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The South Carolina Certificate of Immunization, formally known as DHEC 2740, serves a critical role in ensuring that children entering daycare and school settings within the state are vaccinated according to the required immunization schedules, thereby safeguarding the health of all students. This form requires detailed documentation of each vaccine received, including the date of vaccination, and it assesses whether a child meets the immunization criteria for attendance in daycare and schools through a certification status section. It is noteworthy that certain sections, such as the declaration of a medical exemption for one or more vaccines, require the direct input from a licensed physician, emphasizing the form's thoroughness in capturing a child's immunization history. Furthermore, the form accommodates for children who have either a temporary or permanent medical exemption from specific vaccines, specifying the precise nature and duration of such exemptions. Completion of this form not only involves healthcare providers but also allows designated school nurses and other authorized representatives to participate in the certification process, underscored by the clinician or representative's signature at the conclusion of the document. By requiring meticulous completion and offering clear instructions for every section, South Carolina's Certificate of Immunization form stands as a key document in the state's public health efforts to maintain high vaccination rates among its youngest residents, thereby contributing to the broader goal of preventing vaccine-preventable diseases within the community.

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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

Form Characteristics

Fact Name Description
Purpose of the South Carolina Certificate of Immunization (DHEC 2740) To provide valid documentation of immunizations for daycare and school attendance in South Carolina.
Sections Requiring Prior Completion for Certification Status Vaccination Date (Section 2) and Medical Exemption (Section 3) must be completed before determining the Certification Status.
Certification Status Options Options include Certificate Expires, Meets Day Care Requirements, Meets Day Care & School Requirements, and Meets School Requirements. Each option serves a different level of compliance based on the child's immunization record and/or medical exemptions.
Medical Exemption Documentation Must be completed with the name of the vaccine(s) the child is exempt from, specifying whether the exemption is temporary or permanent. This section requires approval from a licensed Physician (MD or DO) or authorized representative.

Guidelines on Filling in South Carolina Immunization Certificate

Filling out the South Carolina Certificate of Immunization form (DHEC 2740) is a straightforward process essential for daycare and school attendance in the state. It requires accurate documentation of vaccinations or titer levels and, if applicable, medical exemptions. Careful attention to detail ensures the form is completed accurately, allowing students to fulfill South Carolina's requirements. Here's how to correctly fill out the form:

  1. Start with Section 1, Identification/Name: Enter the child's full name and date of birth. If the child has an MCI or chart number, record it in the designated area.
  2. Proceed to Section 2, Vaccination Date: Document the month/day/year for each vaccination given that matches the appropriate vaccine. If the child had a reliable history of Varicella disease, tick the relevant box. For documented positive titers, record the date it was confirmed and specify "Positive Titer" along with the disease for which the titer was positive.
  3. Move to Section 3, Medical Exemption* (if applicable): Indicate the name(s) of any vaccine(s) from which the child is exempt due to a temporary or permanent medical reason. This section requires approval from a licensed Physician (MD or DO) or an authorized representative. Mark the appropriate box to signify whether the exemption is temporary or permanent. For temporary exemptions, specify the date when the exemption expires.
  4. Fill out Section 4, Physician/ Authorized Representative Information: Print the name of the certifying physician. For DHEC staff, the "DHEC Director of Clinical Services" should be printed. School nurses will also print "DHEC Director of Clinical Services," while private practices should print the name of the specific physician issuing the certificate. If an authorized representative is completing the form, their name must be printed, and their signature is required. Include the facility's telephone number, name, and address. The person completing the form must sign it, and the date the certificate is issued should be noted. The immunization dates must precede this issuance date.

Once the form is completely filled out, it's critical to provide the parent, legal guardian, or responsible adult with the certificate of immunization. This document is a key part of ensuring compliance with South Carolina's health regulations for school and daycare attendance. Proper completion and timely distribution of this form help prevent any delays or interruptions in the child’s educational journey.

Common Questions

What is the purpose of the South Carolina Certificate of Immunization?

The South Carolina Certificate of Immunization form (DHEC 2740) is designed to provide valid documentation of vaccinations for children attending daycare and school within the state. It's a crucial form that ensures that each child meets the immunization requirements set by state health and education authorities, aiming to maintain a healthy environment in these facilities by preventing the spread of vaccine-preventable diseases.

