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)

Vision Screening Card (PDF) – If screened by an ophthalmologist or optometrist

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**
PreK     5th dose* 2 doses 4th dose* 2 doses 3 doses
KG X X 5th dose*  2 doses  4th dose*  2 doses 3 doses
3rd X
7th  X X
9th X
12th X

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

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

** 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,  call your regular physician to schedule an appointment with the immunization nurse. (A doctor appointment is not necessary.) Pella Medical Clinic serves those who have insurance, no insurance or Title 19. Their hours are 8 am-5 pm Monday through Friday. If you do not know your physician’s phone number, dial the Pella Regional Health Center at 641-628-3150 and ask to be transferred to your doctor’s office.

At Marion County Public Health in Knoxville, they are able to vaccinate children with no health insurance coverage, or are enrolled in Medicaid (Title XIX), are American Indian or Alaskan Native, or are under-insured (has some type of health insurance, but the benefit plan does not include immunizations.) They also do complimentary dental screenings.  Call 1-641-828-2238 to set up an appointment.