School Year 2015-2016 Enrollment and Immunization Primer Please take note of the following

School Year 2015-2016

Enrollment and Immunization Primer
Please take note of the following:

1. 
   OUT OF COMPLIANCE CALCULATION: For all vaccines given as a series (requires more than one dose (“shot”) to be compliant), students become out of compliance once the minimum interval between doses has passed. See page 12 for full details of vaccine dose requirements.
   

2. 
   NEW IMMUNIZATION REQUIREMENTS:
   
   1. 
      2 doses of Varicella vaccine for entry into KINDERGARTEN and 1^ST GRADE
      
   2. 
      1 dose of Tdap vaccine for entry into 7^th and 8^th GRADES
      
   3. 
      1 dose of Meningococcal for entry into 7^th and 8^th GRADES
      

3. 
   IMMUNIZATION EXEMPTIONS: The entry and definitions for immunization exemptions are the same as they were last year.  Review the primer for new definitions and entry procedures (Appendices 4 and 5).
   

4. 
   REPORTS: Reports are in SMS, and are intended to be real-time but could take up to 20 minutes to refresh. Principal Dashboard reports update daily overnight. Data Cleansing Report #122 identifies Immunization Out of Compliance students and vaccinations.
   

5. 
   EXCLUSION: Exclusion begins on Monday, September 21^st this year.
   

6. 
   ASSISTANCE:
   

Louise Fink, Ph.D.- Director, Home and Hospital/Health Services- [e-mail]

John Lamoureux- Baltimore City Health [e-mail]

Judith DeBose, MD – Medical Director, Baltimore City Health Department – [e-mail]


Baltimore City Public Schools (City Schools)

August 2015


Table of Contents

Introduction 3
Key Immunization Campaign Dates 3
Key Immunization Contacts 3
Introduction to SMS and SMS Tutorials 4
Accessing Enrollment and Immunization Reports 5-10

• 
  Immunization Non-Compliance Report in SMS
  
• 
  No Records Report in SMS
  
• 
  T-10 Report on Principal’s Dashboard
  
• 
  No Show Kids Report on Principal’s Dashboard
  
• 
  Attending in September, not in October
  

Implementation Tools 10
Immunization Regulations 11-13

• 
  Maryland State Regulations
  
• 
  City Schools and City Health Department Out of Compliance Policy
  

Immunization Resources 14
Appendices:

1. 
   Sample Letter to Parents 15-17
   

• 
  English
  
• 
  Spanish
  

2. 
   Sample Non-Compliance Report 18
   
3. 
   Entering Required Immunization Dosage Information 19-20
   
4. 
   Entering Immunization Exemptions 21-22
   
5. 
   Defining Immunization Exemptions 23
   
6. 
   Frequently Asked Questions: For schools, for parents, about SMS 24-27
   

School Year 2015-2016 Immunization Primer

Before the start of each school year, City Schools embarks on a multi-agency effort to ensure that all students are immunized and ready to attend school on the first day, and remain in compliance for the remainder of the school year. Every year, immunization requirements extend from Pre-K through the 12^th grade in Baltimore City, and thousands of students are non-compliant. This primer is intended to serve as a comprehensive resource for school-level staff and administrators.

Use this as your reference guide and toolkit for reaching the system-wide goal of 99.7% compliance in ALL schools by September 30, 2015. All immunization information should be entered promptly into SMS when it is received from families.
2015 Key Dates

• 
  By Friday, August 28^th:
  
  • 
    SCHOOLSOnline Training Completed by Immunization Project Managers
    
  • 
    CENTRALNon-compliance calls made to students
    

• 
  Monday, August 31^st: Start of School. First day of exclusion for non-compliant students, unless one of the following documents is provided: 1) DHMH Form 896 (MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE IMMUNIZATION CERTIFICATE) or other immunization record; 2) An appointment slip documenting that the student will receive the required vaccine(s) before September 21^st; 3) A verbal or written statement from the parent/guardian that the student has an appointment (date required) with a health care provider or the Health Department before September 21^st.
  
  • 
    SCHOOLSInformation Sent Home with Non-compliant students on first day of school, followed by on-going monitoring and communications (phone calls, letters, conferences) with families.
    
