Filling Out Your Immunization Card

Yellow Card 101

About the Immunization Card

Yellow Card 101

Also known as the International Certificate of Vaccination (ICV) or Carte Juane

Card approved by World Health Organization but can be issued by other organizations such as the Center for
Disease Control & Prevention, US Department of Health, etc.

Key components include cover page, routine immunization record, and proof of vaccination (for a specific
vaccine like Polio or Yellow Fever).

Recognized Internationally and may be required for entry into specific countries

It is advisable to keep this card in or with your passport as this is like a medical passport

Only vaccine that is required worldwide includes: Yellow Fever

Fill out changeable information in Pencil

Example Immunization Cards

Yellow Card 101

US Department of Health

World Health Organization

Center for Disease Control &

Prevention (CDC)

Filling Out the Cover Page - Traveler

Yellow Card 101
1. Fill out your full name (legibly) in
the format of First Middle Last.
2. Fill out entire street name
3. Fill out address city
1.

Jane Mary Doe

2.
3.

123 Main Street

Tampa

4. Hillsborough,

FL

4. Fill out county and State code

Filling Out Routine Immunization Record

Yellow Card 101

Routine Immunizations - Children

Yellow Card 101

Hepatitis B

Flu

Rotavirus

MMR

DTaP

Chickenpox

Hib

Hepatitis A

Pneumococcal

Meningococcal

Polio

HPV

Information available through the Center of Disease Control & Prevention (CDC) http://wwwnc.cdc.gov/travel/diseases/routine

Routine Immunizations - Adults

Yellow Card 101

Flu

Shingles

Td (Tetanus, Diphtheria)

Pneumococcal

Tdap (Tetanus,

Meningococcal

Diphtheria, Pertussis)

Hepatitis A

HPV

Hepatitis B

Information available through the Center of Disease Control & Prevention (CDC) http://wwwnc.cdc.gov/travel/diseases/routine

Filling Out Routine Immunizations - Doctor

Yellow Card 101
Fill out date of
immunization, vaccine
name, dosage, & include
Doctors signature or
stamp
Can be typed or
handwritten

Typed Version

Hand Written

Showing Proof of Vaccination Sample - Polio

Yellow Card 101

1. Filling Out Your Name - Traveler

Yellow Card 101
Fill out your full
name (legibly) in
the format of First
Middle Last.
Ensure the patients
name appears
exactly as it is on
the patients
passport

2. Filling Out Your Date of Birth - Traveler

Yellow Card 101
Fill out your Date of
Birth (DOB).
The patients date of
birth should be
entered with the day
in numerals, followed
by the month in
letters, and then the
year (for example, 14
July 2014)

Filling Out Gender - Traveler

Yellow Card 101
Fill in your gender,
use M for male
and F for female

Filling Out Nationality - Traveler

Yellow Card 101
Fill in your country
of Nationality spell out, do not
abbreviate

Filling Out Passport Number - Traveler

Yellow Card 101
Fill in your
passport number.
Ensure that the
passport number is
entered correctly

3. Filling Out Your Signature - Traveler

Yellow Card 101
Fill in your
signature but
ensure that you
sign your full name
(First Middle Last)
Ensure the patients
name appears
exactly as it is on
the patients
passport

4. Filling Out the Disease or Condition (for Vaccination) - Doctor

Yellow Card 101

Polio (example) should be
written on this line. (If the ICVP is
also being used to document other
required vaccines or prophylaxis,
each relevant disease or condition
should be listed on this line. Other
non-required vaccines may be
listed on the other side of the card.)

5. Filling Out the Vaccine - Doctor

Yellow Card 101
Fill in your
signature but
ensure that you
sign your full name
(First Middle Last)
Ensure the patients
name appears
exactly as it is on
the patients
passport

6. Filling Out the Vaccine - Doctor

Yellow Card 101
Fill in the date on
which the
vaccination is
given should be
entered with the
day in numerals,
followed by the
month in letters,
and then the year
(for example, 14
July 2014)

7. Filling Out the Vaccine - Doctor

Yellow Card 101
A handwritten
signature of the
clinician who
administered the
polio vaccine
should appear in
this box.
A signature stamp
is not acceptable

Filling Out the Batch or Lot # - Doctor

Yellow Card 101
Fill in the batch or
lot # if available

8. Filling Out Valid Dates of the Vaccine - Doctor

Yellow Card 101
The ICVP is valid between 4 weeks
and 12 months after the date of
vaccination. The ending date for a
valid vaccination recorded on the
ICVP is 1 calendar day before the
calendar day on which the vaccine
was given. (For example, a
vaccination given on 16 June 2014
will be valid from 14 July 2014
through 15 June 2015.)

9. Certifying Stamp - Doctor

Yellow Card 101
If the provider has a Uniform
Stamp used to validate yellow
fever vaccination, then place it
in this box.

If not, record the name and

contact information of the
health care facility in this box.

You are Ready to Fill Out your Immunization Card

Yellow Card 101