Student Immunization Data Sheet

It is very easy for students to be taken advantage of when it comes to immunizations and what is needed. 
The following chart gives some indication of  fair market price. Students can contact their doctor, health clinics and pharmacies for assistance as well.

Standard Price/Dose Vaccine Description
$75 -$95 each Hepatitis B Adult (Series of 3 shots)
$110 each Varicella (Chicken Pox)
$55 - $75 Titer Test's
$80 MMR
$55 Td
$70 Tdap
$25 Flu
$20 - $60 Office visit

The school only offers the TB test.  We can give it during one class session and read it 48-72 hours later at the next class session. Saves you time in going back for a reading. The charge is $15 for TB.


EMS students must bring copies of requested information to the school by due date on program schedule.

Acceptable Documentation

Not Acceptable Documentation

Pharmacy/Clinic given shots: must have manufacturer, lot number and name of administrator on documentation per immunization. School records
Doctors Office: must have name of doctors office on documents, name/initials of person who administered immunizations or test. Self-reported immunizations.
Public Health Dept. or Military records will be take as is if completed by staff properly at time of immunizations.  
Actual Lab Reports for titer results  


Varicella (Chicken Pox) History Form

Chicken pox (varicella) is now a vaccine-preventable disease.  Chicken pox can be a serious and even life threatening illness in certain individuals.  Several hospitals and clinical agencies with whom EMTS is affiliated with for clinical experience now require that we furnish documentation of a history of chicken pox immunity. 


Option 1) Provide Two (2) separate  doses of Varicella vaccination.

*Note: Varicella vaccines  are given a minimum of 30 days apart.  As long as student has documentation of receiving 2 shots at this point in their life they are compliant.
*If the student has only completed  1 vaccination they must complete the series and receive the 2nd shot for a total of 2 doses.
* If the student has only proof of 1 vaccination they must complete the series and receive the 2nd shot for a total of 2 doses.

Option 2) If student has never received any Varicella vaccinations or has no proof of any  Varicella vaccinations in the past the student may provide a titer lab report showing immunity.


Hepatitis B Immunizations

Current CDC guidelines are confusing and complex.  If you have a history of having a suppressed immune system please contact the school for requirements.  For those who are not immunosuppressed the CDC only recommends a three shot series be completed and is valid for 22 years.  Shot Series:  Typically it is a 3 shot series followed by blood work to verify results.  Fastest timeline: Shot #2 is give a minimum of 30 days after shot #1 and shot #3 is given a minimum of 2 months after the 2nd
Option 1) Must provide appropriate documentation of receiving all three immunization doses at any time prior to course due date.

* If student has records showing they  have started the series but not completed all 3 shots a titer will not be accepted.  Student must complete the entire series.

Option 2) If student has no proof of any hepatitis B vaccines a titer test may be completed showing immunity.  A lab titer report must be provided.

NOTE: Waiver applies to only those students who completed the series and immunity cannot be obtained.


TB PPD Skin Test

Tuberculosis (TB) is a common and deadly infectious disease that is caused by mycobacteria.  TB most commonly affects the lungs but can also affect the central nervous system, lymphatic system, circulatory system, bones and joints.  An injection (PPD) is typically given in the skin followed by a reading taken 48 to 72 hours later.

Option 1) Provide documentation of a negative PPD TB skin test valid for 6 months prior to the end of the course student registered for. NOTE: TB PPD documentation from pharmacy, clinic and/or doctors office  must provide:  *Name of manufacturer   *Trade name given  * Lot/batch #   *Signature/Initials who gave immunization     *Date of immunization given *Results in mm not just positive or negative.

Option 2) If student is not permitted to complete a PPD TB test because of testing positive in the past the student must provide documentation of the past positive test result and complete one of the following;

   a) Chest X-ray report showing no TB present within 6 months prior to the end of the course student registered for.
   b) T-Spot blood test report showing no TB present within 6 months prior to the end of the course student registered for.

The school does offer TB (PPD)  testing in class for $15 which includes the reading of the test 48 to 72 hours after it was given. 

MMR Mumps, Measles, and Rubella

MMR vaccine childhood injection(s) as well as a adolescent/adult booster shot.  CDC suggests that you have:

  1. As a child students immunization records may not be documented as MMR but rather lists the vaccines individually (mumps, measles, rubella).  Student need two rounds of childhood measles, mumps and rubella injections at separate times as a child to not be required to take an MMR adolescent/adult booster shot.

  2. Option 1) Provide documentation of 2 separate rounds of MMR.

  3.     * May both be a child.
       * May both be as adult/adolescent

  4.    * May be a combination of childhood and adult.

Option 2) If student has documentation of only 1 round of MMR but not two the student must complete the series by getting another MMR booster.

Option 3) If student has no recollection or documentation of any MMR shots a blood titer is acceptable indicating immunity.

Tetanus/Diphtheria (Td) or Tetanus/Diphtheria/Pertussis (Tdap):


Tetanus: also known as lockjaw, is a rare, serious, and preventable disease that affects the body's muscles and nerves. It often arises from a skin wound that becomes contaminated by the bacterium Clostridium tetani, which is often found in soil. It is not contagious.   Tetanus/Diphtheria/Pertussis (Tdap): The difference between Td and Tdap is that Tdap includes pertussis which is whooping cough.

EMT-B students:  Td or Tdap vaccine within 10 years is acceptable.
Advance Level Students:  If Td within the last 10 years only, student will need a solo pertussis immunization (whooping cough) added within the last 5 years.  If student have Tdap - pertussis was included in the vaccine.  
Simple explanation: 1) You have to have had a Tdap within the last five years.




Influenza - Will be required for the upcoming 2017-2018 flu season.  (Only applies to EMT-B classes that conduct clinicals between November 1st and March 31st)
All healthcare workers should receive a flu shot.  Dependent upon flu season risk and clinical sites.  At this time the standard seasonal flu shot is required at all  clinical sites. 

Advance EMS Students:  Children's Medical Center requires season flu immunization year long.  If clinicals start and the current flu season immunizations are available the student is required to be immunized.

NOTE: Flu documentation from pharmacy, clinic and/or doctors office  must provide:
*Name of manufacturer   *Trade name given  * Lot/batch #   *Signature/Initials who gave immunization     *Date of immunization given