  • 
    CENTRALParent Link calls before start of school
    

• 
  Friday, September 4^th:
  
  • 
    SCHOOLSSend letters home with all non-compliant students who submitted appointment information informing their parents that students must bring documentation to school by Monday, September 21st or they will be excluded from attending school. Letters will be made available in Principal’s Dashboard from September 4^th.
    
  • 
    CENTRALExclusion guidance sent to Principals via City Schools Inside. Parent Link calls sent to students regarding exclusion.
    

• 
  Monday, September 21^st: First day of exclusion for non-compliant students who provided documentation that they were scheduled to receive the required vaccines, but did not return documentation of the required vaccines (DHMH Form 896 or other immunization record).
  

• 
  September 30^th: Students who are not in compliance by September 30 will NOT be counted as enrolled students for funding purposes.
  
  • 
    SCHOOLSPhone calls and home visits to students.
    
  • 
    CENTRALParent Link calls to students.
    

Key Immunization Contacts

Contact your School Support Liaison and/or your School Nurse for direct support.
Baltimore City Health Department: 410-396-4454 or www.baltimorehealth.org

City Schools Office of School Support – Health Services: 410-396-8904 or http://www.baltimorecityschools.org/Page/25226

SMS

SMS is the data system that houses all City Schools immunization records electronically. School staff members are the only personnel who are authorized to make changes or additions to student records in SMS. Therefore, it is important to enter all immunization records in a timely and accurate manner.

Students can become non-compliant because of simple data entry errors, and families can be burdened with multiple letters, phone calls and house visits if their students are considered non-compliant because schools have not entered their documentation into SMS.
If you have questions at any time, call the City Schools Help Desk at 443-984-2000 and ask to speak with ITD.
SMS Tutorials

City Schools created a tutorial for how to enter:

• 
  Immunization dosage information
  
• 
  Immunizations exemptions (including the new definitions for immunization exemptions)
  

Please see Appendices 3, 4, and 5 for step by step instructions and definitions.
These tutorials are step-by-step, screen-by-screen instructions on the correct way to enter this data. Please familiarize yourself with how to enter exemptions. The importance of entering data correctly cannot be overstated. Your students will become non-compliant if you do not enter these exemptions correctly. Remember to look for possible data entry errors when a student is non-compliant without an obvious reason. Check the cumulative folder to make sure that shot dates in SMS match the written records.

Enrollment and Immunization Reports

SMS Reports are the best tool for keeping students in compliance for immunizations.

These reports can be accessed any time:

• 
  SMS reports are real-time and automatically updated
  
• 
  Principal Dashboard reports are updated nightly
  
• 
  Data Cleansing Reports are updated nightly
  

Principal Dashboard

The principal’s dashboard now includes key measures for immunization, so that the principal can directly and easily monitor the progress of the initiative at their school site. Access the dashboard via the “tree” icon on your desktop -- only principals have access to this dashboard. Under “Student Information”, click on “Immunizations”. To see just Non-compliant students, click on “Out-of-Compliance”.

Report: Non-Compliance in SMS

This report is real time and is accessed via SMS. It will list by name all students who are currently out-of-compliance at your school. The report indicates which shot(s) each student needs to receive or provide documentation of having received. A sample Non-Compliance report is available in Appendix 2 of this primer.

Directions to access the report detail level of students (student names)

1. 
   Log in to SMS.
   
2. 
   Click on Admin > Reports
   
3. 
   Under “City Schools – Immunization Reports”, click on “Immunization Out of Compliance”
   
4. 
   Enter three digit school number and click “Run Report”
   

Report: Data Cleansing in EWEB

The Data Cleansing Reports now includes immunizations, so that all staff with data cleansing access can directly and easily monitor the progress of the initiative at their school site. Access eweb at http://eweb – only staff who have been granted access to data cleansing reports will be able to view this report. Under “Reports”, click on “Data Cleansing Reports.” To see your out-of-compliance students, click on “Student with Immunization out of Compliance” – this is Report #122.

