SHS Immunization

1. Student Health Services:
Immunization and School
Physical Requirements

2. Objective:
• This section will review the District’s immunization
and school physical requirements.
• Entrance Policy SP6.132 outlines the immunization
and school physical requirements for students. The
policy is in compliance with Tennessee State law
and State Board of Education requirements.

3. Entrance Requirements
• All students entering MNPS MUST present proof of immunization,
physical examination from within the U.S. and record of birth prior
to admission. Appointment cards showing scheduled physicals or
immunizations will not be accepted.
• Exceptions:
- Students transferring from another school in Tennessee will be
given thirty (30) days or until the cumulative record is received
if sooner, to show proof of immunizations and a physical
examination.
- Students transferring from an out-of-state school will be given
thirty (30) days to complete their physical examination, however,
immunization records MUST be provided prior to admission.

4. Immunizations
• Immunization is a simple, safe and effective way to
protect children from a wide variety of potentially
deadly diseases.
• According to TCA § 49-6-5001 children must be
immunized prior to attending any school.

5. Immunization Certificates
• Schools can accept
only an Official
“Certificate of
Immunization”
provided by the Tn.
Department of Health.
It is to be completed
and signed by a health
care provider as proof
of immunization for
enrollment purposes.

6. Immunization Certificates
• An original is preferred
but schools may accept
properly completed and
legible, faxed copies of
the official Certificate of
Immunization or an e-
mailed, scanned
certificate.
• Schools may fax
certificates as part of the
routine of faxing student
records from one school
to another.
• Certificates are valid only
for the date and/or
grade level(s) as
documented on the
certificate & updated
certificates may be
required for continued
enrollment.
• Immunization Certificates
and attachments are to
be filed in the student’s
cumulative school
record.

7. Immunization Certificates
• Immunization certificates can be any color paper
including white and on any weight paper.
• Schools should not provide parents or students with
blank immunization certificates. If a school
distributes a copy of the immunization certificate for
clarification purposes, SAMPLE must be written
across the identifying information section.

8. Non-compliance of
Immunizations
• According to TCA § 49-6-5001, students must be immunized
prior to attending any school.
• If a student is identified as being out of compliance with the
immunization standard, the principal is responsible for notifying
the parent/guardian in writing of the deficiency.
• The letter should indicate that the parent has 5 school days to
return the required Certificate of Immunization to the school. A
copy of the dated letter shall be kept at the school. Following
the allotted time period and to be in compliance with the law,
the student should not be allowed to return to school until the
immunization certificate is presented to the school.

9. MNPS Policy
Immunization
Letter
(Place on School Letterhead)
(Insert date)
Dear Parent/Guardian,
Our records show that a current Tennessee Certificate of Immunization is not
on file at the school for (INSERT NAME).
If you have the updated certificate, please bring it or send it to school with
your child immediately. If your child does not have the required form, please
take your child to a private health provider or to the Metro Public Health
Department immediately to obtain the certificate and/or immunizations. You
have five school days from the date of this letter to provide the required form.
After (Insert date), your child will not be allowed to return to school until the
required certificate is provided per State law.
If your child has insurance that does not pay for vaccines and you cannot
afford them, Metro Public Health Department can provide the vaccine. They
may charge a small administration fee to give the free vaccine, which can
be adjusted based on your income. Immunizations are available through the
Metro Public Health Department at the Lentz, East and Woodbine Clinic
locations. The clinics are open from 8:00 a.m. to 3:00 p.m. Monday through
Friday for walk-in vaccinations. No appointments are necessary and families
should carry their child’s shot record to confirm what immunizations are
needed.
Please contact the school if you have any questions or need assistance in
meeting this requirement.
Sincerely,
( Insert Name)
Principal
An updated form letter &
translations are sent to
Principals before school
opening each year & are
available on the Employee
Portal as well.

10. Temporary Certificates
• Immunizations marked Temporary are valid for school
entry and attendance till the expiration date shown on
the certificate.
• Schools may want to develop an Excel log for
Temporary certificates with the student’s name and
expiration date.
• When a Temporary certificate expires, parents should be
notified using the “Immunization Letter” and given five
school days to provide an updated certificate. Students
cannot return after the five day grace period without an
updated Immunization Certificate.