What does it mean if a child's immunization certificate expires?

If a child's immunization certificate is marked as "Expires," this indicates that the child has not received all the required immunizations for school or daycare attendance and does not have any medical exemptions. The section titled "Date next immunization is due" must be completed, specifying when the next vaccine is scheduled. The child may temporarily attend daycare or school but can do so for no more than one month from the specified date. This condition emphasizes the urgency of completing the vaccination series for ongoing attendance.

Can a child attend daycare or school with a temporary medical exemption?

Yes, a child can attend daycare or school with a temporary medical exemption. This exemption is applicable when there's a medical reason, endorsed by a licensed physician, physician assistant, or advanced practice registered nurse, preventing the child from receiving a particular vaccine(s) for a specific period. The form must document the name of the exempt vaccine(s) along with an expiration date for this exemption, indicating when the child is expected to receive the vaccine post the temporary exemption period.

What is a "permanent exemption" on the immunization form, and how is it obtained?

A permanent exemption indicates that a child is exempt from receiving one or more vaccines due to a life-long medical reason. To obtain a permanent exemption, a licensed physician must validate and approve the exemption, documenting it on the immunization certificate. This exemption doesn't have an expiration period, meaning the child is not required to receive the specified vaccine(s) at any future point due to the enduring nature of the medical condition.

Who can complete and sign the South Carolina Certificate of Immunization form?

The form must be completed and signed by a licensed physician or their authorized representative, such as a physician's assistant or an advanced practice registered nurse. Additionally, for convenience and administrative purposes, specific sections, like the physician's name and facility information, can be completed by DHEC staff for public health settings or school nurses for educational institutions. However, the signature must come from either the physician directly involved in the child's care or their designated authorized representative.

Common mistakes

Filling out the South Carolina Immunization Certificate can be a complex task that demands attention to detail. Mistakes during this process can lead to delays or issues with school and daycare admissions. Here are eight common mistakes people make when completing the form:

  1. Not completing the Vaccination Date (Section 2) and Medical Exemption (Section 3) before determining the Certification Status. This initial step is crucial for the rest of the form to be filled out correctly.
  2. Forgetting to check only ONE box in the Certification Status section. This error can cause confusion about the child's immunization status and eligibility for daycare or school attendance.
  3. Omitting to fill out the "Date next immunization is due" for children who haven't received complete immunizations and do not have any medical exemptions, potentially leading to enrollment challenges.
  4. Incorrectly marking the Certification Status without carefully reviewing the child’s vaccination/titer documentation and the specific requirements for South Carolina School and Day Care attendance.
  5. Failing to correctly enter the child's full name and date of birth in Section 1, which could lead to mismatches in official records or processing delays.
  6. Improperly documenting the vaccination dates in the format of mm/dd/yy, or inaccurately recording positive titer information, can lead to questions about the child's immunization status.
  7. Not adequately completing the Medical Exemption section if applicable, including neglecting to indicate whether an exemption is temporary or permanent, or missing the expiration date for temporary exemptions.
  8. Overlooking the Physician/Authorized Representative Information section can invalidate the certificate. This section validates the authenticity of the immunization record and must be completed accurately.

It is vital that individuals take care when filling out this form, double-checking each section for accuracy and completeness to avoid these common mistakes. Proper documentation of immunizations not only complies with regulations but also ensures the safety and well-being of all children in public settings.

Documents used along the form

When managing immunization requirements in South Carolina, particularly for daycare and school attendance, the South Carolina Certificate of Immunization (DHEC 2740) plays a pivotal role. However, to ensure a comprehensive understanding of an individual's health status and compliance with state laws, a suite of additional documents often accompanies this form. These documents complement each other to provide a fuller picture of the health and immunization status.

  • Birth Certificate: This fundamental document verifies the child's age and is necessary for initial enrollment in school or daycare. It serves as a primary identification document.
  • Physical Examination Form: Many schools and daycares require a recent physical examination certificate to ensure that a child is fit to participate in school activities. It also helps identify any physical conditions requiring special attention.
  • Special Health Care Plan: For children with chronic health conditions (e.g., asthma, allergies, diabetes), a detailed care plan, approved by a healthcare provider, outlines necessary steps and precautions for managing the condition at school or daycare.
    • Exemption Forms: If a child is exempt from certain vaccines due to medical or religious reasons, official exemption documents must be supplied. These are obtained through specific processes determined by state health departments.
  • Medication Administration Consent Form: Should a child require medication during school hours, this form, completed by the parent or guardian and a healthcare provider, authorizes school staff to administer the medication according to prescribed guidelines.

