6 CCR 1009-2
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT THE INFANT IMMUNIZATION PROGRAM AND IMMUNIZATION OF STUDENTS ATTENDING SCHOOL 6 CCR 1009-2 [Editor’s Notes follow the text of the rules at the end of this CCR Document.] ______________________________________________________________________ Adopted by the Board of Health on December 17, 2025, effective February 14, 2026.
I. Definitions A. Advisory Committee on Immunization Practices (ACIP) – a federal advisory committee that develops recommendations on the use of vaccines for the public to control diseases in the United States.
B. Alternate Certificate of Immunization – A Certificate of Immunization created by a school district, college or university, or practitioner’s Electronic Health Record system that must meet a minimum criteria set by the Department to be considered equivalent with Colorado’s Official Certificate of Immunization. The Alternate Certificate of Immunization must be approved by CDPHE and renewed annually. This includes approved Certificates of Immunization from select states that the Department recognizes to be consistent with Colorado’s Official Certificate of Immunization.
C. American Academy of Family Physicians (AAFP) – A national medical association for family physicians, residents, and medical students with a commitment to treating the whole person through the specialty of family medicine. The AAFP supports recommendations on the use of vaccines to prevent and control diseases in the United States.
D. American Academy of Pediatrics (AAP) – A national medical organization for pediatricians committed to the optimal physical, mental, and social health and well-being for all infants, children, adolescents, and young adults. The AAP supports evidence-based recommendations on the use of immunizations to prevent and control diseases in the United States.
E. American College of Obstetricians and Gynecologists (ACOG) – A national professional membership organization for obstetricians and gynecologists that is dedicated to improving the lives of all people seeking obstetric and gynecologic care, their families, and communities. The ACOG supports recommendations on the use of vaccines to control diseases in the United States.
F. American College of Physicians (ACP) – A global medical specialty organization of internal medicine specialists and subspecialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults. The ACP supports recommendations on the use of vaccines to control diseases in the United States.
G. Child – any student less than 18 years of age.
H. College or university student – any student who is enrolled in one or more classes at a college or university and who is physically present at the institution for participation in classes, enrichment, athletics, or other activities.
1. This includes students who are auditing classes, but does not include
I. Department (the) – the Colorado Department of Public Health and Environment.
J. Dose – a measured quantity of an immunizing agent; quantity and frequency of administration described in Section II and Appendix A of these rules and the manufacturer of each agent.
K. Emancipated student – any student who has reached 18 years of age; a lawfully married child of any age; a child 15 years of age or older who is managing their own financial affairs and who is living separate and apart from their parent.
L. Immunization information system – a comprehensive immunization tracking system the Department is required to maintain pursuant to Section 25-4-2403(2), C.R.S. that enables the collection of epidemiological information from the sources delineated in Section 25-4-2403(2), C.R.S. and the investigation and control of communicable diseases. Individuals, parents and guardians may provide information to the immunization information system; however, pursuant to Section 25-4-2403(7), C.R.S., they have the option to exclude their or their student’s immunization information from the immunization information system at any time.
M. Immunization record – a paper or electronic document from the records of a licensed physician, a physician assistant, an advanced practice registered nurse, or a public health official that includes the dates and types of immunizations administered to a student.
N. Indigent child – any child whose parent cannot afford to have the child immunized or, if emancipated, who cannot themself afford immunization, and who has not been exempted.
O. Infant – any child up to twenty-four months of age or any child eligible for vaccination and enrolled under the Colorado Medical Assistance Act, Articles 4, 5, and 6 of Title 25.5, C.R.S.
P. In-process student – for non-college and university students as defined in Section I (BB), a student may be considered in-process in one of the following two situations:
1. Within thirty days of receiving direct personal notification that the student’s Official Certificate of Immunization is not up-to-date according to the requirements of the State Board of Health, the parent, guardian or emancipated student submits documentation that the next required immunization(s) have been given and, if needed, a signed written plan for obtaining the remaining required immunizations administered according to the medically recommended minimum intervals consistent with the immunization schedule as defined in Section II and Appendix A of these rules. If the next dose is not medically indicated within thirty days, then the medically approved minimum intervals would apply. If the parent, guardian, or emancipated student does not provide documentation to demonstrate compliance or or does not fulfill the in-process plan, the school shall suspend or expel the student for noncompliance per Section 25-4-907, C.R.S.
