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Official Nebraska Government Website

DHHS Internet Website - Public Health

Nebraska DHHS: Immunization Program : Forms

Immunization Home

Children & Adults

International Travel

State Registry (NESIIS)

Immunization Program : Forms

The School Record Card

Refusal of Immunization for Medical Reasons

Refusal of Immunization of Student for Religious Reasons

Documentation of Varicella (Chicken Pox) Disease

Schools Vaccine Reference Sheet

Daycare Vaccine Reference Sheet

Immunization Proxy Form

Title 173 - Control of Communicable Disease - Ch. 3

Title 173 - Control of Communicable Disease - Ch. 4

Contact Information

Immunization Program
PO Box 95026
Lincoln, NE 68509-5026
Phone: (402) 471-6423
FAX: (402 471-6426
Email: barbara.ludwig@nebraska.gov

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