ATTENTION: ALL PARENTS OF HIGH SCHOOL AGE STUDENTS
IMMUNIZATION REQUIREMENT FOR STUDENTS ENTERING
12TH GRADE DURING 2021-2022
Your student will be required to receive two (2) doses of meningococcal vaccine
(A, C, W, and Y - representing the four different strains of meningitis that the vaccine covers) prior to their 12th grade school year.
*This is a State of Ohio immunization law requirement ORC 3313.671.
* If the 1st dose of this vaccine was administered on or after their 16th birthday, a 2nd dose
is NOT required.
This immunization can be obtained from your doctor or from a Franklin County Public Health Community Immunization Clinic. Information for these clinics can be found at http://www.myfcph.org. If you have any questions or need more information, please call the Ohio Department of Health Immunization Program at (800) 282-0546.
***New NCH School Based Health Center located at Livingston Campus 614-355-2590***
DOCUMENTATION OF THIS IMMUNIZATION MUST BE ON FILE AT THE SCHOOL PRIOR TO THE START OF THE 2021-2022 SCHOOL YEAR.
RHS Livingston Campus Fax# 614-501-4055 - RHS Summit Campus Fax# 614-501-2295
This is to verify that the named student (printed name)
has received the required meningococcal vaccine(s) on the following dates
__________________ and ___________________.
Physician Signature (required): __________________________________