Primary Reasons for Non-Compliance*

Common Reasons for OOC	Applicable Shot(s)
Invalid shot - under age 1 year	MMR Varicella
Two or more doses required- over age 13 years	Varicella Hep-B (3 doses required)
Data Entry Error or Omission	Wrong Date of Birth Wrong Date of Vaccine Dose
New Requirements	7^th Grade and 8^th Grade: Tdap and Meningococcal Kindergarten and 1^st Grade: 2^nd dose of Varicella

*Refer to the full descriptions of immunization requirements for more information.

Common Names for Vaccines

Vaccine Name	Common Names
DTaP/DTP/DT/Td	Diphtheria Tetanus Pertussis
Tdap	Tetanus, Diphtheria, acellular Pertussis
MCV	Meningococcal
Polio	Polio
Mumps	Measles, Mumps, Rubella (MMR), MMR-4
Measles	German Measles Measles, Mumps, Rubella (MMR), MMR-4
Rubella	Measles, Mumps, Rubella (MMR), MMR-4
Varicella	Chicken pox vaccine
Hep B	Hepatitis-B
HIB	Hemophilus influenza type B
PCV	Pneumococcal conjugate vaccine Prevnar

Report: No Records

This report is real-time and will show students who have no records entered for immunizations in SMS. Typically, these students are new enrollees, and their immunization information was not entered at the time of initial entry into SMS.

Directions to access the report  detail level of students (student names)

1. 
   Log in to SMS.
   
2. 
   School based immunization contacts must switch their role to SCCHP to have SMS Immunization and Entry Access.
   
3. 
   Click on Admin > Reports
   
4. 
   Under “City Schools – Immunization Reports”, click on “Immunization No Records”
   
5. 
   Enter three digit school number and click “Run Report”
   

Report: Missing Students- T-10 Status

This report is real-time and will show students who are missing from City Schools records. Students will be listed under the last school they attended, with their last available contact information and their number of days absent. “Leaving schools” must attempt to contact their missing students to determine if they are enrolled in another city school. Once that determination is made, student records should be transferred to the current school and SMS should be updated to reflect the new information.

Directions to access the report  overview number of students

1. 
   Log in to Principal Dashboard.
   
2. 
   Click on “Student Information” tab
   
3. 
   Make sure you are on “Enrollment Overview”
   
4. 
   See T-10 Student data on right hand side
   

Directions to access the report  detail level of students (student names)

1. 
   Log in to SMS.
   
2. 
   Click on Admin > Reports
   
3. 
   Under “City Schools – Data Validation Reports”, click on “Aging T10 report”
   
4. 
   Enter three digit school number and click “Run Report”
   

Report: No Show Kids (helps with attendance and T-10)

This report identifies students who are in T-10 status and students who have yet to attend school for the current year. This is a target list for principals and staff for phone calls and home visits to determine enrollment status of students.

Directions to access the report  detail level of students (student names)

1. 
   Log in to SMS.
   
2. 
   Click on Admin > Reports
   
3. 
   Under “City Schools – September 30^th Enrollment Reports”, click on “No Show List”
   
4. 
   Enter three digit school number and click “Run Report”
   

Report: Attending in September, but not in October

This report is real time and will list by name all students who attended school in September, but have not attended yet in October.

Directions to access the report  detail level of students (student names)

1. 
   Log in to SMS.
   
2. 
   Click on Admin > Reports
   
3. 
   Under “City Schools – September 30^th Enrollment Reports”, click on “Students Absent on Sept. 30^th and no atten in Oct”
   
4. 
   Enter three digit school number and click “Run Report”
   

City Schools Implementation Tools
Tool: Web-based Access to Student Health Records of BCHD
The Baltimore City Health Department is again offering services to help ensure that City public school students are in compliance with their required immunizations (“shots”). These services include:

(1) TIKE free shot clinics [see the attached schedule for August]; 

(2) Health Department staff will search for and then fax back to schools the shot records of students who may have a “lost” or “incomplete” vaccination history (please call 410-545-3048 for assistance); and,

(3) School immunization managers have direct access to Maryland’s BIRP-ImmuNET immunization registry. To access ImmuNET, point your Internet browser to https://www.mdimmunet.org then log in with the same user name and password as you used last year.

