Colorado State Vaccine Requirements

• General Information
• Vaccination Requirements
• Exemption Information

• General Information
• Vaccination Requirements: C.R.S. 23-5-128
• Exemption Information

• General Information
• Vaccination Requirements
• Exemption Information

• Vaccination Requirements for Healthcare Workers, Patients, Inmates & Developmentally Disabled
• State of Colorado Legislature – see applicable statutes and their hyperlinks below. Visit NVIC’s Advocacy Portal for information on legislation introduced impacting vaccine exemption rights. 
• State of Colorado Department of Health  
• State of Colorado Immunization Program
• State of Colorado Vaccine Tracking System
• State of Colorado Vaccine Tracking System Opt-Out Information & Forms – Under Colorado law an individual or parent may exclude vaccination information for themselves or their child from the Colorado Immunization Information System (CIIS) at any time. Opting out does not remove an individual's name, date of birth, gender, city, county and zip code from the registry. 
• State of Colorado Proposed Rule-Making – View your state’s registry to learn about proposed rule-making.

TITLE 25. HEALTH
DISEASE CONTROL
ARTICLE 4. DISEASE CONTROL
PART 9. SCHOOL ENTRY IMMUNIZATION

C.R.S. 25-4-901. Definitions

As used in this part 9, unless the context otherwise requires:

(1) "Certificate of immunization" means one of the following forms of documentation that include the dates and types of immunizations administered to a student:

(a) A paper document that includes information transferred from the records of a licensed physician, registered nurse, or public health official;or

(b) An electronic file or a hard copy of an electronic file provided to the school directly from the immunization tracking system, established pursuant to section 25-4-2403.
 

(1.5) "Child" means any student less than eighteen years of age.

(1.7) "Nonmedical exemption" means an immunization exemption based upon a religious belief whose teachings are opposed to immunizations or a personal belief that is opposed to immunizations.

(2) (a) "School" means, except as otherwise provided in paragraph (b) of this subsection (2), a public, private, or parochial nursery school, day care center, child care facility or child care center as defined in section 26-6-102 (5), C.R.S., family child care home, foster care home, head start program, kindergarten, elementary or secondary school through grade twelve, or college or university.

(b) "School" does not include:

(I) A public services short-term child care facility as defined in section 26-6-102 (30), C.R.S.;

(I.5) A guest child care facility as defined in section 26-6-102 (16), C.R.S., or a ski school as defined in section 26-6-103.5 (6), C.R.S.; or
(II) College or university courses of study that are offered off-campus, or are offered to nontraditional adult students, as defined by the governing board of the institution, or are offered at colleges or universities that do not have residence hall facilities.
 

(3) "Student" means any person enrolled in a Colorado school or child care center as defined in subsection (2) of this section. "Student" does not include a child who enrolls and attends a licensed child care center, as defined in section 26-6-102 (5), 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.

C.R.S. 25-4-902. Immunization prior to attending school - standardized immunization information

(1) A student shall not attend any school in the state of Colorado on or after the dates specified in section 25-4-906 (4) unless he or she has presented one of the following to the appropriate school official:

(a) An up-to-date certificate of immunization from a licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), advanced practice nurse, or authorized representative of the department of public health and environment or a local public health agency stating that the student has received immunization against communicable diseases as specified by the state board of health, based on recommendations of the advisory committee on immunization practices of the centers for disease control and prevention in the federal department of health and human services; or

(b) A written authorization signed by one parent or legal guardian, an emancipated student, or a student eighteen years of age or older requesting that local public health officials administer the immunizations; or

(c) A certificate of medical exemption, or a certificate of completion of the online education module or a certificate of nonmedical exemption in compliance with section 25-4-903. A certificate of medical exemption, or a certificate of completion of the online education module or a certificate of nonmedical exemption, is only valid if completed in compliance with section 25-4-903.

(1.5) A student is not required to comply with subsection (1) of this section if the student is participating in a nonpublic home-based educational program pursuant to section 22-33-104.5; except that:

(a) A school district may require compliance with subsection (1) of this section pursuant to section 22-33-104.5 (3)(g); and

(b)
(I) A school district may require compliance with subsection (1) of this section if the student participating in a nonpublic home-based educational program attends a school of the school district for a portion of the school day;

(II) An institute charter school may require compliance with subsection (1) of this section if the student participating in a nonpublic home-based educational program attends the institute charter school for a portion of the school day; or

(III) A private school may require compliance with subsection (1) of this section if the student participating in a nonpublic home-based educational program attends the private school for a portion of the school day.
 

(2) If the student's certificate of immunization is not up-to-date according to the requirements of the state board of health, the parent or guardian or the emancipated student or the student eighteen years of age or older shall submit to the school, within fourteen days after receiving direct personal notification that the certificate is not up-to-date, documentation that the next required immunization has been given and a written plan for completion of all required immunizations. The scheduling of immunizations in the written plan shall follow medically recommended minimum intervals approved by the state board of health. If the student begins but does not continue or complete the written plan, he or she shall be suspended or expelled pursuant to this part 9.