2. Within thirty days of receiving direct personal notification that the student’s Certificate of Medical or Nonmedical Exemption has expired, is not signed, is on the wrong form, or is missing information, the parent, guardian or emancipated student submits: (1) an immunization record documenting that the student is up-to-date, (2) a signed written plan for obtaining the remaining required immunizations, administered according to the medically recommended minimum intervals consistent with the immunization schedule as defined in Section II and Appendix A of these rules, or (3) a new and complete Certificate of Medical or Nonmedical Exemption. If the parent, guardian, or emancipated student does not provide documentation to demonstrate compliance or or does not fulfill the in-process plan, the school shall suspend or expel the student for noncompliance per Section 25-4-907, C.R.S.
Q. In-process college or university student – for college or university students, as defined in Section I (H), a student may be considered in-process in one of the following two situations:
1. Within thirty days of receiving direct personal notification that the student’s Official Certificate of Immunization is not up-to-date according to the requirements of the State Board of Health, the parent, guardian or emancipated student submits documentation that the next required immunization(s) have been given and, if needed, a signed written plan for obtaining the remaining required immunizations administered according to the medically recommended minimum intervals consistent with the immunization schedule as defined in Section II and Appendix A of these rules. If the next dose is not medically indicated within thirty days, then the medically approved minimum intervals would apply. If the student does not provide documentation to demonstrate compliance, the student will not be allowed to enroll, remain enrolled, or audit for the current term or session.
2. Within thirty days of receiving direct personal notification that the student’s Certificate of Medical or Nonmedical Exemption has expired, is not signed, is on the wrong form, or is missing information, the parent, guardian or emancipated student submits: (1) an immunization record documenting that the student is up-to-date, (2) a signed written plan for obtaining the remaining required immunizations, administered according to the medically recommended minimum intervals consistent with the immunization schedule as defined in Section II and Appendix A of these rules, or (3) a new and complete Certificate of Medical or Nonmedical Exemption. If the student does not provide documentation to demonstrate compliance, the student will not be allowed to enroll, remain enrolled, or audit for the current term or session.
R. McKinney-Vento District Liaison – required in every school district by 42 USC 11432(g)(1)(J)(ii); a person designated to be the primary point of contact to ensure students experiencing homelessness are identified and aware of their rights under the federal law.
S. Medical exemption – an immunization exemption available when the physical condition of the student is such that one or more specified immunizations would endanger their life or health or are medically contraindicated due to other medical conditions.
T. Nonmedical exemption – an immunization exemption based upon a religious belief whose teachings are opposed to immunizations or a personal belief that is opposed to immunizations.
U. Official Certificate of Immunization – one of the following forms of documentation that includes the dates and types of immunizations administered to a student:
1. Information from an immunization record transferred by a licensed physician, a physician assistant, an advanced practice registered nurse, a public health official, or a school official onto a paper or electronic version of the Official Certificate of Immunization form created and maintained by the Department of Public Health and Environment; or 2. An electronic file or a hard copy of an electronic file provided to the school directly from the immunization information system, established pursuant to Section 25-4-2403 C.R.S.
V. Online Immunization Education Module – also known as the online education module, the module, or the online education module – is administered by the Department and offered to the public as one way for the parent, guardian, or emancipated student to obtain a Certificate of Nonmedical Exemption.
W. Parent or guardian – the person or persons with parental or decision-making responsibilities for a child.
X Practitioner – a duly licensed physician, advanced practice nurse, physician assistant (sometimes known as a physician associate), or other person who is permitted and otherwise qualified to administer vaccines under Colorado law. Y School – all child care facilities licensed by the Colorado Department of Early Childhood or the Colorado Department of Human Services including: child care centers; school-age child care centers; preschools; day camps; resident camps; day treatment centers; family child care homes; foster care homes; and Head Start programs; unlicensed Head Start programs; public, private, or parochial kindergarten; elementary or secondary schools through grade twelve; or a college or university. Schools include educational programs where courses are offered online (an online school or program as defined in Section 22-30.7-102 C.R.S.) but where enrolled students are physically present at the institution for participation in enrichment, athletics, or other activities.
