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School Form (Wyoming)

This report creates an Official State Record of Immunization for a specific patient. Search for the patient first.

To include compromised doses (invalid vaccinations) on this report, first enable the Administration > Settings > Properties > Vaccination Settings > Mark Invalid Vaccinations on the Patient Record Report option.

The printing format for this report allows up to ten doses to be displayed. The adult Td vaccine is separate from the DTaP family and printed as a separate line item. Also, doses administered as Hib PRP-OMP (3 dose) is differentiated on the report from the other Hib types (4 dose).

Run the Report

To run this report, search for the patient and then click the Reports > State Reports > School Form link. The Official State Record of Immunization report displays for that patient in a new browser tab.  To print the form, use the browser's print function.

Example Report

The following image is of an example school form report:

Example School Form for Wyoming

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