What are the acceptable forms of evidence for the bacterial meningitis immunization?
- A Proof of Bacterial Meningitis Immunization Compliance Form containing the required information with the signature or stamp of a physician or his/her designee, or public health personnel*. The form must be completed fully, including the month, day, and year the vaccination dose or booster was administered.
- An official immunization record generated from a state or local health authority. Documentation must be in English and submitted with the Proof of Bacterial Meningitis Immunization Compliance Form.
- An affidavit or a certificate signed by a physician who is duly registered and licensed to practice medicine in the United States, and in which it is stated that, in the physician’s opinion, the vaccination required would be injurious to the health and well being of the student. Documentation must be in English and submitted with the Proof of Bacterial Meningitis Immunization Compliance Form.
- A Texas Department of State Health Services conscience exemption form
- An official record received from school officials, including a record from another state
All documentation must include the month, date, and year that the vaccine or booster dose was administered.
*Please read the compliance form instructions carefully. All students must choose either option 1 or 2 and fully complete the document. The Proof of Bacterial Meningitis Immunization Compliance Form must have the health professional's signature and credentials and be submitted with attachments to UH.
Thank you for your feedback. Click Here to submit again.