1. Schools do not include a public services short-term child care facility as defined in Section 26.5-5-303(22), C.R.S., a guest child care facility as defined in Section 26.5-5-303(16), C.R.S., a ski school as defined in Section 26.5-5-307(6), C.R.S., a homeless youth shelter as defined in Section 26-6-903(13), C.R.S., or college or university classes which are: Offered off-campus; offered at colleges or universities which do not have residence hall facilities within their systems; or a school whose normal course of student instruction is delivered online only.
Z. School health authority – an individual working for or on behalf of the child care facility or school who is knowledgeable about child care/school immunizations.
AA. School official – the school’s chief executive officer or any person designated by them as their representative.
BB. Student – any person enrolled in a Colorado school or enrolled in an online-only school but registered in-person with any school as defined in Section I (Y) for enrichment, athletics, or other activities, except:
1. A child who attends educational programs where courses are offered online (an online school or program as defined in 1 CCR 301-71) and the child is not physically present at the institution for participation in enrichment, athletics, or other activities;
2. A child who enrolls and attends a licensed child care center, as defined in Section 26.5-5-303(3), C.R.S., which is located at a ski area, for up to fifteen days or less in a fifteen-consecutive-day period, no more than twice in a calendar year, with each fifteen-consecutive-day period separated by at least sixty days; and 3. College and university students as defined in Section I (H).
CC. Student identified as eligible for the McKinney-Vento Homeless Assistance Act – as described in 42 U.S.C. 11434a(2); a student attending public school (preK- 12th grade) who lacks a fixed, regular, and adequate nighttime residence, including those who are living in transitional housing, living with others due to economic hardship, or are living in emergency or transitional shelters. This also includes students with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for people.
1. Unaccompanied students experiencing homelessness as described in 42 U.S.C. 11434a(6) are also eligible for if two conditions are met:
DD. Titer – a laboratory test that measures the presence and amount of antibodies in blood. An antibody titer can be used to show that a person has a measurable level of immunity to a specific disease.
EE. Up-to-date – all school-required vaccines have been administered to the student in accordance with Section II and Appendix A of these rules.
II. Incorporation by reference A. Throughout these regulations, standards and requirements of an outside organization have been adopted and incorporated by reference. The material incorporated by reference cited herein includes only those versions that were in effect on August 19, 2025, and no later amendments to the incorporated materials. These regulations incorporate by reference:
1. 2025 Recommended Child and Adolescent Immunization Schedule for Ages 18 Years or Younger as approved by the American Academy of Pediatrics, as published on November 21, 2025.
2. To align with the list of school-required vaccines in Colorado in Section III.A of these rules, these rules do not incorporate by reference recommendations for the following vaccines or immunizing agents:
3. Meningococcal vaccine (MenACWY) is not required for school entry by these rules. However, the information requirements stipulated in Section IX(A)2 of these rules are guided by these referred materials.
B. The Division of Disease Control and Public Health Response shall maintain certified copies of the complete text of the incorporated materials, which shall be available for public inspection during regular business hours, and shall provide certified copies of the materials at cost upon request. For information regarding how the incorporated materials may be obtained or examined, the Division can be contacted electronically at cdphe.dcdimmunization@state.co.us or by mail at Division Director Division of Disease Control and Public Health Response Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246-1530 C. The incorporated materials are available at:
https://drive.google.com/file/d/1b45XXj_- V5RaJEbBVs5MxTT3_1ATbTfx/view?usp=sharing D. The incorporated materials are available from the American Academy of Pediatrics, which can be contacted electronically at https://www.aap.org/en/pages/contact-us/contact-national-headquarters/ or by mail at 345 Park Boulevard Itasca, Illinois 60143 III. Minimum immunization requirements A. To attend school, a student must have an up-to-date Official Certificate of Immunization with the dates and types of immunizations administered. Meeting the initial immunization requirements does not exempt a student from meeting subsequent requirements. This Official Certificate of Immunization must demonstrate immunization against the following diseases:
1. Hepatitis B 2. Pertussis 3. Tetanus 4. Diphtheria 5. Haemophilus influenzae type b (Hib)
6. Pneumococcal disease 7. Polio 8. Measles 9. Mumps 10. Rubella 11. Varicella B. Except as required in paragraphs (C) and (D) of this Section III, when healthcare providers administer the immunizations identified in paragraph (A) of this Section III, the immunizations will be administered according to the schedule incorporated by reference in Section II and the schedule in Appendix A of these rules.
