Pennsylvania students missing required vaccine doses can attend school when their provider documents a plan to finish the series. This red and white card lists each remaining dose of DTaP or Td, Tdap, polio, hepatitis B, MMR, varicella and meningococcal vaccine with the date it will be given. It goes to the school nurse with the record of vaccines already received.
A physician, certified registered nurse practitioner, physician assistant or local health department completes the schedule and signs, circling the signer's title. The student's name, birthdate, address, parent and grade go at the top.
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Pennsylvania Department of Health - Medical Certificate
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The signature line lets the signer circle physician, certified registered nurse practitioner, physician assistant or local health department. The signer lists the date each remaining dose will be given so the school can follow the student's plan to complete the required vaccines.
The card says to attach the EHR record of vaccines already given. The certificate itself only lists future doses, so the attached record shows the school nurse which doses the student has already received and which remain.