Together, these documents ensure that the educational institution is fully informed about each student's health needs, leading to a safer and more inclusive environment for all. While the South Carolina Certificate of Immunization (DHEC 2740) is central for confirming immunization compliance, the additional forms allow for a holistic approach to health management within schools and daycare centers, supporting the overarching goal of safeguarding the well-being of children in these settings.

Similar forms

The South Carolina Certificate of Immunization (DHEC 2740) shares similarities with the Proof of Yellow Fever Vaccination. Both documents serve as official records verifying specific vaccinations have been administered, whether for school attendance or international travel requirements. Like the South Carolina immunization form, the yellow fever certificate provides essential information such as the date of vaccination and the issuer's details, ensuring compliance with health regulations to facilitate safe community integration or border crossing.

Similarly, the Child Health and Disability Prevention (CHDP) Gateway form in California parallels the South Carolina immunization certificate by recording a child's health checkups and vaccinations. Both forms are integral in confirming a child's health status for entry into public schools or daycare centers. They compile comprehensive health information, including immunization dates and exemptions, if applicable, to ensure that public health requirements are met.

Another counterpart is the Medical Exemption Statement for Children's Immunization in various states. This document, like Section 3 of the South Carolina form where medical exemptions are documented, allows for the recording of valid medical reasons why a child cannot receive certain vaccinations. Both forms must be endorsed by a licensed healthcare provider, thereby ensuring that exemptions are legitimate and based on medical necessity.

The International Certificate of Vaccination or Prophylaxis (ICVP) also bears resemblance to the South Carolina immunization record. While the ICVP is used internationally to prove vaccination against diseases like yellow fever, the principles of documenting vaccine type, dates, and issuer authority are shared with the DHEC 2740 form. Each serves as a passport in their respective arenas, allowing individuals to proceed with schooling, travel, or employment.

The Military Pediatric Immunization Record is another document that parallels the South Carolina Certificate of Immunization. It details the immunizations received by children of military personnel, similar to how the South Carolina form tracks vaccinations for school and daycare requirements. Both documents are critical for ensuring that children are protected against vaccine-preventable diseases, fulfilling both public health and organizational mandates.

College Immunization Records exemplify another version of health documentation similar to the South Carolina form. These records verify that incoming college or university students have received their necessary immunizations prior to campus integration, echoing the same public health protection goal as the DHEC 2740. Although aimed at an older population, the intention to prevent disease outbreaks on campus unites both documents in purpose and necessity.

Lastly, the Vaccine Adverse Event Reporting System (VAERS) form, while distinct in its purpose, aligns with the South Carolina Immunization Certificate in its emphasis on vaccination documentation. VAERS collects information on adverse effects following vaccination, underscoring the broader importance of comprehensive immunization records for monitoring public health outcomes. Both forms contribute to a larger framework of vaccine safety and community health management.

Dos and Don'ts

When filling out the South Carolina Certificate of Immunization (DHEC 2740), it's important to adhere to guidelines that ensure the form is completed accurately and effectively. To assist individuals in this process, here are essential dos and don'ts:

Do:
  • Ensure that the Vaccination Date (Section 2) and Medical Exemption (Section 3) information are completed first. These sections are critical for determining the Certification Status.
  • Check only one box in the Certification Status section after thoroughly reviewing the child’s vaccination/titer documentation, medical exemption section, and South Carolina School and Day Care attendance requirements.
  • Provide the child’s full name and date of birth in the Identification/Name section clearly and accurately to avoid any confusion or misidentification.
  • Obtain the signature of the physician or authorized representative completing the certificate. This is a requirement for the certificate to be valid.
Don't:
  • Leave the Date Certificate Issued section blank. The form cannot be issued if immunization dates in the Vaccination Date (Section 2) are recorded after the certificate’s issue date.
  • Forget to document a date indicating when a temporary exemption for vaccine(s) expires in Section 3 if applicable. This is crucial for maintaining accurate medical records.
  • Check more than one box in the Certification Status section. It is vital to select the option that accurately reflects the child's current immunization status.
  • Overlook providing the parent, legal guardian, or person in loco parentis with the certificate of immunization. This is an essential step to complete the immunization documentation process.

