Each year in January and February, all schools and child care facilities must report the immunization status of their students to the Health Department

Reporting Forms

• Immunization Report Instructions
• Tally Worksheet

Immunization Primary Review Summary Forms:

• Section A 
• Section B-D
• Section E
• Section F-H

Step 1: Collect Information for All of Your Students

Forms you will need: Certificate of Immunization Status Form

Step 2: Assess Student Immunization Records

Forms you will need:

• Certificate of Immunization Status Form
• Primary Review Table

Step 3: Fill Out the Primary Review Summary

Forms you will need:

• Section A (page 1)
• Section B, C, D (page 2)

Step 4: Send the First Report

Due by January 11, 2023

Mail, email, fax or drop off the forms to Jackson County Public Health:

• Section A (page 1)
• Section B, C, D (page 2)
• Photocopies of the CIS forms or ALERT records for students listed in Section B

Step 5: Fill Out Section D and Cancel Exclusion Orders

Between February 1 - February 15, 2023

• Fill out Section D (page 2) of the Immunization Primary Review Summary, include the dates that the records were returned to you.
• Keep your copy of exclusion orders for children at your site, and be prepared to enforce them. If a student’s record is not up-to-date by the beginning of school on February 15, 2023, they are not able to attend until you have an updated record.
• If updated records are returned AFTER the beginning of school on February 15, 2023, the student is “excluded.” Mark a “Y” in the column in Section D (page 2) of the Primary Review Summary. Keep a copy for your records.

Step 6: Complete and Send Pages 3 and 4 of the Primary Review Summary

By February 27, 2023

Using the Tally Worksheet, complete page 3 of the Immunization Primary Review Summary (Sections E, F and G) and Section H as appropriate for your facility:

• Section E for preschool, day care or Head Start
• Section F for kindergarten
• Section G for 7th graders
• Section H for kindergarten through 12 graders

Mail, email, fax or drop off the forms to Jackson County Public Health (keep a copy for your records):

• Page 2 (Section D) of the Primary Review Summary
• Page 3 (Sections E, F, G) of the Primary Review Summary
• Page 4 (Section H) of the Primary Review Summary

Contact Us
Jackson County Public Health
140 South Holly Street
Medford, OR 97501

541-774-8209
541-774-7954 (Fax)
schoolimmunizations@jacksoncounty.org