Documentation

Acceptable documentation of immunizations includes one of the following:

1. The immunization form filled out and signed by your health care provider.

2. Documentation of vaccines administered that include the signature or stamp of the physician or his/her designee, or public health personnel.

3. An official immunization record generated from a state or local health authority, such as a registry.

4. A record received from school officials.

5. Immunization History Form

Please note:

1. Vaccines administered after September 1, 1991, shall include the month, day, and year each vaccine was administered.

      2. Enclose a copy of the laboratory report on all immune titers.

(For medical students, many residency programs require immune titers for measles, mumps, rubella, varicella, and hepatitis B. If you have insurance which will cover the cost of immune titers, you are encouraged to obtain the titers now.)

One of the following is required for each immunization:

Pertussis /Tetanus/Diphtheria:  Documentation of one dose of tetanus-diphtheria, acellular pertussis (Tdap) within the past ten years.  (note:  This is a new requirement as recommended by the CDC.  Be sure and receive Tdap.)

Measles (Rubeola or Red Measles): If you were born on or after January 1, 1957:

(1) Documentation of two doses of measles vaccine administered since January 1, 1968 OR

(2) Documentation of two doses of MMR vaccine administered since January 1, 1968   OR

(3) Documentation of one dose of measles vaccine and one dose of MMR vaccine administered since January 1, 1968   OR

(4) A positive titer (blood test) confirming immunity or evidence of prior infection (include copy of laboratory report)

Mumps: If you were born on or after January 1, 1957:

(1) Documentation of one dose of mumps vaccine   OR

(2) Documentation of one dose of MMR vaccine   OR

(3) A positive titer (blood test) confirming immunity or evidence of prior infection

(include copy of laboratory report)

Rubella (German Measles): If you were born on or after January 1, 1957:

(1) Documentation of one dose of rubella vaccine   OR

(2) Documentation of one dose of MMR vaccine   OR

(3) A positive titer (blood test) confirming immunity or evidence of prior infection (include copy of laboratory report)

Hepatitis B:

(1) Documentation of three doses of Hepatitis B vaccine   OR

(2) A positive titer (blood test) confirming immunity or evidence of prior infection (include copy of laboratory report)

Varicella (Chicken Pox):

(1) Documentation of two doses of varicella vaccine   OR

(2) A positive titer (blood test) confirming immunity or evidence of prior infection (include copy of laboratory report)   OR

(3) History of disease validated by yourself, your parent/guardian, or health care provider. You may enclose a letter written by you, your parent/guardian, or healthcare provider stating the approximate date or year that you had the disease.

Tuberculin skin test (ppd):

(1) If you have never had a positive ppd: Documentation of one purified protein derivative (ppd) tuberculin skin test within the past year (must include the millimeters of induration whether positive or negative). If the skin test was positive, documentation of a chest x-ray is required.   OR

(2)If you have a history of a positive skin test: Include the approximate month, day, and year of the positive test on the Immunization History Form, and documentation of a chest x-ray within the past year.

Please call if you have any questions regarding the required immunizations.

Mail or fax all immunization information to:

University of Texas Southwestern Medical Center
Student Health Services
5323 Harry Hines Blvd.
Dallas, Texas 75390-8861

Telephone (214) 645-8690 Fax (214) 645-8676