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Certificate of Immunization (West Virginia)
This report creates a Certificate of Immunization for a specific patient. Search for the patient first.
This green certificate includes an option for a temporary medical exemption. If this option is enabled (selected), Part A for shots prints in its entirety if the record contains:
- 3 doses DTaP/DTP with one dose being on or after the 4th birthday
- 3 doses Polio with one dose being on or after the 4th birthday
- 2 doses MMR with first dose being on or after 12 months of age
If the record is not complete but Temporary Medical Exemption is enabled (selected), the shots appear in Part B of the certificate and both pages print. A Yes is added in the History of Varicella section if a parent report of disease is recorded.
To create this Certificate of Immunization, search for the patient and then click the Reports > State Reports > Provisional Certificate of Immunization > Current Patient's Form link. The Certificate of Immunization page opens. Select the Temporary Medical Exemption option if necessary and click Continue. The West Virginia Certificate of Immunization opens in a new window.
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