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Washington CIS (DOH 348-013): Immunization Status

Washington requires a Certificate of Immunization Status for every child entering school or child care, listing dates of each required vaccine. Provider offices that use the Washington Immunization Information System can print it already filled in, and that printout counts as medically verified. Clinicians also sign its Documentation of Disease Immunity section to verify chickenpox history or a positive titer.

Who completes it

Parents fill in hand-written copies from medical records, and provider offices print it from the IIS. A licensed health care provider signs the disease immunity section, and a provider or school official signs to verify hand-copied dates.

Submitting and payment

How to submit it
Give the CIS to the family for the school or child care, or send a medically verified CIS directly to the school with the parent's agreement.

Good to know

  • Titer claims need the lab report attached, and polio immunity requires all three serotypes; a chickenpox history must be verified by a health care provider.
  • A hand-filled CIS needs a provider signature or attached medical immunization records; attaching records to a blank form is not acceptable.
  • Children catching up enter in conditional status and have until the next dose's minimum valid date plus 30 days to turn in documentation, or they are excluded.
  • The hardcopy CIS is posted in English and 17 other languages. Exemptions use the separate Certificate of Exemption, DOH 348-106.

Get the official form

Download the current version from the source each time; forms change without notice.

Certificate of Immunization Status (CIS)

Certificado del Estado de Vacunación (CIS)

Official pagePDFVersión en español

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

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.

Vero is not affiliated with, or endorsed by, the agencies and insurers listed here. Read our editorial policy.

Frequently asked questions

Does a CIS printed from the Washington IIS need a provider signature?

No. DOH says a CIS printed from the Washington Immunization Information System, including the MyIR version, is medically verified and needs no additional signature. A hand-filled hardcopy needs a health care provider signature or attached medical immunization records checked by school staff.

How does a provider verify chickenpox history on the Washington CIS?

The provider checks the verified varicella history box in the Documentation of Disease Immunity section and signs and dates it. If school staff can see the verification in the IIS, they check the box under varicella in the vaccine section instead.