C. Students between the ages of 4 through 6 years are required to receive their final doses of diphtheria, tetanus, and pertussis (DTaP), inactivated polio vaccine (IPV), measles, mumps, and rubella (MMR), and varicella vaccines prior to kindergarten entry.
D. Students are required to receive a dose of tetanus, diphtheria, and pertussis vaccine (Tdap) prior to 7th grade entry. One dose of Tdap is required for 7th through 12th grades.
E. Laboratory confirmation of positive titers is an acceptable alternative to the following vaccine components when submitted to the student’s school:
1. For DTaP and Tdap, both the diphtheria and tetanus titers must be positive. A titer is never acceptable to demonstrate immunity to pertussis. The Department will accept positive titers for tetanus and diphtheria. For pertussis, the Department will require: (1) vaccination with an age- appropriate pertussis-containing vaccine series in alignment with the schedule incorporated in Section II of these rules and Appendix A; or (2) a Certificate of Medical or Nonmedical Exemption for the pertussis component.
2. For MMR, titers for measles, mumps, and rubella must all be positive. If any single titer is negative, the Department will require: (1) vaccination with an age-appropriate MMR vaccine series in alignment with the schedule in Section II and Appendix A of these rules, or (2) a Certificate of Medical or Nonmedical Exemption for the component(s) for which the titer is negative.
3. For varicella, the titer for varicella must be positive. If the titer is negative, the Department will require: (1) vaccination with an age-appropriate varicella vaccine series in alignment with the schedule incorporated by reference in Section II and Appendix A of these rules, or (2) a Certificate of Medical or Nonmedical Exemption for the varicella vaccine.
4. A titer is not an acceptable alternative for Haemophilus influenzae type b, hepatitis B, pneumococcal, or polio vaccines, or the pertussis component of Tdap and DTaP vaccines.
IV. Exemptions from immunization A parent or guardian shall have their student immunized, unless the student is exempted. An emancipated student shall have themselves immunized, unless the student is exempted. A student is exempted from receiving the required immunizations when the requirements of either Paragraph A or B of this Section IV are met.
A. Medical exemption – A student obtains a medical exemption from one or more immunization requirements through submission of the Department’s Certificate of Medical Exemption completed and signed by an advanced practice nurse, a physician assistant, or a physician licensed to practice medicine or osteopathic medicine in any state or territory of the United States indicating that the physical condition of the student is such that one or more immunizations would endanger their life or health or is medically contraindicated due to other medical conditions. This form is to be submitted to the school once for permanent conditions. Medical exemptions for temporary conditions will expire after the “temporary until” date has elapsed, which is determined by the authorized immunizing provider who signed the form. This expiration date shall be monitored by the school to determine when the student is eligible to receive the required immunization(s) and must be maintained on file at each new school the student attends.
B. Nonmedical exemption – A student obtains a nonmedical exemption from one or more immunization requirements through submission of the Department’s Certificate of Nonmedical Exemption signed by one parent, guardian or an emancipated student.
1. A completed Certificate of Nonmedical Exemption must also include either:
2. Frequency of submission by the parent, guardian, or emancipated student:
C. In the event of a disease outbreak for which immunization is required, exempted persons may be subject to exclusion from school and quarantine.