(4) Medical review of immunization records to determine if vaccines have been inappropriately administered (contact your school nurse, or Judith DeBose, MD – Medical Director for the Bureau of School Health at [e-mail])
Please call or e-mail John Lamoureux (410-545-3048; [e-mail]) for BIRP-ImmuNET questions and other assistance.
2015-2016 Immunization Regulations
The following two documents give a description of vaccine requirements in the State of Maryland for school year 2015-2016.

State of Maryland Vaccine Requirements

Explains State of Maryland immunization requirements.

City Schools Immunization Compliance Logic

Details how the City Schools and the Baltimore City Health Department determine out-of-compliance students (based upon Maryland State law). Each required vaccine has unique minimum intervals, age requirements and required dosages. Familiarizing yourself with this document will enable you to answer parent questions quickly and efficiently.

Highlights of 2015-2016 Immunization Requirements

1) Students have a 20-day grace period beyond their first date of entry into City Schools (or the first day of school) to get the next required dose, only if there is documentation of the date of an appointment for vaccines within the 20 day grace period, with either their health care provider or the Health Department. Students must be excluded on the first day of school if no documentation of an appointment date is provided.

2) Students become out of compliance when the minimum interval between doses of shot has passed. For example, there is a 4 week minimum between Hep-B doses one and two. If a student receives their first Hep-B dose on September 1^st, then the student will not become out of compliance until that 4 week window has passed on September 29^th. In addition, any shots given within that 4 week window will not be counted as valid in SMS. So it is important that students wait those minimum time periods before getting their next dose. See page 12 for more detailed information on shot intervals. If there are any questions about minimum intervals, please contact your school nurse.
2) You must enter a date, including month and year, into the ‘Comments’ field on the Immunizations Exemption dialog page. This date should either be the student’s disease date or date of titer that determined history of the disease, if disease date is unknown. See Appendix 4 for this important tutorial.
3) Temporary Medical Exemptions should not be used in lieu of an immunization. The temporary medical exemptions should be used with discretion and can be granted for medical situations such as pregnancies and either student or family illness, as documented by a physician. For example, if either a student or family member is receiving chemotherapy, a physician may choose to exempt a student from receiving vaccines that contain live pathogens and could be a threat to the immune system. To appropriately enter this exemption into SMS, remember to put an end date, as dictated by a physician, into the ‘Expiry Date’ field on the Immunizations Exemption dialog page. See Appendix 4 for this important tutorial.
4) Permanent Medical Exemptions for illness can also be granted at the discretion of a physician, and must be documented. There is no end date for these exemptions, so you do not need to enter an Expiry date.
5) Religious Exemptions: Parents must sign the bottom of DHMH form 896 confirming that their bona fide religious beliefs exempt them from immunizations. This is the ONLY documentation that is needed for a religious exemption to be granted. Students do not need physician approval for a religious exemption. Simply select ‘Religious Exemption’ from the Immunization Exemption list. See Appendix 4 for this important tutorial. If you experience difficulty with entering a religious exemption for a 7^th or 8^th grade student, please contact Louise Fink by email, [e-mail]
6) Students may not be excluded from registering or enrolling in school due to a lack of immunization documentation. Guidelines for this can be found from the Department of Health and Mental Hygiene at

http://phpa.dhmh.maryland.gov/OIDEOR/IMMUN/Shared%20Documents/Min_Vacc_Req%2015_16_FINAL.pdf

 


Additional Immunizations Resources
Baltimore City Health Department (BCHD)

The Baltimore City Health Department offers free immunizations for students through its Community Health Clinics, TIKE van, and school-based health suites. Students will need to either be accompanied by a parent or guardian to provide the necessary informed consent. Students should also bring their past shot records with them whenever possible.

BCHD Health Clinics

Students can be immunized for FREE without an appointment at Baltimore City’s Eastern District and Druid Health Clinics at the following addresses. Clinic hours vary, so contact the BCHD at 410-396-4454.

