Each year in January and February, all schools and child care facilities must report the immunization status of their students to the Health Department.
Reporting Forms
Immunization Report Instructions (163.35 KB)
Tally Worksheet (182.53 KB)
Immunization Primary Review Summary:
Step 1: Collect Information for all Your Students
Forms you will need: Certificate of Immunization Status (CIS) Form
Step 2: Assess Student Immunization Records
Forms you will need:
Step 3: Fill out the Primary Review Summary
Forms you will need:
Step 4: Send the First Report
By January 13, 2021
Email or fax to Multnomah County Health Department:
- Section A (page 1)
- Section B, C, D (page 2)
- Photocopies of the CIS forms or ALERT records for students listed in Section B
Step 5: Fill Out Section D and Cancel Exclusion Orders
Between February 4-17, 2021
- Fill out Section D (page 2) of the Immunization Primary Review Summary with the dates records are returned to you.
- If a student’s record is not up-to-date by the beginning of school on February 17, 2021, they will not be able to attend until you have an updated record.
- If updated records are returned AFTER the beginning of school on February 17, 2021, the student is “excluded.” Mark a “Y” in the column in Section D (page 2) of the Primary Review Summary. Keep a copy for your records.
Step 6: Complete and Send Pages 3 and 4 of the Primary Review Summary
By March 1, 2021
Using the Tally Worksheet (182.53 KB), complete page 3 of the Immunization Primary Review Summary (Sections E, F and G) and Section H as appropriate for your facility:
- Section E for preschool, day care or Head Start
- Section F for kindergarten
- Section G for 7th graders
- Section H for kindergarten through 12 graders
Email or fax to Multnomah County Health Department (keep a copy for your records):
- Page 2 (Section D) of the Primary Review Summary
- Page 3 (Sections E, F, G) of the Primary Review Summary
- Page 4 (Section H) of the Primary Review Summary
Questions? Contact Us
Multnomah County Health Department
Community Immunization Program
619 NW 6th Ave, 4th Floor
Portland, OR 97209
503-988-4724
503-988-5847 fax
immiprogram@multco.us
