South Carolina uses a single state form, the Certificate of Immunization, both to certify that a child has the vaccines required for child care and K-12 and to record a medical exemption. Providers generate it from SIMON, the state immunization registry, rather than downloading a blank. Parents give the printed certificate to the school or child care.
Only someone licensed to practice medicine, surgery or osteopathy, or that person's representative, may issue it as a certificate of medical exemption; health departments also issue certificates.
Download the current version from the source each time; forms change without notice.
South Carolina Certificate of Immunization
South Carolina Department of Public Health (formerly DHEC), Division of Immunization takes this form through its online services or your EMR, so there is no PDF to fill. Vero Scribe writes the visit note it draws on, so the details are ready when you complete it.
A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.
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DPH does not post a blank. The certificate is produced from SIMON, the state immunization registry, by a provider's office or the health department, and then given to the parent for the school or child care. DPH's instructions for completing it are published as a video playlist.
DPH says only an individual licensed to practice medicine, surgery or osteopathy, or that person's representative, may issue a certificate of medical exemption, and that it is done on the South Carolina Certificate of Immunization rather than a separate form.