(1) Before a child may attend a school or child care center, a parent must provide proof of immunization status using the following documentation:

(a) A department-approved CIS form signed by the parent. The CIS form must include:

(i) Name of child;

(ii) Birth date;

(iii) Type of vaccine(s) administered;

(iv) Month, day, and year of each dose of vaccine received;

(v) A section to indicate whether a COE form accompanies the CIS form;

(vi) A section to document serologic proof of immunity signed by a health care provider acting within his or her scope of practice and including a copy of a lab report; and

(vii) Parent signature and date.

(b) If applicable, a department-approved COE form signed by a parent. A COE form must include:

(i) Name of child;

(ii) Birth date;

(iii) A place to indicate whether the parent is claiming a medical, religious, personal, or philosophical exemption. This must include:

(A) A statement signed and dated by a health care practitioner stating that he or she has provided the parent information about the benefits and risks of immunization to the child as a condition of obtaining a medical, religious, personal, or philosophical exemption;

(B) The requirement in (b)(iii)(A) of this subsection does not apply to a parent who demonstrates a religious membership under subsection (b)(iii)(F) of this subsection;

(C) A place to indicate any permanent or temporary medical exemption for one or more vaccines which must be signed and dated by a health care practitioner;

(D) A place to indicate any personal or philosophical exemption for one or more vaccines;

(E) A place to indicate any religious exemption for one or more vaccines; and

(F) A place to demonstrate religious membership. This must include a statement signed and dated by the parent identifying the name of the church or religious body, affirming membership in it, and affirming that the religious beliefs or teachings of the church or religious body preclude a health care practitioner from providing medical treatment to the child;

(iv) Notice to parents that if an outbreak of vaccine-preventable disease for which the child is exempted occurs, the child may be excluded from the school or child care center for the duration of the outbreak; and

(v) Parent signature and date.

(2) Parents who must include a signed statement from a health care practitioner under subsection (1)(b)(iii) of this section may submit:

(a) A photocopy of the signed COE in place of the original; or

(b) Along with the COE form, a letter from the health care practitioner in place of the signed statement under subsection (1)(b)(iii) of this section. The letter must:

(i) Indicate that the health care practitioner has provided the parent information about the benefits and risks of immunization to the child;

(ii) Reference the child's name; and

(iii) Be signed and dated by the health care practitioner.

(3) If immunizations are deferred on a temporary basis for medical reasons under subsection (1)(b)(iii)(C) of this section, the child must make satisfactory progress toward full immunization once the medical exemption has expired.

(1)(a) Before a child may attend a school or child care center, a parent must provide proof of immunization status using either a CIS or a COE form, or both. Information provided on these forms is to be used by a school nurse, child care health consultant, or the chief administrator to determine the immunization status of a child as: Fully immunized, out of compliance, conditional, or exempt.

(b) Any child identified as experiencing homelessness under the McKinney-Vento Homeless Assistance Act 42 U.S.C. 11431 et seq., or in foster care under 20 U.S.C. 6311(g)(1)(E) lacking documentation of immunization status on or before the first day of attendance must be immediately enrolled and allowed to fully participate in all school activities.

(2) The CIS form must be either produced from the WAIIS or a department-approved hardcopy CIS form. A hardcopy CIS form not produced from the WAIIS must include completion of the following fields:

(a) Name of child;

(b) Birth date;

(c) Type of vaccine(s) administered;

(d) Month, day, and year of each dose of vaccine received;

(e) A section to indicate whether a COE form accompanies the CIS form;

(f) If applicable, a statement signed and dated by a parent acknowledging the requirements for their child's attendance under conditional status, which includes progress towards full immunization consistent with the schedule established in WAC 246-105-060 (2)(a);

(g) A section to document serologic proof of immunity signed by a health care provider acting within their scope of practice; and

(h) A statement signed and dated by a health care provider stating that the information on the CIS is accurate; or

(i) A statement signed and dated by a school nurse, child care health consultant, or the chief administrator stating that they have confirmed the accuracy of the CIS by review of the child's medically verified immunization record, and have attached the medically verified record to the CIS. For the verification to be valid the immunization record must contain:

(i) Name of child;

(ii) Birth date;

(iii) Type(s) of vaccines administered;

(iv) Month, day, and year of each vaccine administration or if applicable serologic proof of immunity verified by a health care provider acting within their scope of practice; and

(v) The name and signature of the health care provider responsible for administering or reviewing each immunization; or

(vi) A unique stamp, logo, or other information identifying the health care provider or facility at which the provider practices.

(3) Alternately, in lieu of a CIS, a school or child care center using the WAIIS school module may accept verification by school staff that the child is fully immunized as recorded in the WAIIS.

(4) A parent who seeks an exemption to the immunization requirement must provide a department-approved COE form signed by a parent. A COE form must include:

(a) Name of child;

(b) Birth date;

(c) A field to indicate whether the parent is claiming a medical, religious, personal, or philosophical exemption. Philosophical and personal objections may not be used to exempt a child from measles, mumps, and rubella vaccine as described in WAC 246-105-055. This field must include:

(i) A statement from a health care practitioner that includes the practitioner's printed name, signature, and date of signature stating that they have provided the parent information about the benefits and risks of immunization to the child as a condition of obtaining a medical, religious, personal, or philosophical exemption;

(ii) The requirement in (4)(c)(i) of this subsection does not apply to a parent who demonstrates a religious membership under subsection (4)(c)(vi) of this subsection;

(iii) A field to indicate any permanent or temporary medical exemption, and if temporary, the exemption expiration date for one or more vaccines which must be signed and dated by a health care practitioner;

(iv) A field to indicate any personal or philosophical exemption for one or more vaccines, except for the measles, mumps, and rubella vaccine as described in WAC 246-105-055;

(v) A field to indicate any religious exemption for one or more vaccines; and

(vi) A field to demonstrate religious membership. This must include a statement signed and dated by the parent affirming membership in a church or religious body where the teachings of the church or religious body preclude a health care practitioner from providing medical treatment to the child;

(d) Notice to parents that if an outbreak of vaccine-preventable disease for which the child is exempted occurs, the child may be excluded from the school or child care center for the duration of the outbreak; and

(e) Parent signature and date.

(5) Parents who must include a signed statement from a health care practitioner under subsection (4)(c)(i) of this section may submit:

(a) A photocopy of the signed COE in place of the original; or

(b) Along with the COE form, a letter from the health care practitioner in lieu of the signed statement under subsection (4)(c)(i) of this section. The letter must:

(i) Indicate that the health care practitioner has provided the parent information about the benefits and risks of immunization to the child;

(ii) Reference the child's name; and

(iii) Be signed and dated by the health care practitioner.

(6) If immunizations are deferred on a temporary basis for medical reasons under subsection (4)(c)(iii) of this section, the child must provide proof of full immunization consistent with the schedule established in WAC 246-105-060 (2)(a) once the medical exemption has expired.