Maryland preschools and schools may not admit or retain a student without evidence of age-appropriate immunity under COMAR 10.06.04.03, and MDH Form 896 is the standard certificate. It records vaccine dates by month, day and year, a certifying signature, and, when needed, a permanent or temporary medical contraindication or a parent's religious objection.
The medical provider who gave the vaccines records and certifies the dates; another provider, local health department official, school official or child care provider may transcribe them from an authenticated record. Only a medical provider or LHD official signs the Medical Contraindication section.
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Maryland Department of Health Immunization Certificate
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A medical provider or local health department official signs the Medical Contraindication section, marking the condition permanent or temporary until a stated date and listing the vaccines and reason. The religious objection section below it is signed only by the parent or guardian.
No. Dates must be entered as month, day and year, and check marks are not acceptable. Combination vaccines are listed separately by component, and the form may not be altered. Signature lines 2 and 3 are for certifying vaccines given after the first signature.
Yes. An ImmuNet printout may be used in place of the form for school or preschool. The certification line on Form 896 itself refers to vaccines administered according to the information in Maryland's Immunization Information System.