Public health form
School immunization form
A school immunization form is the record public health and the school use to see whether a pupil has the antigens required by provincial law. In Ontario that is the Immunization of School Pupils Act; other provinces have their own lists. You document what you administered or what you verified. Parents still usually have to report doses to the public health unit — your EMR note does not automatically update Panorama or ICON.
Record versus exemption
This page is the immunization record: dates, products, lots if the form asks, and who gave the dose. If the child cannot be vaccinated, that is the medical-exemption form. Do not write “exempt” on a yellow card because the parent asked you to skip a line.
Ontario requires reporting to the local public health unit. Clinic staff do not always do that for the family. Say so in the visit. ICON / Immunization Connect Ontario (or your province’s portal) is how many parents upload.
The yellow card is not the registry
Update the card in front of you. Also put the dose in your EMR. Public health may still have a hole until someone reports. A school suspension letter is often a reporting gap, not a missing needle.
Who completes it
The clinician or nurse who gave the vaccine, or who is transcribing a verified foreign record. Do not invent dates from memory. If the only evidence is a parent’s phone photo of a card in another language, transcribe what you can read and say what you could not.
How to complete the record
- Child identifiers matching the school and health unit.
- Each antigen the statute or program cares about, with dates.
- Product name and lot when the form or your EMR requires it.
- Site and route if this is a dose you just gave.
- Ontario ISPA list (as of current law) includes diphtheria, tetanus, polio, measles, mumps, rubella, meningococcal, pertussis, and varicella for children born in 2010 or later — confirm the current list before you counsel.
- Grade 7 school-clinic vaccines (Hep B, HPV, meningococcal ACYW in Ontario) are often public-health clinics, not your office. Do not mark them given unless they were.
Worked example (fictional)
School record — catch-up MMR in clinic
Fictional 5-year-old. Do not copy into a real yellow card.
Given today 2026-08-28: MMR (named product, lot on EMR), left arm, SC. Prior: DTaP-IPV-Hib series complete on the card; varicella ×1 (2023); no second MMR on any record. Card updated. Family told to report to the public health unit via ICON. Not an exemption. Not a camp form. I am the FP. Nurse documented lot in the EMR.
Why schools still send a letter
- Dose given but never reported to public health.
- Foreign record not translated or not accepted until reviewed.
- Wrong child’s sticker on the card.
- Exemption started and never filed.
- Assuming HPV or Hep B given at school without checking.
Draft the school immunization record from the visit
In Scribeberry, open Forms, search for school immunization or yellow card, or upload the public-health PDF. Generate from the encounter and your notes, then review every date before you sign. Scribeberry does not pre-map this form. You still review and sign. Scribeberry does not report doses to the public health unit.
Frequently asked questions
Do I report the vaccine to public health?
In Ontario, parents are responsible for reporting to the health unit unless your clinic has a local arrangement. Tell them that. Other provinces differ. Do not assume your EMR talks to Panorama.
What if the record is from another country?
Transcribe what you can verify. Public health may still ask for a review. Do not recreate a Canadian series you did not give.
Is this the medical exemption form?
No. Records document doses. Exemptions document why a dose will not be given. Use the exemption form only when that is the situation.
Does Scribeberry update ICON or Panorama?
No. Scribeberry helps you complete the PDF or card. Reporting stays with you or the family through the provincial channel.
Forms
