California School Immunization Record

Students to Include

Indicate which students to include in the report by selecting one of the following options:

• The selected [number] students only – Run the report for all students (active and inactive) in the current selection who meet the selection criteria.

• All students – Run the report for all active students in the current school who meet the selection criteria.

Notes:

• If running the report for a single student, or group of students, select the students prior to running the report.

• This report must be run for individual schools; the report cannot be run for the district.

Report Student Name as

Choose either Legal Name or Preferred Name.

Note:

The display of this parameter and its values are dependent on the configurations made to the California School Immunization Record on the Report Parameter Authorizations page (District ->System Administrator -> Report Parameter Authorizations)

Include Instructions page

Choose Yes or No to indicate whether the instructional page should be printed along with the immunization card.

Student Name

The student’s legal name

[StudentCoreFields]PSCore_Legal_Last_Name

[StudentCoreFields]PSCore_Legal_First_Name

[StudentCoreFields]PSCore_Legal_Middle_Name

[StudentCoreFields]PSCore_Legal_Suffix

Statewide Student Identifier (SSID)

The student's statewide identifier.

[Students]State_StudentNumber

Ethnicity

The student’s ethnicity.

[Students]Fedethnicity

Race

The student’s race.

African-American/Black: [StudentRace]Racecd = 600

American Indian/Alaskan Native: [StudentRace]Racecd = 100 (American Indian)

Asian:

[StudentRace]Racecd = 201 (Chinese)

[StudentRace]Racecd = 202 (Japanese)

[StudentRace]Racecd = 203 (Korean)

[StudentRace]Racecd = 204 (Vietnamese)

[StudentRace]Racecd = 205 (Asian Indian)

[StudentRace]Racecd = 206 (Laotian)

[StudentRace]Racecd = 207 (Cambodian)

[StudentRace]Racecd = 208 (Hmong)

[StudentRace]Racecd = 299  (Other Asian)

[StudentRace]Racecd = 400 (Filipino)

Native Hawaiian/Other Pacific Islander:

[StudentRace]Racecd = 301 (Hawaiian)

[StudentRace]Racecd = 302 (Guamanian)

[StudentRace]Racecd = 303 (Samoan)

[StudentRace]Racecd = 304 (Tahitian)

[StudentRace]Racecd = 399  (Other Pacific Islander)

White: [StudentRace]Racecd = 700

Name of Parent or Guardian

The name of the student’s primary parent or guardian.

Designate the primary parent or guardian on the CALPADS Guardian Information student page (Parent/Guardian 1).

[S_CA_STU_X]PrimaryGuardian

Parent or Guardian Name:

[Students]Mother

or [Students]Father

or [Students]Guardian_LN / [Students]Guardian_FN

or [S_CA_STU_X]Guardian2_LastName / [S_CA_STU_X]Guardian2_FirstName

Birthdate

The student’s date of birth.

[Students]DOB

Sex

The student’s sex.

[Students]Gender

Vaccination Details

For some immunizations, the required number of doses varies depending on the student's age at the time that a particular vaccine was administered. For these vaccines, an age indicator field is displayed for the applicable dose(s). The value displayed is a calculation of the student's age on the date entered for the vaccine dose(s).

IPV / OPV

The date that each vaccine dose was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

Age calculated based on the date immunization was administered.

[HealthStudImmRec]HealthVaccineID

[HealthStudDoseRec]Dose (1^st, 2^nd, etc.)

[HealthStudDoseRec]DateAdministered

[HealthStudDoseRec]HealthImmExemptID

DTap / DTP (age 0-6 years)

Tdap / TD (age 7+ years)

The date that each vaccine dose was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

Age calculated based on the date immunization was administered.

[HealthStudImmRec]HealthVaccineID

[HealthStudDoseRec]Dose (1^st, 2^nd, etc.)

[HealthStudDoseRec]DateAdministered

[HealthStudDoseRec]HealthImmExemptID

MMR

The date that each vaccine dose was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

[HealthStudImmRec]HealthVaccineID

[HealthStudDoseRec]Dose (1^st, 2^nd, etc.)

[HealthStudDoseRec]DateAdministered

[HealthStudDoseRec]HealthImmExemptID

HIB

The date that each vaccine dose was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

Age calculated based on the date immunization was administered.

[HealthStudImmRec]HealthVaccineID

[HealthStudDoseRec]Dose (1^st, 2^nd, etc.)

[HealthStudDoseRec]DateAdministered

[HealthStudDoseRec]HealthImmExemptID

Hep B

The date that each vaccine dose was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

[HealthStudImmRec]HealthVaccineID

[HealthStudDoseRec]Dose (1^st, 2^nd, etc.)

[HealthStudDoseRec]DateAdministered

[HealthStudDoseRec]HealthImmExemptID

VAR / VZV

The date that each vaccine dose was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

[HealthStudImmRec]HealthVaccineID

[HealthStudDoseRec]Dose (1^st, 2^nd, etc.)

[HealthStudDoseRec]DateAdministered

[HealthStudDoseRec]HealthImmExemptID

Tdap - 7th grade

The date that the vaccine was administered, and an indicator of whether the student has a permanent medical exemption for this vaccine.

Age calculated based on the date immunization was administered.

[HealthStudImm]HealthVaccineID

[HealthStudDoseRec]DateAdministered

[HealthStudImm]HealthImmExemptID

[Students]DOB

[Students]Grade_Level

Status of Requirements

Status requirements are grouped by grade levels according to California's immunization admission requirements.

Staff Initials

The initials of the staff member who reviewed the student's immunization record.

Manual entry

Has All Required Vaccine Doses

Indicates that the student has met all immunization requirements for their current grade level.

Calculated

[Students]DOB

[Students]Grade_Level

[HealthImmExempt]HealthImmExemptID

[HealthVaccine]StateReportCode

[HealthStudDoseRec]DateAdministered

Temporary Medical Exemption

Indicates that the student has a temporary medical exemption.

[Students]DOB

[Students]Grade_Level

[HealthImmExempt]HealthImmExemptID

Missing Doses Not Currently Due - Conditional

Indicates that the student does not have all of the required doses but does not have any doses due at the time of admission.

Manual entry

Missing Doses are Overdue - Needs Doses Now

Indicates that the student does not have all of the required doses and is subject to exclusion from admission.

Note: This is not applicable for students in grade level below 7.

Manual entry

Follow-up Dates

The date the follow-up is needed.

Manual entry

Other

Indicates that the student does not have all of the required immunizations, does not meet the criteria for conditional admission, and is:

• accessing special education services required by the student's individualized education program (IEP), or

• enrolled in an independent study program and does not receive classroom-based instruction (IND), or

• enrolled in a home-based private school (Home), or

• transferring from another school in California with a valid personal beliefs exemption filed before 2016 (PBE).

Manual entry

Date Requirements Met

The date the student met all immunization requirements.

Note: The individual requirements for each vaccination may not be the most recent dose. Depending on the age of the student and the age they were when each dose was administered, the individual requirement may be met by an earlier dose.

[Students]DOB

[HealthImmExempt]HealthImmExemptID

[HealthVaccine]StateReportCode

[HealthStudDoseRec]DateAdministered