District Health State Health Requirements

Does your child need medication during the school day? Please complete the Parental Authorization of Medical Administration Form (PDF). For more information, please review our Medication At School page.

The Iowa Department of Public Health state law requires every school to have an up to date and completed certificate of immunization on file for each student enrolled. For more details on specific information regarding each screening or vaccination, click on the column name or talk to your medical care provider.

Please use this health form matrix to determine which medical forms and immunizations are required for students at each grade level. All completed forms are to be turned in or faxed to your child’s appropriate building.

Dental Certificate (PDF)

Immunization Certificate (PDF)

Immunization Requirements (PDF)

Vision Screening Certificate (PDF) – If screened by other approved providers (physician, physician assistant, nurse, free clinic, child care center, local public health department, school or approved community based organization)

State Health Requirements By Grade

Grade	Dental Screen	Vision Screen	Tdap	DTaP	MMR	Polio	Varicella	PCV	Hep B	Hib	Meningococcal
PS				4 doses	1 dose	3 doses	1 dose	See below**	3 doses	3 doses**
PreK				5th dose*	2 doses	4th dose*	2 doses		3 doses
KG	Y	Y		5th dose*	2 doses	4th dose*	2 doses		3 doses
1st
2nd
3rd		Y
4th
5th
6th
7th			Y								1 dose*
8th
9th	Y
10th
11th
12th											2 doses

* Dtap Vaccination Details – 5th dose after age 4 years old
* Polio Vaccination Details – 4th dose after age 4 years old

* Meningococcal Vaccination Details – On or after 10 years of age for students in grade 7 or above

** Hib Vaccination Details – Number of required doses will vary depending on your child’s immunization history. Please check with your health provider.
** PCV Vaccination Details – Number of required doses will vary depending on your child’s immunization history. Please check with your health provider.

Where can my child receive vaccines?

At Pella Medical Clinic or a medical clinic of your choice. Pella Medical Clinic serves those who have health insurance, no health insurance, or are enrolled in Medicaid (Title 19). Call 641-621-2200 to schedule an appointment. If your child already has an established physician at Pella Medical Clinic and is not due for a well-child checkup, an appointment may be scheduled with the immunization nurse.

At Marion County Public Health in Knoxville. They are able to vaccinate children with no health insurance coverage, or are enrolled in Medicaid (Title 19), are American Indian or Alaskan Native, or are under-insured (has some type of health insurance, but the benefit plan does not include immunizations). Call 641-828-2238 to schedule an appointment.