Mississippi State Department of Health

About Form 121 (Immunization Compliance)


Form 121 (Immunization Compliance) can be obtained from your child's doctor, county health departments, or be downloaded online.

To enter a school or daycare in Mississippi for the first time, a child must have had certain childhood immunizations, or else be exempted from immunizations for medical reasons. Form 121 certifies that required immunizations have been received. Form 122 certifies that a child is exempt from required immunizations.

How to Get a Form 121

From your child's doctor or medical provider: Request a signed Form 121 from your child’s pediatrician or medical provider in Mississippi. If your child received some or all immunizations from another state, you may need to give that information when you make your request.

From a county health department: If you do not have a Mississippi health care provider for your child, contact a county health department near you to request a Form 121.

Online: You can register with our MyIR service, which will try to locate your child's immunization records. If they are found, you can download a copy of your child's form 121.

Links referenced on this page
County health department locations    http://msdh.ms.gov/msdhsite/index.cfm/19,0,166,html ok
More about MyIR and how to register    http://msdh.ms.gov/msdhsite/index.cfm/14,0,71,969,html ok

Find this page at https://msdh.ms.gov/page/14,25485,71,303.html

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