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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. Download and complete the yellow fever application below. If you have questions or are unable to download the yellow fever application, please contact the Illinois Department of Public Health Communicable Disease Control Section at 217-782-2016.
  2. Completed application may be faxed (217-524-0962), or e-mailed (DPH.YFVapplication@illinois.gov). Incomplete applications will not be approved.

Medical providers applying for the uniform stamp must include certification of completion of the U.S. Centers for Disease Control and Prevention (CDC) Yellow Fever Vaccine Course. Health care staff members screening patients for yellow fever vaccine must also successfully complete this course, and make their certificates available upon request to Illinois Department of Public Health Communicable Disease Control Section upon request. Additionally, the CDC has developed a Web-based registry of authorized yellow fever vaccination clinics. It is important this information remain up-to-date, as travelers will be using it to locate vaccine providers in their area. The Illinois Department of Public Health must be notified immediately of an address or staff (medical director, physician) 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





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About the Department

Illinois Department of Public Health
535 West Jefferson Street
Springfield, Illinois 62761
Phone 217-782-4977
Fax 217-782-3987
TTY 800-547-0466
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