(3) Notwithstanding the provisions of subsection (1) of this section, a school shall enroll a student who is in out-of-home placement within five school days after receiving the student's education information and records as required in section 22-32-138, C.R.S., regardless of whether the school has received the items specified in subsection (1) of this section. Upon enrolling the student, the school shall notify the student's legal guardian that, unless the school receives the student's certificate of immunization or a written authorization for administration of immunizations within fourteen days after the student enrolls, the school shall suspend the student until such time as the school receives the certificate of immunization or the authorization.

(4) (a) On or before January 15, 2021, the department of public health and environment shall develop and provide to the department of education and the department of human services a standardized document regarding childhood immunizations. The department of education and the department of human services shall post the standardized immunization document on their websites on or before January 31, 2021, and on or before January 31 each year thereafter. The standardized document must be updated annually and must include, but need not be limited to:

(I) A list of the immunizations required for enrollment in a school and the age at which the immunization is required;

(II) A list of immunizations currently recommended for children by the advisory committee on immunization practices of the centers for disease control and prevention in the federal department of health and human services and the recommended age at which each immunization should be given;

(III) A place on the document where a school can include the school's specific immunization and exemption rates for the measles, mumps, and rubella vaccine and for every other 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; and

(IV) A statement that the school is required to collect and report the information pursuant to this subsection (4)(a) 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.(II) A list of immunizations currently recommended for children by the advisory committee on immunization practices of the centers for disease control and prevention in the federal department of health and human services and the recommended age at which each immunization should be given;

(b) On or before February 15, 2021, and on or before February 15 each year thereafter, a 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. 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. The school shall directly distribute the document to the parent or legal guardian of each student enrolled in its school, emancipated students, or students eighteen years of age or older, consistent with section 25-4-903 (5).
 

(5) The document created pursuant to subsection (4) of this section shall comply with the provisions of section 25-4-903(4) regarding allowable exemptions from required immunizations.

(6) Notwithstanding any provision of law to the contrary, a school district that is exercising its authority pursuant to section 22-33-104.5 (3)(g) or an independent school organized pursuant to section 22-33-104 (2)(b) where students are enrolled but do not attend is entitled to only:

(a) A student's immunization records, as provided by the parent or legal guardian; or

(b) A statement signed by a parent or legal guardian that the student is exempt from immunization.
 

C.R.S. 25-4-902.5 Immunization prior to attending a college or university - tuberculosis screening process development.

(1) Except as provided in section 25-4-903, no student shall attend any college or university in the state of Colorado on or after the dates specified in section 25-4-906 (4) unless the student can present to the appropriate official of the school a certificate of immunization from a licensed physician, licensed physician assistant authorized under section 12-240-107 (6), licensed advanced practice nurse, or authorized representative of the department of public health and environment or county, district, or municipal public health agency stating that the student has received immunization against communicable diseases as specified by the state board of health or a written authorization signed by one parent or guardian or the emancipated student or the student eighteen years of age or older requesting that local health officials administer the immunizations or a plan signed by one parent or guardian or the emancipated student or the student eighteen years of age or older for receipt by the student of the required inoculation or the first or the next required of a series of inoculations within thirty days.

(2) (Deleted by amendment, L. 94, p. 695, § 2, effective April 19, 1994.)

(3) (a) Each college and university in Colorado may work to create a tuberculosis screening process with the goal of making the process as uniform as possible for all colleges and universities in the state. The department of public health and environment may attend and participate in any meetings held by the universities and colleges regarding the screening process. The screening process may include a tuberculosis risk questionnaire, a tuberculosis education policy, a clinical review process for each completed questionnaire, and follow-up testing procedures for students who are determined to be at risk for tuberculosis. On or before January 1, 2009, the colleges and universities that work to create a tuberculosis screening process pursuant to this subsection (3) shall report to the health and human services committees of the senate and the house of representatives, or their successor committees, regarding any legislative recommendations necessary regarding a tuberculosis screening process.

(b) This subsection (3) shall not apply to a university or college that provides course work solely online.

C.R.S. 25-4-903. Exemptions from immunization 

(1) (Deleted by amendment, L. 97, p. 409, § 2, effective July 1, 1997.)  

(2) A parent or legal guardian shall have his or her student immunized, unless the student is exempted pursuant to this section, or an emancipated student or a student eighteen years of age or older shall have himself or herself immunized, unless the student is exempted pursuant to this section. A student is exempted from receiving the required immunizations in the following manner:

(a) By submitting to the student's school a completed certificate of medical exemption from a licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), or advanced practice nurse that the physical condition of the student is such that one or more specified immunizations would endanger his or her life or health or are medically contraindicated due to other medical conditions; or

(b) (I) By submitting to the student's school either a completed certificate of completion of the online education module or a completed certificate of nonmedical exemption signed by one parent or legal guardian, an emancipated student, or a student eighteen years of age or older that the parent, legal guardian, or student is an adherent to a religious belief whose teachings are opposed to immunizations or has a personal belief that is opposed to immunizations.

(II) (A) A complete certificate of completion of the online education module is acquired upon completing the online education module described in subsection (2.7) of this section.