Misconceptions

Understanding the South Carolina Certificate of Immunization (DHEC 2740) is crucial for protecting the health of children and ensuring compliance with school and daycare requirements. However, misconceptions about this form can create confusion. Here are eight common misunderstandings about the South Carolina Immunization Certificate form, explained to provide clarity:

  • Misconception #1: Any staff member at a school can complete the DHEC 2740 form. Only authorized healthcare professionals and specific designated personnel, such as DHEC staff or the physician’s authorized representative, can accurately complete and sign off on the form. School nurses are designated to help manage but are not authorized to complete all sections, particularly sections that require a healthcare provider's certification.

  • Misconception #2: The form can be completed without the child's vaccination dates. The Vaccination Date (Section 2) must be filled out before determining the Certification Status. This requirement ensures that the child's immunization records are up to date in accordance with South Carolina's immunization requirements for school and daycare attendance.

  • Misconception #3: A child with incomplete immunizations cannot attend school or daycare. If the “Certificate Expires” box is checked, indicating incomplete immunizations, the child may still attend school or daycare for up to one month from the provided date, giving parents/guardians time to ensure their child receives the necessary immunizations.

  • Misconception #4: Separate immunization certificates are required for daycare and kindergarten. If a child meets all the immunization requirements for daycare and the 5K-6th grade upon entering a 4K program, a separate certificate for kindergarten is not needed. Choosing "Meets Day Care & School Requirements" covers both.

  • Misconception #5: Documentation of a positive titer is not acceptable as proof of immunity. On the contrary, if a child has a documented positive titer, it is valid evidence of immunity against that specific infection and should be recorded on the DHEC 2740 form accordingly.

  • Misconception #6: Medical exemptions are permanent. There are two types of medical exemptions: temporary and permanent. A temporary exemption must indicate when the exemption expires, whereas a permanent exemption does not have an expiration period. It's essential to document the correct type of exemption based on the physician's evaluation.

  • Misconception #7: Any healthcare provider can authorize the form. Only licensed physicians (MD or DO), or their authorized representatives (such as a Physician's Assistant or Advanced Practice Registered Nurse), can approve the medical exemption section of the form. This ensures that medical exemptions are based on professional judgment and meet legal standards.

  • Misconception #8: The form is valid even if the immunization dates are after the date the certificate is issued. The date of issuance is critical for the form's validity. If any immunization dates occur after the certificate has been issued, the certificate cannot be considered valid. All immunization dates must precede the issuance date to ensure the information is accurate and up-to-date.

Clearing up these misconceptions is essential for parents, guardians, and school administration to understand the legal and health requirements regarding immunization documentation in South Carolina. Compliance with the South Carolina Certificate of Immunization (DHEC 2740) helps protect not only the individual child but also the broader community by preventing the spread of vaccine-preventable diseases.

Key takeaways

Understanding the South Carolina Immunization Certificate, also known as DHEC 2740, is essential for ensuring that children meet the state's immunization requirements for daycare and school attendance. Here are five key takeaways from the form:

  • The certificate serves as valid documentation of a child’s immunizations, crucial for enrollment in daycare and schools within South Carolina.
  • Vaccination dates and any applicable medical exemptions must be meticulously completed prior to determining the child’s certification status, which aligns with South Carolina's attendance stipulations for educational institutions.
  • The options under the Certification Status section—ranging from "Certificate Expires" to acknowledging that a child meets all immunization requirements for daycare, school, or both—should be selected after reviewing the child's immunization records and any potential medical exemptions.
  • A notable aspect of this form is the accommodation for medical exemptions, which acknowledges both temporary and permanent situations, emphasizing the necessity for these declarations to be validated by a licensed physician or an authorized representative.
  • Comprehensive identification of the healthcare professional or authorized representative responsible for the certification, alongside accurate clinic or school information, is imperative for the document’s validity. Additionally, the form specifies distinct instructions for who may complete certain sections, detailing roles for DHEC staff, school nurses, and private practice employees.

This certificate underscores the importance of public health compliance while providing a systematized approach for documenting and verifying immunization records for children’s integration into educational settings. For parents and guardians, comprehending these key facets ensures preparedness and compliance with South Carolina's health regulations.

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