Health Forms and Information

Information about CIIS, the Colorado Immunization Information System referenced below: 

Vaccination and exemption data are submitted to CIIS by school districts, medical providers and some online forms. Here are some FAQs for CIIS.

 

You can choose to opt in or opt out of CIIS at any time.

  • Your doctor's office should attach a signed copy of the form(s) to your child’s medical record.

  • You will mail, email, or fax one signed copy of the CIIS Opt-Out Form or the Rescind Opt-Out Form to the CIIS office at the address on the bottom of the form.

  • Keep one signed copy of the form(s) for your records.

There are four immunization records options for the 2021-22 school year (beginning 07/01/2021).

(1) Submit a copy of an immunization record provided by your health care provider.

  •  This form will not need to be provided every year or be labeled with a specific date, although a new copy should be submitted to Summit South when your child receives new vaccinations.

  • Vaccination data will be submitted to CIIS (see above).

(2) Submit a Medical Exemption form signed by an immunizing provider (MD, DO, APN, or PA)

  • You will need to submit this form to Summit South only once, unless the student’s information or school changes.

  • Forms must be dated and submitted after July 1, 2021.

  • Per Colorado Revised Statutes 25-4-2403(2.5), immunizing providers must submit medical exemption data to CIIS (see above).

(3) Submit a Non-Medical Exemption form with a signature from an immunizing provider (MD, DO, APN, or PA)

 

  • You will need to submit this form to Summit South every school year.

  • Forms must be dated and submitted after July 1, 2021.

  • Per Colorado Revised Statutes 25-4-2403(2.5), immunizing providers must submit medical exemption data to CIIS (see above).

(4) Submit a Non-Medical Exemption form received upon the completion of CDPHE’s Online Immunization Education Module.

 

  • You will need to submit this form to Summit South every school year.

  • Forms must be dated and submitted after July 1, 2021.

  • This is an online course you can take instead of having the certificate signed by an immunizing provider. You can view a transcript of this course here.

  • You can view the Non-Medical Exemption Form here. You must sign the form and provide the date and time stamp from the online course completion page.

  • You must keep a copy of this form for your records and submit a copy to Summit South, where it is filed in the student's paper cumulative file. No data is stored electronically or submitted to CIIS.

  • You are also given an option for the form at the end of the online course to Submit and Print, or Print Only.

 

Submit and Print

If you choose this option:

  • You will be able to print this form for your records and submit a copy to Summit South.

  • Your child's exemption data will be added to CIIS (see above).

 

Print Only

If you choose this option:

  • You will be able to print this form for your records and submit a copy to Summit South.

  • Your child's exemption information will NOT be added to CIIS.

  • Your exemption information will be erased after printing; CDPHE will NOT store your information.

Health Plans:

 

If your child has a reported health condition, a detailed health plan signed by your doctor must be turned in on or before orientation. All health plans must be updated for the new school year; these must be dated on or after July 1st and signed by your health care provider.

Medication Paperwork:

If you will be leaving any medications in the office for your child to access during the school year, you must have a medicine form completed and signed by your doctor for each medication - this includes over the counter medicines.

​​​​​​​​​​​Diabetes Forms

http://www.coloradokidswithdiabetes.org/nurse-files