D. The following rules pertain to immunization records:
1. Immunization records of each student participating in a nonpublic home- based education program pursuant to Section 22-33-104.5, C.R.S. shall be maintained on a permanent basis by the parent in charge and in control of said program and are required to be submitted:
2. A school district that is exercising its authority pursuant to Section 22-33- 104.5(3)(G), C.R.S. or an independent school organized pursuant to Section 22-33-104 (2)(B), C.R.S. where students are enrolled but do not attend is entitled to only:
E. All information distributed to parent(s) and guardians by school districts regarding immunizations shall inform them of their rights in Section IV (A-D).
V. Examination and audit of official school immunization records The Department’s representative has the right to audit and verify records to determine compliance with the law. Discrepancies found through audits shall be corrected by school officials, and any student not in full compliance shall be suspended or expelled from school according to the following rules:
A. If the parent(s), guardian, or emancipated student was informed of the deficiencies in the student’s official school immunization records pursuant to Section I (P) of these rules, the school shall suspend or expel the student for noncompliance per Section 25-4-907, C.R.S.
B. If the parent(s), guardian or emancipated student was not informed by a direct personal notification of the immunizations required and alternatives for compliance with the law, the school shall notify the parent(s), guardian or emancipated student within seven calendar days of the finding.
1. After notification, the parent, guardian, or emancipated student shall: provide proof of immunization or exemption in accordance with Section IV of these rules within 30 days; or provide an in-process plan in accordance with Section I (P) of these rules. If the parent, guardian, or emancipated student does not comply, the school shall suspend or expel the student pursuant to Section 25-4-907, C.R.S.
VI. Denial of attendance A. A student who is not in-process, not appropriately vaccinated for their age, or not exempt shall be denied attendance in accordance with the law.
1. No indigent child shall be excluded, suspended, or expelled from school unless the immunizations have been available and readily accessible to the indigent child at public expense.
2. No students identified as eligible for the McKinney-Vento Homeless Assistance Act may be denied enrollment due to a lack of immunization records. These students may participate in a documented interview with the McKinney-Vento District Liaison that may extend the in-process period beyond 30 days.
B. If the student is attending a school that is not subject to the School Attendance Law, Section 22-33-101 et seq., C.R.S., school officials shall take appropriate action to deny attendance to the student in accordance with that school’s procedures or contract with the student.
VII. Official school immunization records A. Official school immunization records shall include:
1. The Department’s Official Certificate of Immunization or an Alternate Certificate of Immunization approved by the Department 2. The Department’s Certificate of Medical Exemption, and 3. The Department’s Certificate of Nonmedical Exemption.
B. Any immunization record (original or copy) as defined by this rule may be accepted by a school official as proof of immunization. If not already documented per Subsection (A)(1) of this Section the information must be transferred to an Official Certificate of Immunization or Alternate Certificate of Immunization.
1. In lieu of an Official Certificate of Immunization, a licensed children's resident camp may maintain on file an out-of-state immunization record for an out-of-state camper attending the resident camp.
C. Except as provided in Subsection (B)(1) of this Section, schools shall have on file an official school immunization record for every student enrolled. The official school immunization record will be kept apart from other school records. When a student withdraws, transfers, is promoted to a new school, or otherwise leaves a school, the school official shall return the official school immunization record to the parent(s), guardian, or emancipated student upon request, or transfer it with the student’s school records to the new school. Upon a college or university student’s request, the official school immunization record shall be forwarded by the school as specified by the parent, guardian, or emancipated student.
D. Schools must verify minimum immunization requirements are met on all submitted immunization records to ensure students are and remain in compliance with this rule.
