1. Health History
To be completed by parent or guardian.
Dunellen Public Schools Health History Form
2. Physical Examination
Physical examination should be performed by your child’s primary healthcare provider within the last year. Please document in the Universal Child Health Record Form.
If your child has a medical condition and/or will need medication or other nursing services (example: life-threatening allergies, seizures, asthma, diabetes, daily medication, etc.), forms completed by your child’s healthcare provider and parent/guardian are required prior to the first day of school.
3. Immunization Record
Official documentation, as stated below.
- NJ State Sanitary Code: Chapter 14
- Immunization of Pupils in Schools
- NJ Administrative Code 8:57-4.1 8:57-4.16
Documents Accepted as Evidence of Immunization
The following documents will be accepted as evidence of a pupil’s immunization history provided that the individual immunizations and the date when each immunization was administered are listed. If available, please include your child’s New Jersey Immunization Information Registry ID #.
- An official school record from any school indicating compliance with the immunization requirements of this Chapter.
- A record from any public health department indicating compliance with the immunization requirements of this Chapter.
- A certificate signed by a physician licensed to practice medicine, osteopathy, physician’s assistant or a licensed nurse practitioner in any jurisdiction in the United States indicating compliance with the immunization requirements of this Chapter.
Proof of Immunizations
DPT (Diphtheria, Tetanus Toxoid, and Pertussis)
Every pupil less than seven years of age, a minimum of 4 doses DPT required. One dose must be administered on or after 4th birthday. Any child with a total of 5 doses will also be in compliance with this regulation.
All children born after January 1, 1997 are required to have a booster of Diphtheria, Tetanus and Pertussis within one month following their 11th birthday.
Polio Virus Vaccine
Every pupil less than 7 years of age, a minimum of three doses of oral polio vaccine (OPV or IPV) is required provided one dose is given on or after 4th birthday. Alternatively, a pupil with any four doses of polio vaccine spaced by a minimum of one month (28 days) will be in compliance with this regulation.
MMR (Measles, Mumps, Rubella Vaccine or 1 Mumps, 1 Rubella and 2 Measles)
Two doses of a measles containing vaccine given on or after the first birthday (MMR). Two doses of measles containing vaccine must be separated by an interval of at least one month (28 days). If your child has had antibody titers in lieu of a second dose of MMR, laboratory results be submitted with the immunization record.
Hepatitis B Vaccine
All students are required to have documentation of 3 doses of Hepatitis B. The minimum interval between the 1st and 2nd dose: 1 month or 4 weeks or 28 days. There are 3 minimum intervals that must be met for the 3rd dose:
- After 1st dose — 4 months or 16 weeks or 112 days
- After 2nd dose — 2 months or 8 weeks or 56 days
- After birth — 6 months or 24 weeks or 168 days
All children born on or after January 1, 1998, must have one dose of varicella vaccination given on or after first birthday or official proof of disease from a physician, physician’s assistant or nurse practitioner.
Every pupil born after January 1, 1997, must have one dose of meningococcal vaccine within one month following their 11th birthday.
A medical exemption is acceptable from a licensed M.D., D.O., Certified Nurse Practitioner or PA. Medical exemptions must be reviewed annually. A medical exemption is acceptable if it is based upon a valid medical contraindication according to the American Academy of Pediatrics standards.
Required Mantoux Tuberculin Testing in New Jersey Schools
Only a positive interferon gamma release assay (IGRA) result or a Mantoux skin test using 5 TU of stabilized PPD meets testing criteria. Tuberculin skin test result measuring equal to or over 10mm of induration shall be considered a “significant reaction” and evidence of latent TB infection.
The following tuberculosis testing requirements apply to ALL school districts:
- Students born in a country that is not listed below and entering school in the U.S. for the first time, regardless of age or grade.
- Students transferring into the New Jersey school system directly from a country not listed below regardless of age or grade.
Exceptions for Both Groups of Students Listed Above
Entering at grades K through 5: Tuberculosis testing is not required if the student has documentation of an IGRA or a Mantoux tuberculin skin test at the age of three years or older, regardless of the result of that test.
Entering at grades 6 through 12: Tuberculin testing is not required if the student has documentation of a negative tuberculosis test in the last six months or a positive test, regardless when this test was done.
Tuberculosis testing is not required if the student has attended school in another state prior to entering the New Jersey school system.
Any student with parents claiming religious exemption (TB-8 Form) cannot be compelled to submit evidence of tuberculosis testing. In these instances, a symptom assessment must be done. If TB-like symptoms are reported, a physician must document that the student does not have active disease. Appropriate forms are available in the office of each district school nurse.
Students entering a U.S. school for the first time in New Jersey or transferring into a New Jersey school from any country NOT listed below must receive an IGRA or Mantoux Tuberculin skin test unless they meet the exemption criterion.
Antigua and Barbuda
Saint Kitts and Nevis
St. Maarten (Dutch)
Trinidad and Tobago
Turks and Caicos Islands
United Arab Emirates
United States of America
United States Virgin Islands
West Bank and Gaza