Eastern

620 North Caroline St.

Baltimore, MD 21205

Phone: [phone]

Metro: Johns Hopkins Station

MTA buses: No. 5 (Monument and Central Ave.)
Druid

1515 North Ave.

Baltimore, MD 21217

Phone: [phone]

Metro Subway: Penn North Station

MTA buses: No. 13 (Pennsylvania and North Ave.)
TIKE Clinics

The Baltimore City Health Department offers FREE immunizations for students through its TIKE clinics, which are located in different locations around Baltimore each week. Appointments are not necessary to be immunized through the TIKE clinics. Updated schedules are available online each month at:

http://health.baltimorecity.gov/node/107

or

http://health.baltimorecity.gov/sites/default/files/TIKE%20Clinic%20Schedule_5.pdf

Appendix 1: Sample Letter to Parents
Appendix 1 is a sample letter that schools can send to parents of non-compliance students throughout the year. Letters are an important method of communicating with parents and ensuring that the addresses in student files are correct. If a letter is returned to you in the mail, be sure to track down that student’s correct mailing address and enter it into SMS.
If you are viewing the letter electronically and would like to copy and paste the text, use the ‘select’ tool (cursor) in Adobe Reader. It is found in the upper left corner of your screen. Highlight all the text, and then choose ‘copy’ under the ‘edit’ menu.

Exclusion Letters Printed from SMS (anticipated availability by mid-September)

In addition to this letter, the intent is for schools to be able to print the exclusion letter to send to families directly from SMS. This functionality should be available mid-September. A communication will be sent to project managers regarding this option.

The instructions for printing these letters will likely be:

1. 
   Log-in to SMS.
   
2. 
   Click on Admin > Reports
   
3. 
   Scroll down to Health Reports and click ‘Immunization Delinquency Letter.’
   
4. 
   Enter three digit school number
   
5. 
   Click “Run Report”
   

Placeholder: Sample Letter to Parents (English)

<> <>, 2015
To the parents/guardians of <>, school number <>

Dear Parents/Guardians:

The State of Maryland requires that all students enrolled in preschool through 12th grade be up-to-date with age-appropriate immunizations at the start of the new school year. Our records show that your child does not have the required immunizations, or that your child’s immunizations will soon be out of date. Specifically, your child requires immunizations against the following disease(s):
<>
Please provide your child’s school with proof of the immunization(s) on or before the first day of school on Monday, August 31, 2015. If your child does not have proof of the required immunizations, you must provide either: 1) An appointment slip from a doctor’s office or the Health Department with the date that your child will receive the immunization(s); or 2) a written statement from you, stating the date that your child will receive the required immunization(s). The appointment must be before September 21^st, 2015. Your child cannot attend school if these documents are not provided in the first week of school. If your child does not receive the required immunizations and the records are not current before September 21^st, they will not be permitted to attend school.
If your child does need immunizations, please make arrangements with your doctor, clinic or the Baltimore City Health Department to get the necessary vaccination shots. The Baltimore City Health Department offers free vaccinations; please call 410-396-4454 for information about this service. When you take your child for vaccinations, please bring your immunization record with you for completion by the medical staff.
Please direct questions about immunization requirements and your child’s immunization record to the principal of your child’s school at <>. You can also call City Schools’ Health Services division at 410-396-8904.
Thank you for all that you do to support our students and our schools.
Sincerely,

Karl E. Perry, Sr.

Chief School Supports Officer

Placeholder: Sample Letter to Parents (Spanish)

<>
A los padres de:
Queridos padres y tutores:
Todos los niños matriculados en programas pre-escolares hasta el duodécimo grado deben estar totalmente inmunizados contra ciertas enfermedades transmisibles para poder asistir a la escuela en el año nuevo escolar. Nuestros expedientes indican que actualmente su niño no cumple o está aproximando no cumplir con las vacunas siguientes:

Por favor provee a la escuela de su niño prueba de las vacunas antes de empezar la escuela el lunes, 31 de agosto de 2015. Los estudiantes podrán asistir a la escuela hasta el 20 de septiembre sin tener el registro de vacunas más corriente. Pero a partir del viernes, 21 de septiembre, no podrán asistir la escuela si no han recibido las vacunas requeridas y sus registros no están corrientes.