VIII. Reporting of statistical information A. Annually, by January 15 of each year, any child care center, preschool or Head Start program that is licensed by the Colorado Department of Early Childhood or the Colorado Department of Human Services to provide care to ten or more children and are not exempt from reporting pursuant to Section VIII (B); unlicensed Head Start programs; and public, private, or parochial schools with kindergarten, elementary or secondary schools through grade twelve, shall send aggregate immunization and exemption data, by antigen, to the Department. Required data shall include:
1. Total number of students and total number of kindergarten students enrolled in the school;
2. Total number of students and total number of kindergarten students who are up-to-date with immunizations, as required in Section III;
3. Total number of students and total number of kindergarten students who have a medical exemption for all immunizations, as required in Section III;
4. Total number of students and total number of kindergarten students who have a medical exemption for one or more but not all immunizations, as required in Section III;
5. Total number of students and total number of kindergarten students who have a nonmedical exemption for all immunizations, as required in Section III;
6. Total number of students and total number of kindergarten students who have a nonmedical exemption for one or more but not all immunizations, as required in Section III;
7. Total number of in-process students and total number of in-process kindergarten students;
8. Total number of students and total number of kindergarten students not up-to-date for immunizations, as required in Section III, with no exemption on file, and not in-process; and 9. Total number of students and total number of kindergarten students with no immunization records.
B. Schools not required to send aggregate immunization and exemption data to the Department include: K-12th grade schools whose normal course of schooling is online only, school-age child care centers, family child care homes, drop-in centers, day treatment centers, foster care homes, day camps, and resident camps.
C. All schools required to report immunization data to the Department must make the immunization and exemption rates of their enrolled student population publicly available upon request.
IX. Requirements for college and university students, colleges, and universities The provisions below apply only to colleges or universities, or college or university students.
A. Minimum immunization requirements 1. Two valid doses of the MMR vaccine are required for all college or university students, unless they were born before 1957.
2. Pursuant to Section 25-4-901, C.R.S. et. seq., and Section 23-5-128 (3), C.R.S., each college and university shall provide information concerning meningococcal disease and meningococcal vaccine to each new college or university student residing in student housing, or if the college or university student is under 18 years, to the college or university student’s parent or guardian.
B. Exemptions from immunization A college or university student is exempted from receiving required immunizations in the following manner:
1. Medical exemption – A student obtains a medical exemption through the submission of the Department’s Certificate of Medical Exemption completed and signed by an advanced practice nurse, a physician assistant, or physician licensed to practice medicine or osteopathic medicine in any state or territory of the United States indicating that the physical condition of the college or university student is such that one or more immunizations would endanger their life or health or are medically contraindicated due to other medical conditions. This form is to be submitted once to the college or university at enrollment for permanent conditions. Medical exemptions for temporary conditions will expire after the “temporary until” date has elapsed, which is determined by the authorized immunizing provider who signed the form. This expiration date shall be monitored by the school to determine when the student is eligible to receive the required immunization(s) and must be maintained on file at each new school the student attends.
2. Nonmedical exemption – A student obtains a nonmedical exemption through the submission of the Department’s Certificate of Nonmedical Exemption signed by the college or university student or if not emancipated, the college or university student’s parent or guardian. The Department’s Certificate of Nonmedical Exemption must be submitted at enrollment. A new Certificate of Nonmedical Exemption is required anytime a student enrolls in a new college or university. A Certificate of Nonmedical Exemption must also include either:
C. Examination and audit of official school immunization records 1. The Department’s representative has the right to audit and verify records to determine compliance with the law. Discrepancies found through audits shall be corrected by school officials, and any college or university student not in full compliance shall be denied attendance from school according to the rules in this Section, Subsection (D).
D. Denial of attendance 1. A school official shall deny attendance to a college or university student who is not in-process, not appropriately vaccinated for their age, or not exempt in accordance with Section 25-4-903, C.R.S.
2. No college or university student shall be denied attendance for failure to comply unless there has been a direct personal notification of noncompliance by the school. Notification must be made by the school within seven days of the finding of noncompliance to the college or university student or if not emancipated, the student’s parent or guardian.
E. Official school immunization records 1. Official school immunization records shall include:
2. Schools shall have on file an official school immunization record for every college or university student enrolled.
F. Reporting of statistical information – Annually, by January 15 of each year, any college or university that constitutes a school as defined by Section I (Y) of these rules shall send aggregate immunization and exemption data, by antigen, to the Department.
