. However, mistakes made during its completion can lead to delays or complications. Below are ten common errors often encountered:

  1. Not verifying whether the Vaccination Date (Section 2) and Medical Exemption (Section 3) information have been filled out before determining the Certification Status, leading to inaccuracies regarding the child's immunization status.
  2. Overlooking the requirement to check only one box in the Certification Status section, which can result in conflicting information about the child's immunization completeness or exemptions.
  3. Forgetting to complete the "Date next immunization is due" section when the Certificate Expires box is checked, which is crucial for keeping the child's immunization schedule on track.
  4. Failure to document the month, day, and year (mm/dd/yy) for each immunization administered, as required in the Vaccination Date area, causing confusion or delays in understanding the child’s immunization timeline.
  5. Not checking the box for a reliable history of Varicella disease if applicable, or improperly documenting a positive titer, which may affect the accuracy of the child's immunization records.
  6. Selecting the incorrect Certification Status for the child, for example, marking "Meets Day Care Requirements" when the child also meets the requirements for school, which could necessitate unnecessary additional documentation.
  7. Misunderstanding the appropriate use of the Medical Exemption section, for instance, using the Temporary Exemption section without indicating an expiration date, or failing to appropriately check off a Permanent Exemption.
  8. Not completing the physician or authorized representative's name and signature, which is essential for the certificate’s validity.
  9. Issuing the certificate when the immunization dates listed are after the date the certificate is issued, which contradicts the office mechanics guidelines.
  10. Providing incomplete or incorrect facility contact information, making it difficult for the form to be validated or for follow-up queries to be addressed.

Identifying and avoiding these mistakes can streamline the immunization verification process and help ensure that all children attending day care and school in South Carolina do so with proper immunization documentation.

Documents used along the form

When handling the South Carolina Certificate of Immunization (DHEC 2740), several other forms and documents might often be used alongside it to ensure comprehensive immunization documentation and compliance with state requirements. These additional materials support various needs, from documenting exceptions to providing clear evidence of vaccination status.

  • Medical Exemption Form: This document is critical for children who cannot receive certain vaccines due to medical reasons. It must be filled out by a licensed physician and provides details about the temporary or permanent medical exemption, specifying which vaccines are exempt and why.
  • Record of Varicella (Chickenpox) Disease Form: For children with a reliable history of Varicella, this form, often completed by a healthcare provider, documents the diagnosis or verification of the disease. It negates the need for the Varicella vaccine by providing proof of natural immunity.
  • Official Health Department Immunization Record: This comprehensive record, issued by a health department or a healthcare provider, lists all vaccinations a child has received. It serves as a detailed vaccination history and is often used to complete the South Carolina Certificate of Immunization.
  • Religious Exemption Form: Available through the South Carolina Department of Health and Environmental Control, this form documents a child's exemption from immunization requirements based on religious beliefs. It must be approved and kept on file for daycare or school attendance.
  • Tdap (Tetanus, Diphtheria, and Pertussis) Verification Form: Specifically for older children, this form is used to document receipt of the Tdap vaccine, a school requirement for students entering the 7th grade and above. It ensures compliance with South Carolina's school immunization laws.

Understanding and utilizing these forms correctly is crucial for parents, guardians, and healthcare providers to ensure that children meet South Carolina's immunization requirements for daycare and school attendance. Proper documentation helps maintain a healthy and safe environment for all children and staff within educational and childcare settings.

Similar forms

The South Carolina Certificate of Immunization form shares similarities with other documents designed to track health and safety requirements, such as the Vaccination Record Card. Both documents serve as vital records proving an individual's vaccination status. The Vaccination Record Card, commonly used at clinics and vaccination sites, lists all vaccines an individual has received, including the dates administered, similar to how the South Carolina Certificate of Immunization details vaccination dates and types for school and daycare compliance.

Another similar document is the Medical Exemption Form, which is used in various states for people who cannot receive certain vaccinations due to medical reasons. Like the Medical Exemption section of the South Carolina Immunization Certificate, this form must be completed and signed by a licensed healthcare provider. Both documents provide a way for individuals to be exempted from vaccine requirements based on legitimate health concerns, documenting any temporary or permanent medical exemptions.

The International Certificate of Vaccination or Prophylaxis is an internationally recognized document similar to the South Carolina Certificate of Immunization. This certificate is often required for entry into certain countries where specific vaccinations, like yellow fever, are mandated. Both documents serve as official records of immunizations but for different jurisdictions, with the South Carolina Certificate ensuring compliance with local school and daycare regulations and the International Certificate fulfilling global health requirements.

Health History Forms that are typically used in schools, colleges, and workplaces share similarities with the South Carolina Certificate of Immunization. These forms document a person's overall health history, including immunization records, allergies, and significant medical conditions. Like the South Carolina Certificate, Health History Forms are essential for managing health and safety in communal settings, ensuring individuals receive necessary protections and accommodations.

The Childcare Enrollment Health Form, another similar document, requires up-to-date vaccination records and a health statement from a healthcare provider before a child can attend daycare or preschool. It mirrors the section of the South Carolina Immunization Certificate specifying daycare requirements, ensuring that all children in a childcare setting are protected against communicable diseases via proper vaccination.

Lastly, the Pre-employment Health Screening form, used by employers to ensure a candidate meets the health requirements of a job, also parallels the South Carolina Certificate of Immunization. Although primarily focused on occupational health and safety, this form often includes vaccination status as part of its assessment, similar to how the South Carolina document tracks immunization compliance for educational settings.

