Iowa allows provisional enrollment in school or licensed child care for a child who has received at least one dose of each required vaccine but has not finished the series, or for a transfer student moving between US elementary or secondary schools. This certificate records the immunizations given, the vaccines still required and an expiration date.
A physician (MD or DO), physician associate, nurse or certified medical assistant completes the record, remaining vaccines and expiration date, and signs to certify they informed the family of the provisional enrollment requirements.
Download the current version from the source each time; forms change without notice.
Provisional Certificate of Immunization
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.
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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No more than 60 calendar days, beginning on the date the certificate is signed, and the remaining doses should be given as rapidly as medically feasible. The signer records an expiration date and lists the remaining vaccines required to qualify for a Certificate of Immunization.
A child who has received at least one dose of each required vaccine but has not completed all required immunizations, or a transfer student moving from one US elementary or secondary school to another. The signer selects one of those two reasons on the certificate.