Si su niño necesita vacunas, por favor haz una cita con su doctor, organización de seguros médicos, o el Departamento de Salud de la Ciudad de Baltimore para recibir las vacunas necesarias. Si usted tiene preguntas sobre cómo obtener vacunas gratis, por favor llame al Departamento de Salud de la Ciudad de Baltimore al 410-396-4454. Cuando tomando aprovecho de estas oportunidades, por favor traiga el registro de vacunas más corriente de su niño para que los empleados médicos lo puedan completar.
Preguntas sobre las vacunas de su niño se deben dirigir al director/a de la escuela de su niño llamando al <>. También puede llamar al la Oficina de Servicios de Apoyo para Estudiantes al 410-396-8904.
Gracias por todo lo que hace para apoyar a nuestros estudiantes y a nuestras escuelas.
Atentamente,
Karl E. Perry, Sr.

Chief School Supports Officer

APPENDIX 2: Sample Out of Compliance Report




FIRST and SECOND STUDENT: If these students had the chicken pox, no shots should appear – they should be entered as a medical exemption for Varicella. However, in these cases, the students did not have the chicken pox (after reviewing their cumulative folders). They both need a second dose of Varicella because the first doses were administered on or after her 13^th birthday.

THIRD STUDENT: This student is out of compliance for Varicella even though he ahs a medical exemption. Most likely, the exemption was entered incorrectly in SASI’s Health History tab. You must include a month and a year of the disease date or titie in the ‘Fol. Date’ field. See the Medical Exemption: Varicella Disease Date tutorial in the appendix for complete details.

APPENDIX 3: Entering Required Immunization Dosage Information

1. 
   Log in to SMS.
   

2. 
   Switch Role in the upper right hand corner and make sure that SCHHP is selected to have SMS Immunization and Entry Access
   
3. 
   On the Student Search page, enter last name or first name of your student (or student ID number).
   
4. 
   Select the student’s name.
   

On the control bar to the left, click Health Tracking, then click Dose Quick Entry. Any required immunizations assigned to this student appear in the Immunization column.

5. 
   Simply add any required dosage information by entering a date in the past (mm/dd/yyyy). You can enter multiple doses for any of the required immunizations while on this page.
   
6. 
   Click Apply to save the dose information and remain on the Dose Quick Entry page.
   

7. 
   To check the Immunization status for a student after you have entered dose information, click Immunizations, located on the control bar. The required immunization tab appears.
   
8. 
   On the Required tab, the students’ Immunization Status for any immunization is listed directly to the right of each Required Immunization name. Additional dosages may be required in order for the student to be compliant for the immunizations listed. If this is the case, then return to Dose Quick Entry to enter additional doses.
   

Appendix 4: Entering an Immunization Exemption

1. 
   Log into SMS
   
2. 
   On the Quick Search page, enter last name or first name of your student (or student ID number).
   
3. 
   Click Search.
   
4. 
   Select the student’s name.
   

5. 
   On the control bar to the left, click Health Tracking, then click Immunizations.
   
6. 
   Click the name of the required immunization for which you wish to enter an exemption.
   

7. 
   Once you have selected the required immunization, the Immunization Exemption dialog page will appear.
   
8. 
   From the Immunization Exemption drop-down list, select the appropriate exemption.
   
9. 
   If you select a Temporary Exemption or Medical Exemption, then you must enter an Expiry date.
   
10. 
    If you have a Religious Exemption for students in 7^th or 8^th grade, please contact Louise Fink at [e-mail].
    
11. 
    If you select the “Varicella-Disease Date and Blood Test Date” exemption, then you must enter the Disease and Blood Test Date in the Comments box.
    
12. 
    Click OK to save the immunization exemption.
    

13. 
    The required immunization name now displays an exclamation point! The Immunization Status now displays Status to be calculated.
    
