TX HHS Form H1012. Immunization Record

The TX HHS Form H1012, Immunization Record, helps parents and caregivers track their child's immunization schedule and ensure compliance with vaccination requirements. This form is typically filled out by healthcare providers or parents/guardians to document a child's immunizations and provide evidence of good cause for any exemptions.

The form requires information on the date of each immunization visit, including the dates of at least one Measles, Mumps, and Rubella (MMR) vaccination on or after the child's 1st birthday. The form also allows for documentation of alternative medical or religious evidence of good cause. Healthcare providers are responsible for ensuring that children receive the recommended vaccinations according to the schedule outlined in the form.

Key features of this form include:

• The requirement for at least one MMR vaccination on or after the child's 1st birthday
• The need for documentation of immunization visits within specific timeframes (e.g., within 3 months, 4-6 months, etc.)
• The option to provide alternative medical or religious evidence of good cause for exemptions