Required data shall include:
1. Total number of college or university students enrolled in the school;
2. Total number of college or university students who are up-to-date with immunizations, as required in this Section (IX);
3. Total number of college or university students who have a medical exemption for the MMR vaccine;
4. Total number of college or university students who have a nonmedical exemption for the MMR vaccine;
5. Total number of in-process college or university students;
6. Total number of college or university students who have a signed waiver for the Meningococcal vaccine;
7. Total number of college or university students not up-to-date for the MMR vaccine, with no exemption on file, no meningococcal vaccine waiver on file, and not in-process; and 8. Total number of college or university students with no immunization records.
G. All colleges and universities required to report immunization data to the Department must make the immunization and exemption rates of their enrolled student population publicly available upon request.
X. Contract requirements for providers, hospitals, and health care clinics to be an agent of the Department for the purposes of the immunization program A. To be an agent of the Department for the purposes of administering immunizations to infants, children, and students, a provider, hospital, or health care clinic must provide each patient receiving a vaccine, or the parent or guardian, if the patient is an unemancipated minor, a copy of the currently approved Vaccine Information Statement, as required by federal law.
B. The Department shall make such requirements as are necessary to assure the confidentiality and security of information in the immunization information system operated pursuant to Section 25-4-2403(3), C.R.S.
XI. Fee for the administration, reporting, and tracking of vaccine This Section applies to vaccines and immunizing agents provided by the Department and available to Colorado practitioners.
A. Practitioners may charge up to the Centers for Medicare and Medicaid Services maximum regional fee for the administration of a vaccine. These fees apply to all vaccines provided by the Department.
B. A vaccine recipient may not be denied a vaccine provided by the Department because of inability to pay the administration fee.
C. If a practitioner’s vaccine administration costs are less than the Centers for Medicare and Medicaid Services maximum regional fee for the administration of vaccine, then they may only charge up to that lesser amount.
XII. Online Immunization Education Module A. Per Section 25-4-903 (2.5 and 2.7), C.R.S., the Department shall provide immunization information to the public via an Online Immunization Education Module. The immunization information and contents of this module shall include, but are not limited to:
1. Medical and scientific data that is evidence-based and peer reviewed by credible scientific and public health organizations concerning both the benefits and risks of immunizations;
2. A fair presentation of both the benefits and risks of immunizations; and 3. Data concerning the risk of immunization injury.
B. The module shall be interactive such that the viewer of the module must engage with the content successfully to receive a certificate of completion.
C. Upon successful completion of the module, a Certificate of Nonmedical Exemption that includes confirmation of completion of the Department’s Online Immunization Education Module will be electronically generated for downloading and printing.
D. The Online Immunization Education Module shall not require a parent or guardian or emancipated student, to sign or indicate agreement with any language regarding immunizations that may be contrary to a religious belief or personal belief that is opposed to immunizations in order to complete the Online Immunization Education Module.
XIII. Vaccinated children standard A. Per Section 25-4-911 (1), C.R.S., the goal for every school is for 95% of the enrolled student population to be vaccinated with each vaccine required for school entry in Section III in order to reduce the spread of vaccine-preventable disease and protect the health of all people in the school community, including students who cannot be immunized for medical reasons.
XIV. Annual parent letter A. Per Section 25-4-902 (4), C.R.S., annually, by January 15 of each year, the Department shall develop and provide to the Colorado Departments of Education, Early Childhood, and Human Services a standardized document regarding immunizations. The standardized document must include, but not be limited to:
1. A list of the immunizations required for enrollment in a school and the age at which the immunization is required;
2. A list of immunizations currently recommended for children by AAP and the recommended age at which each immunization should be given;
3. A place on the document where a school can include the school’s specific immunization and exemption rates for the MMR vaccine and for every other vaccine for the school’s enrolled student population from the prior school year compared to the vaccinated children standard described in Section 25-4-911, C.R.S.; and 4. A statement that the school is required to collect and report the information pursuant to Section 25-4-902 (4)(a), C.R.S., and that the school does not control the school’s specific immunization and exemption rates or establish the vaccinated children standard described in Section 25-4-911, C.R.S.
B. Annually, by January 31 of each year, the Colorado Departments of Education, Early Childhood, and Human Services shall post this standardized document on their websites.