14. 
    Click Apply to recalculate the student’s Immunization Status.
    

15. 
    The Dose 1 Due Date will display the Expiry Date for Temporary and Medical Exemptions.
    
16. 
    The Immunization Status now displays Compliant—XXXXXX Exempt.
    

Appendix 5: Immunization Exemptions Defined

Name of Exemption	Purpose of Exemption	Expiry Date of Exemption
Hep-B Blood Test	If a student is immune to Hep-B and can verify this with blood test documentation from a health care provider, then they can be exempted from this immunization requirement.	No expiry date needed Enter blood test date in the Comments field on the Immunizations Exemption dialog page.
Hep-B Merck Exemption	Two doses of Hep-B vaccine is acceptable only if the student was vaccinated with the Merck & Co. brand vaccine Recombivax HB Adult Formulation and this vaccine for use in adults 11-15 years of age as a two-dose series.	No expiry date is needed Enter the vaccine date in the comment field.
Medical Exemption	If a student has a medical condition (such as allergies to an immunization), then they can be exempted with verification from a health care professional.	If the condition is permanent, then no expiry date is needed. Enter the reason for exemption in the comments field.
MMR-Blood Test	If a student is immune to MMR and can verify this with blood test documentation from a health care provider, then they can be exempted from this immunization requirement.	No expiry date is needed. Enter the Blood test date in the comment field.
Permanent Exemption	Permanent Medical Exemptions for illness can only be granted at the discretion of a physician.	These are permanent—no expiry date is needed. Enter the reason in the comment field.
Polio-Blood Test	If a student is immune to polio and can verify this with blood test documentation from a health care provider, then they can be exempted from this immunization requirement.	No expiry date is needed. Enter the Blood test date in the comment field.
Religious Exemption	Parent’s bona fide religious beliefs exempt them from immunizations.	No expiry date needed
Temporary Exemption	Temporary Medical Exemptions can be granted for pregnancies and either student or family illness, as documented by a doctor	Dictated by doctor. By default, these exemptions will expire after one day if you do NOT enter an expiry date. Enter the reason in the comment field.
Varicella-Disease Date & Blood Test Date	If a student has had varicella (chickenpox) prior to immunization and this is verified by a health care provider, school health professional or health official, then the student can be exempted from this immunization	No expiry date need be entered. Enter the Disease Date & Blood Test Date in the Comments field on the Immunizations Exemption dialog page.

Immunizations FAQ – Schools

All students must meet certain immunization requirements in order to attend schools in Maryland. Families are given a 20-day grace period to provide documentation of vaccinations according to the schedule on page 12.
Please also see the attached guidance from the Baltimore City Health Department on addressing vaccinations marked in SMS as incorrectly administered. Reports are available in SMS detailing the students and immunizations that are currently outstanding. For more detailed information and instructions, please contact your Student Support Liaison.

For more information, please refer to the Immunization Requirements website at: http://www.baltimorecityschools.org/Page/24371

What steps do I take when a student’s vaccine has been administered incorrectly?

• 
  Please click on “guidance” link above
  

Can I enroll a student even if they do not have their complete immunizations?

• 
  Yes. All students must be enrolled but families must provide an appointment date that is within a 20-day grace period. Any student who does not receive their vaccines by the documented date must then be excluded.
  

How long do enrollment officials have to enter immunization information into SMS?

• 
  Immediately upon receipt of information.
  

What if parents/guardians voice a religious objection?

• 
  City Schools recognizes the rights of parents and guardians to exempt their child from vaccinations based on religious beliefs. Parents/Guardians must complete the “Religious Objection” section of the MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE IMMUNIZATION CERTIFICATE (Form 896), located at the bottom of page 1. Form can be found at: https://www.mdimmunet.org/ir_docs/896_School_Certificate.pdf
  

When will students be excluded from school if they have not received full immunizations?

• 
  Students will be excluded on the first day of school if they have not provided an updated immunization record or evidence of an appointment for vaccines. If the student has a documented appointment, there is a 20 calendar-day period after the first day of school to provide documentation of the required immunizations. September 21^, 2015 is 21 days after the start of the school year. Students who have not provided the required documentation will be excluded from school starting September 21, 2015.
  

When will exclusion letters be available for distribution?

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  Exclusion letters will be available no later than September 11, 2015. Each school will be responsible for mailing the letters to the families.
  

What if they have an appointment but no shot?

