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.
1. Review each child’s Blue Card
Determine the varicella and Tdap booster status for each student.
Tetanus, Diphtheria, Pertussis (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.
PME- Permanent Medical Exemption (C)
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 ADMISSION, NEED FOLLOW-UP:
Conditional – Missing Doses Not Currently Due (B)
TME- Temporary Medical Exemption (D)
REQUIREMENTS NOT MET, MISSING DOSES, NEED FOLLOW-UP:
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
SchoolAssessments@cdph.ca.gov 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.
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
Once logged in, confirm your
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.