Dos and Don'ts

When filling out the South Carolina Immunization Certificate form, it's essential to ensure the document is accurate and properly completed. Here are 10 do's and don'ts to guide you through the process:

Do:
  • Ensure all vaccination dates (Section 2) and any Medical Exemptions (Section 3) are filled out before determining the Certification Status.
  • Use mm/dd/yy format for all dates, including the vaccination dates and the date the certificate is issued.
  • Check only one box in the Certification Status section, based on the current immunization status and requirements for South Carolina day care and school attendance.
  • Fill in the child’s full name and date of birth accurately in the Identification section (Section 1).
  • If applicable, include a reliable history of Varicella (chickenpox) disease, ensuring it meets the specific criteria mentioned in the instructions.

Don't:
  • Don’t leave the "Date next immunization is due" section blank if the Certificate Expires box is checked; it must be completed with a specific due date.
  • Avoid using school nurses to complete items marked with an asterisk (*), as they are not authorized to do so.
  • Do not forget to have the physician or authorized representative’s name and signature on the form, making it valid.
  • Don’t issue the certificate if vaccination dates in Section 2 are after the date the certificate is issued, as this is not permitted.
  • Do not mix up the certification status; make sure the box checked matches the child’s current immunization status according to the provided instructions.

Following these guidelines will help ensure the form is completed correctly and complies with South Carolina requirements for daycare and school attendance.

Misconceptions

Understanding the South Carolina Immunization Certificate form can be tricky, but it's crucial for ensuring children can attend school or daycare. Let's debunk some common misconceptions that often confuse parents and guardians.

  • "Only doctors can fill out the form" – While it's true that certain sections, such as the Medical Exemption, require a licensed physician, other parts of the form can be completed by authorized representatives, like nurses operating under a doctor's guidance.
  • "The form is valid indefinitely" – The South Carolina Immunization Certificate is not evergreen. If a child's immunizations are incomplete, the certificate expires, necessitating a revisit to the stated 'next immunization due' date.
  • "All vaccinations must be completed for the form to be valid" – In reality, there are instances where the form can be valid even if all immunizations aren't complete. For example, if a child meets day care requirements but not yet school requirements, the form can still be issued for daycare attendance.
  • "School nurses cannot complete the form" – School nurses are indeed authorized to fill out certain parts of the form, notably in regions where DHEC (Department of Health and Environmental Control) resources are utilized.
  • "Varicella (Chickenpox) vaccination is always required" – If a child has a reliable history of chickenpox, as verified by a healthcare provider or laboratory evidence, the vaccination requirement can be bypassed.
  • "The form only covers vaccinations required for kindergarten" – The certificate is comprehensive, covering immunization requirements from daycare through 12th grade, depending on what the child has completed at the time of certification.
  • "A positive titer means the child must be vaccinated" – A positive titer, indicating immunity, means that a child does not need to be vaccinated against that specific disease. This should be duly noted on the form.
  • "Medical exemptions are permanent" – Medical exemptions can be temporary or permanent. The form accommodates both by allowing documentation of an expiry date for temporary exemptions.
  • "There's no exception to the rule that the certificate must be issued after all vaccinations are administered" – The certificate must indeed reflect up-to-date vaccinations, but medical exemptions or positive titers affect this requirement.
  • "One form fits all" – While one form is used, it offers multiple checkboxes to indicate whether a child meets daycare, school, or both sets of immunization requirements. There's flexibility built into the system to accommodate different stages of a child’s vaccination journey.

Understanding these points can help clarify the process of meeting South Carolina's requirements for child immunization documentation, ensuring a smooth transition for children entering daycare or school.

Key takeaways

Filling out and using the South Carolina Immunization Certificate form, known as DHEC 2740, ensures compliance with state laws regarding vaccination requirements for children attending daycare and school. Here are five key takeaways to understand when completing this form:

  • Certification Status must be thoroughly reviewed before selection: After recording the vaccination dates and noting any medical exemptions, one of the options in the Certification Status section should be checked. This decision is based on whether the child meets the immunization requirements for daycare, school, or both, or if the form serves solely to document a temporary or permanent medical exemption.
  • Detailed Documentation of Vaccination Dates is Essential: Every vaccine administered must be documented with the month, day, and year of administration. This accurate detailing ensures compliance and helps in determining the certification status accurately.
  • Medical Exemptions Require Specific Details: If a child qualifies for a medical exemption, whether temporary or permanent, the condition must be clearly documented, including the vaccine(s) exempted and, for temporary exemptions, the expiry date of the exemption. This section requires authorization from a licensed physician or their delegate, underscoring the gravity and legitimacy of any exemption claimed.
  • Authorized Signatures Are Mandatory: The form must bear the signature of the physician or their authorized representative to be valid. This signature formalizes the accuracy of the information provided and the compliance with state immunization requirements.
  • Immediate Provision to Parent or Guardian: Once completed and signed, the certificate should be promptly given to the child's parent, legal guardian, or custodian. Timely delivery ensures that the child’s enrollment in daycare or school is not delayed due to lack of proper immunization documentation.

By meticulously following these guidelines, health professionals and educational institution staff can ensure that the South Carolina Immunization Certificate form is accurately filled out and used. This adherence not only abides by legal requirements but significantly contributes to the health and safety of children and the community at large.

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