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  Appointment dates do count towards compliance if it is documented on an appointment slip, by the parent or guardian (signed), or by the school enrollment official (signed). Please do not enter as medical exemptions.
  

Where can students receive shots?

Students are encouraged to see their primary physician to receive their required immunizations. If they are not able to see their primary physician, the Baltimore City Health Department provides free immunizations through its TIKE clinics. Appointments are not necessary to be immunized through the TIKE clinics. Updated schedules are available online each month at:

http://health.baltimorecity.gov/node/107

or http://health.baltimorecity.gov/sites/default/files/TIKE%20Clinic%20Schedule_5.pdf

Additional information can be found by calling BCHD at 410-396-4454 or www.baltimorehealth.org
How much do vaccines cost?

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  In most cases, vaccinations are free of charge for children 18 years of age and under, specifically for families who receive medical assistance, or are un-insured or under-insured.
  

What if I still have students who are not immunized?

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  Consider common engagement strategies including, but not limited to: phone calls, letters, ParentLink outreach, home visits, and incentive strategies. Your Back-to-School Night also provides an opportunity to address and engage your families about the importance of immunizations.
  

How do unimmunized students impact my school?

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  Unimmunized students potentially put the school community at risk of exposure to contagious, vaccine-preventable illnesses. The risk is especially high for those individuals with weakened immune systems, or individuals who are not able to receive a vaccine for medical reasons.
  
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  Students excluded due to immunizations could impact District- and school-level funding from the state. Out of compliance students will not count in the 9/30 enrollment numbers.
  
• 
  Students excluded from school due to immunization miss valuable time learning and engaging in your school. They are at an increased risk of being Chronically Absent.
  
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Immunizations FAQs for Families

1. 
   What happens if my student is not immunized?
   

They can be enrolled in school as long as you provide evidence of an appointment. However, they will not be able to return to school after September 21 if they are not immunized.

2. 
   If my student has an appointment after September 20 will they be removed from school?
   

Yes, if it is for a non-compliant shot.

No, if it is for a series that must be continued at a later date.

3. 
   Do I have to bring a note if I am not immunizing my child for religious reasons?
   

No. However, the immunization form at the school will require your signature stating that you have a religious objection to immunizations.

4. 
   Why does my 7th or 8^th grader need to be immunized?
   

Seventh grade students are now required to have Tdap and Meningococcal Vaccines. These vaccines are recommended by the American Academy of Pediatrics (AAP) and the Advisory Committee on Immunization Practices (ACIP).

5. 
   How do I find out if my child needs immunizations?
   

Please contact your child’s doctor or clinic where you have received vaccinations.

The Baltimore City Health Department (410-396-4454 or www.baltimorehealth.org) as well your child’s most recently attended school should be able to provide some information as well.

6. 
   What do I do if my child is not immunized or needs shots?
   

Please contact your child’s doctor and make an appointment to receive the required vaccines.

7. 
   Where do I find the health clinic schedules?
   

The Baltimore City Health Department Immunization Clinic schedule can be found at http://health.baltimorecity.gov/node/107

or

http://health.baltimorecity.gov/sites/default/files/TIKE%20Clinic%20Schedule_5.pdf

Immunizations FAQs for SMS
Issue 1: Non-7^th/8^th grade students are being flagged as Out of Compliance (OOC) for Tdap and Meningococcal vaccines

Resolution: SMS Immunization module tracks out of compliance by age and not by grade. ITD placed a fix to change the OOC status to Compliant for non-7^th graders.

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  Fix will run every 15 minutes. So please check again to see the change.
  

Issue 2: 7^th/8^th grade students are flagged as OOC even after entering dose dates for Tdap and Meningococcal.

Resolution: ITD placed a fix for this issue and will run every 15 minutes to change the status from OOC to Compliant

Immunization Reports:

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  In SMS: Immunization Reports are available under City Schools – Immunization Reports and also under Health Reports.
  

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  Immunization Out of Compliance Reports are also available in Data Cleansing Report #122 on http://eweb
  

Back to School Immunization Links: http://phpa.dhmh.maryland.gov/OIDEOR/IMMUN/SitePages/back-to-school-immunization-requirements.aspx