filling out the immunization primary review summary

Each year in January and February, all schools and child care facilities must report the immunization status of their students to the Health Department.

Reporting Forms

Immunization Report Instructions (468.81 KB)
Tally Worksheet (603.46 KB)


Step 1: Collect Information for all Your Students

Forms you will need: Certificate of Immunization Status (CIS) Form

Step 2: Assess Student Immunization Records

Forms you will need:

Step 3: Fill out the Primary Review Summary

Forms you will need:

Step 4: Send the First Report

By January 17, 2018: Mail or fax the following to Multnomah County Health Department:

Step 5: Fill Out Section D and Cancel Exclusion Orders

Between February 6-21, 2018:

  • Fill out Section D (page 2) of the Immunization Primary Review Summary with the dates records are returned to you.
  • If a student’s record is not up-to-date by the beginning of school on February 21, 2018, they will not be able to attend until you have an updated record.
  • If updated records are returned AFTER the beginning of school on February 21, 2018, the student is “excluded.”  Mark a “Y” in the column in Section D (page 2) of the Primary Review Summary. Keep a copy for your records.

Step 6: Complete and Send Pages 3 and 4 of the Primary Review Summary

By March 5, 2018: Using the Tally Worksheet (603.46 KB), complete page 3 of the Immunization Primary Review Summary (Sections E, F and G) and Section H as appropriate for your facility: 

  • Section E for preschool, day care or Head Start
  • Section F for kindergarten
  • Section G for 7th graders
  • Section H for kindergarten through 12 graders

Mail or fax to Multnomah County Health Department (keep a copy for your records):

  • Page 2 (Section D) of the Primary Review Summary
  • Page 3 (Sections E, F, G) of the Primary Review Summary
  • Page 4 (Section H) of the Primary Review Summary

Questions? Contact Us

Multnomah County Health Department
Community Immunization Program
426 SW Stark St, 3rd Floor
Portland, OR 97204

503-988-4724
503-988-5847 fax
immiprogram@multco.us