11. Medical or Religious
Exemptions
• Medical: Healthcare provider must indicate which
specific vaccines are medically exempted (because of
risk of harm) on the new form. Other vaccines remain
required.
• Religious: Requires only a signed statement by the
parent/guardian that vaccination conflicts with their
religious tenets or practices. The written statement
should be dated and placed in the cumulative record.
A form is available from Student Health Services that can
be used for religious exemption but this specific form
cannot be required as State law allows for simply a
signed statement. Only parents that specifically request
a religious exemption should be offered the form as it is
not to be routinely provided.

12. Immunization
Requirement Summary
Children in Pre-School and Pre-Kindergarten
• Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
• Hepatitis B (HBV)
• Poliomyelitis (IPV or OPV)
• Haemophilus influenzae type B (Hib): age younger than 5 years only)
• Pneumococcal conjugate vaccine (PCV): age younger than 5 years only
• Measles, Mumps, Rubella (1 dose of each, usually given together as MMR)
• Varicella (1 dose or history of disease)
• Hepatitis A (1 dose by 18 months of age)
• Children entering Kindergarten
• Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
• Hepatitis B (HBV)
• Poliomyelitis (IPV or OPV): final dose on or after the 4th birthday
• Measles, Mumps, Rubella (2 doses of each, usually given together as MMR)
• Varicella (2 doses or history of disease):
• Hepatitis A (2 doses): effective July 1, 2011

13. Immunization Summary (cont.)
Children entering 7th grade
• Tetanus-diphtheria-pertussis booster (“Tdap”) regardless of TD history
• Verification of immunity to varicella (2 doses or history of disease)
Children who are new enrollees in a TN school in grades other than K or 7th:
• Diphtheria-Tetanus-Pertussis (DTaP, or DT if appropriate)
• Hepatitis B (HBV): previously only for Kindergarten, 7th grade entry
• Poliomyelitis (IPV or OPV): final dose on or after the 4th birthday
• Measles, Mumps, Rubella (2 doses of each, usually given together as MMR)
• Varicella (2 doses or history of disease): previously only one dose was required
Children with medical or religious exemption to requirements:
• Medical: Healthcare provider must indicate which specific vaccines are medically exempted
(because of risk of harm) on the new form. Other vaccines remain required.
• Religious: Requires only a signed statement by the parent/guardian that vaccination conflicts
with their religious tenets or practices. If documentation of a health examination is required, it
must be noted by the health care provider on the immunization certificate. In that case, the
provider may explain the absence of immunization information by checking that the parent has
obtained a religious exemption.
Adult students new to the District
• Students who plan to attend Cohn Adult Learning Center and are new to the District are
required to complete the Tennessee Certificate or Alternative Tennessee Adult Immunization
form prior to admission. Forms are available on site at the school.

14. Grade Level Specific Information
Kindergarten
To enroll for Kindergarten in MNPS, a student needs:
(1) A Tennessee Immunization Certificate valid for
Kindergarten.
(2) Evidence of a physical exam within 12 months of
the start of school
Students are not to attend school without both being
on file at the school per MNPS policy. District policy is
in accord with State Law and State Board
requirements.

15. Kindergarten Certificate
For students who attend
Pre-k in MNPS:
• the Pre-k physical is
valid for Kindergarten
entry.
• the Pre-K Immunization
Certificate is valid for
kindergarten entry only
if box D) Complete K-6
is checked as well as
box C).
A valid certificate will
have checked:
• box D)Complete K-6
or
• box A) Temporary & an
Expiration date

16. Grade Level Specific Information
7th Grade
Immunizations- A student needs an official Tennessee
Immunization Certificate showing proof of two additional
immunizations.
• Tetanus-diphtheria-pertussis booster (“Tdap”); regardless
of TD history
• Verification of Immunity to varicella; ( 2 doses or history
of disease)
Only proof of the two additional immunizations is required
on the new certificate which is to be stapled to the existing
certificate in the educational/cum record.
School Physical- If the student was previously enrolled in
MNPS, the original school physical that was provided upon
initial enrollment is still valid. A new physical is not required.

17. MNPS Immunization and Physical
Forms & Resources
• Entrance Requirements (SP6.132) Provides
information regarding immunization and physical
requirements and details concerning transfer
exceptions.
http://www.mnps.org/files/_6VBqb_/317f0686cacc1
9883745a49013852ec4/Policy_Entrance_Requireme
nts_SP_6.132_.pdf
• Useful School Staff Information by Grade Levels is
available on the Employee Portal under Forms &
Resources.
https://employee.mnps.org/Page16503.aspx