C. Annually, on or before April 15 of each year, a school shall directly distribute the document to the parent or guardian of each student enrolled in its school, or emancipated students consistent with Section 25-4-903 (5), C.R.S.
1. The school shall include on the document the school's specific immunization and exemption rates for the measles, mumps, and rubella vaccine for the school's enrolled student population for the prior school year compared to the vaccinated children standard described in Section 25-4-911, C.R.S.
2. The school may include on the document the school's specific immunization and exemption rates for any other vaccine for the school's enrolled student population for the prior school year.
C O D E O F C O L O R A D O R E G U L A TI O N S 6 C C R 1 0 09 - 2 Di s e as e C o ntr ol a n d P u bli c H ealt h R e s p o n s e Di visi o n A p p e n di x A T h e bel o w t abl e d escri b es th e r eq uir e d n u m ber of dos es f or stu d ents att en di ng pu blic, priv at e, or p ar ochi al s ec o n dary sc h ools t hr oug h gr ad e t w elv e w ho ar e a g ed 19 thr o u gh 2 1 y ears.
• C ol u m n A s pecifi es th e v acci n e.
• C ol u m n B descri b es t he n u m ber of d oses a stu d ent w o uld hav e r eceiv e d h a d t h ey b ee n vacci n at e d o n ti m e, acc or din g t o T a ble 1 in t he doc u m e nt i nc or p or ate d by r efer enc e i n S ecti on II of t h es e r ul es. o T o ass ess vali dity of vacci n es a d mi nist er ed be hi n d sc h ed ul e t o a st u d ent b efor e t hey tur n e d 1 9 ye ars of ag e, ref er t o T a ble 2 in t he d oc u m ent i ncor p or ate d by r ef ere nc e i n Secti on II of th es e r ul es, i ncl u di n g:
2 4 Students attending public, private, or parochial secondary schools through grade twelve who are aged 19 through 21 years Column A Column B Column C Hepatitis B (HepB) 3 2-, 3-, or 4-dose series:
accelerated schedule of 3 doses at 0, 7, and 21– 30 days, followed by a final dose at 12 months.
Diphtheria, tetanus, pertussis 5 Not applicable - DTaP products are only licensed (DTaP) through 6 years of age.
Tetanus, diphtheria, 1 1-, 2-, 3-, or 4- dose series:
pertussis (Tdap)
Polio (IPV) 4 1-, 2-, 3 dose series:
Measles, mumps, rubella 2 2 doses: Four weeks between Dose 1 and Dose 2. (MMR)
Varicella (chickenpox) 2 2 doses: Four weeks between Dose 1 and Dose 2. • If two live vaccines are not given on the same day, there must be at least a 28-day interval between the two doses.
______________________________________________________________________ Editor’s Notes History Rule I, Table 1, Table 2 eff. 03/01/2008.
Rule I, Table 1 eff. 03/02/2009.
Rules I-XI, Table 1 eff. 12/30/2010.
Rules I.L., II. A., Table 1 eff. 07/01/2012.
Rule XI emer. rule eff. 01/16/2013.
Rule XI, Table 1, Table 2 eff. 04/14/2013.
Rules I-IV, VI, IX, XI eff. 10/15/2014. Table 1, Table 2 repealed eff. 10/15/2014. Rules I-VII, XII eff. 07/01/2015.
Rules I-IX eff. 10/15/2015. Rules III.C-D repealed eff. 10/15/2015. Rules II, III, VII, IX eff. 07/15/2016.
Rules I.C-IV.A, VI.A-VII.A.11, IX.A.1, IX.E-F eff. 07/30/2017. Entire rule eff. 08/14/2018.
Rules I-IV, VI-X, XII-XIV eff. 01/14/2021.
Rules III.D-E eff. 02/14/2022. Rule III.B.4 repealed eff. 02/14/2022. Rules I.G, I.I, I.O, I.Q, I.R, II.E, V.A, IX.A.1.a, IX.B.2.a eff. 05/15/2023. Entire rule eff. 01/05/2026.
Entire rule eff. 02/14/2026.