Yellow Fever Vaccination Validation Uniform Stamp
and Vaccination Site Agreement

The U.S. Public Health Service has designated the Illinois Department of Public Health as the responsible party for determining which Illinois physicians are authorized to provide, under their orders, yellow fever vaccine for persons who travel outside the United States. The Illinois Department of Public Health, Communicable Disease Section (CD) is responsible for processing application requests, issuing Uniform Stamps, and updating the list of physicians approved to hold the Uniform Stamp at approved sites.

The Uniform Stamp certification is needed to officially document patients' International Certificates of Vaccination that travel vaccinations were given. The Uniform Stamp can be used only to document vaccination at the site listed on the application. The Uniform Stamp also allows the vaccination site to purchase the yellow fever vaccine (purchase of yellow fever vaccine is allowed only for approved Uniform Stamp holders). If the application is approved by the Department, the approved physician becomes a designated Illinois yellow fever vaccine provider and his/her clinic site(s) documented on the form becomes eligible to purchase and administer yellow fever vaccine. Providers are required to report their annual number of yellow fever doses administered to the Department by January 15 of each year.

How to apply:

1. Complete the application(s) available for download below. If unable to download, please call the Communicable Disease Section for a copy at 217-782-2016.
2. Applications must be completed in full, and may be faxed or mailed to the address below. Any applications with missing or incomplete information will be returned to the applicant.

Please note that the physician applying for the Uniform Stamp must include certification of completion of the Centers for Disease Control and Prevention (CDC) yellow fever vaccine course. All health care staff members that will be screening patients for yellow fever vaccine must successfully complete this course, and make their certificates available upon request. Additionally, the CDC has developed a web-based registry of all authorized yellow fever vaccination clinics. It is important that this information remain up-to-date, as travelers will be using the information on these sites to locate vaccine providers in their area. The Department must be notified immediately of an address change.

Application for Yellow Fever Vaccination Validation Uniform Stamp and Vaccination Site Agreement - PDF

Illinois Department of Public Health
Communicable Disease Section
525 W. Jefferson St.
Springfield, IL 62761

Tel: 217-782-2016
Fax:217-524-0962