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7th Grade Immunization Assessment Instructions

This document is for reporting purposes (not for initial screening for admission). Information for this report must be obtained from the California School Immunization Record (Blue Card- CDPH286 PDF) or equivalent record. Use the worksheet to tally the immunization status of each student. List each student and check the designated box of their status for Tdap and Varicella separately. 

Reporting Tools:

1. Review each child’s Blue Card

Determine the varicella and Tdap booster status for each student.



Students need:

  • TetanusDiphtheriaPertussis (Tdap) —1 dose
    (Whooping cough booster usually given at 11 years and up)

  • Varicella (Chickenpox) — 2 doses

    (Usually given at ages 12 months and 4-6 years)

The Tdap sticker may be used to document Tdap vaccine in the student's permanent record on older versions of the Blue Card. Versions of CDPH 286 dated 01/19 or later include a row to document Tdap vaccine; no Tdap sticker is needed.


Requirements Met


  • 2 doses of varicella vaccine. Do not include students who have proof of disease for chickenpox. Please see criteria for permanent medical exemptions.


  • 1 dose of a pertussis-containing vaccine on or after the 7th birthday. No conditional entrance possible.

    Requirements Met, But Missing Doses

PME- Permanent Medical Exemption (C)

  • Submits a medical exemption issued in CAIR-ME for one or more required vaccines and immunization records with dates for all required shots not exempted. Can include medical exemption documentation should be used for a child who had chickenpox disease that was documented by a physician.

Other (F):

  • Schools may contact their authorized local educational agency (LEA) for additional information about these categories.

  • Only use if students do NOT have All Required Vaccine Doses, a temporary medical exemption or conditional admission and WHO ARE:
    F1. Accessing special education or related services required by their individualized education program (IEP), OR
    F2. Enrolled in an independent study program and do not receive classroom-based instruction (IND), OR
    F3. Enrolled in a home-based private school (Home).


Conditional – Missing Doses Not Currently Due (B)

  • If a child is missing the 2nd dose in the varicella series and that dose is not currently due at the time of reporting (as determined by intervals listed in Conditional Admission Schedule, column entitled "EXCLUDE IF NOT GIVEN BY" (table PDF).

TME- Temporary Medical Exemption (D)

  • Submits a TME issued in CAIR-ME for varicella and has submitted immunization records for vaccines not exempted.


Overdue- Needs Doses Now (G)

  • Out of compliance, missing doses are overdue and child may not attend school until overdue doses are received. Period of time listed in Conditional Admission Schedule, column entitled "EXCLUDE IF NOT GIVEN BY" (table PDF), has passed.

  • Homeless and foster students (allowed initial enrollment without records) counted here if still in the process of meeting requirements/waiting for records. If students do not have records, count the student as missing all doses.

2. Tally each child's Reporting Status on the Worksheet

Use the worksheet to tally the immunization status of each student. List each student and check the designated box of their status for varicella and Tdap separately.


Total the columns for the number of children in each reporting category. The total of A+ B + C + D + F+ G must be equal the total enrollment since each child is only in one group. 

Note for children meeting criteria of multiple categories:

  • If a student has an exemption and is also a conditional entrant, please report the student as having the exemption only.

  • Only place a child in "Other" if they do not fit in any other category.  Email with difficult reporting cases.

Retain the worksheet for your records in case of audit and as a roster of students who do not meet all immunization requirements in the event of an outbreak.

3. Submit Report at


  • To log-in, confirm your CDE School Code, which is last 7 digits of the 14-digit county-district-school (CDS) code assigned to your school.

  • If you are unsure of your CDE Code, try using the drop-down menu on the reporting site and see FAQ1.

  • Once logged in, confirm your

    • School Information

    • Contact Information

  • Submit Report using the totals from your worksheet. Fill out all required fields to complete the reporting form.

    • If there are no students in a particular category or if the category is not applicable, place a zero in the box.

    • Changes can be made up until reporting closes. Log in again and click "Revise Your Submitted Report" to make any modifications based on changes in a student's status. 

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