(B) A complete certificate of nonmedical exemption must include the signature of a person who is authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate of nonmedical exemption is sought. Nothing in this subsection (2)(b)(II)(B) requires a person authorized pursuant to title 12 to administer immunizations within his or her scope of practice to sign a certificate of nonmedical exemption. Notwithstanding any law or rule to the contrary, a body that regulates the professional conduct of a person who is authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate is sought shall not order a disciplinary action against the person because the person authorized to sign the certificate signed such certificate pursuant to this subsection (2)(b)(II)(B). It is unlawful for the employer or any professional organization to retaliate against a person because the person authorized to sign a certificate signed such certificate pursuant to this subsection (2)(b)(II)(B). 
 

(2.2) (a) (I) A licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), or advanced practice nurse shall provide a copy of a completed certificate of medical exemption to the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older.

(II) The certificate of completion of the online education module must be immediately available to download or print upon completion of the online education module. The certificate of completion of the online education module developed by the department of public health and environment must include the same information as the certificate of nonmedical exemption pursuant to subsection(2.3) of this section.

(III) A person authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate of nonmedical exemption is sought and who signs the certificate of nonmedical exemption form shall provide a copy of a completed certificate of nonmedical exemption to the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older.


(b)
(I) A licensed physician, physician assistant authorized pursuant to section 12-240-107 (6), or advanced practice nurse shall submit the medical exemption data to the immunization tracking system created in section 25-4-2403.

(II) A person authorized pursuant to title 12 to administer immunizations within his or her scope of practice to the student for whom the certificate of nonmedical exemption is sought and who signs the certificate of nonmedical exemption shall submit the nonmedical exemption data to the immunization tracking system created in section 25-4-2403.

(III) Notwithstanding subsections (2.2)(b)(I) and (2.2)(b)(II) of this section, a licensed physician, a physician assistant authorized pursuant to section 12-240-107 (6), an advanced practice nurse, or a person authorized pursuant to title 12 to administer immunizations within his or her scope of practice is not subject to a regulatory sanction for failing to submit medical exemption or nonmedical exemption data to the immunization tracking system.
 

(2.3) (a) On or before January 1, 2021, the department of public health and environment shall develop and post on its website a standardized certificate of medical exemption form and a standardized certificate of nonmedical exemption form. The department of public health and environment shall post any updated form on its website. 

(b) At a minimum, the forms developed by the department of public health and environment must:

(I) Include a notice that informs the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older of the option to exclude the student's medical or nonmedical exemption information from the immunization tracking system established in section 25-4-2403;

(II) Be limited to requests for information related to collecting data pertaining to a medical or nonmedical exemption, including but not limited to:

(A) The student's immunization information and the vaccine or vaccines for which the exemption applies; and

(B) Whether a medical exemption or a nonmedical exemption is claimed;

(III) Not require the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older to provide any demographic data except the student's name, date of birth, sex, and school's name and location, and the parent's or legal guardian's name;

(IV) Include references to scientifically based information regarding the benefits and risks of immunizations; and

(V) Not require the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older to provide any information that would identify the religious faith or describe the reasons for the personal belief of the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older who is claiming a nonmedical exemption. The existing immunization tracking system established in section 25-4-2403 must not receive or store any information that would identify the religious faith or the reasons for the personal belief of the student's parent or legal guardian, the emancipated student, or the student eighteen years of age or older who is claiming the exemption.
(c) The forms developed by the department of public health and environment must not require a parent or legal guardian, emancipated student, or student eighteen years of age or older 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 form.
 

(2.5) The state board of health shall promulgate rules regarding:

(a) Immunization information, including exemption rates, that is available to the public through the department, including evidence-based research, resources and information from credible scientific and public health organizations, peer-reviewed studies, and an online learning module; and

(b) The frequency of submission of exemption forms.
 

(2.7) (a) The online learning module administered by the department of public health and environment pursuant to subsection (2.5)(a) of this section must:

(I) Include 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 and evidence-based practices. The module must fairly present both the benefits and risks of immunizations and include data concerning the risk of immunization injury.

(II) Be interactive; and

(III) Include other criteria adopted by the department of public health and environment. (b) The online learning module must not require a parent or legal guardian, emancipated student, or student eighteen years of age or older 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 learning module.
 

(3) The state board of health may provide, by regulation, for further exemptions to immunization based upon sound medical practice.

(4) All information distributed to parents by school districts regarding immunization shall inform them of their rights under subsection (2) of this section.

(5) In addition to the requirements pursuant to section 25-4-902 (4)(b), each school shall make the immunization and exemption rates of their enrolled student population publicly available upon request.

C.R.S. 25-4-904. Rules and regulations - immunization rules - rule-making authority of state board of health

As used in this part 9, unless the context otherwise requires:

(1) The state board of health shall establish rules and regulations for administering this part 9. Such rules and regulations shall establish which immunizations shall be required and the manner and frequency of their administration and shall conform to recognized standard medical practices. Such rules and regulations may also require the reporting of statistical information and names of noncompliers by the schools. The department of public health and environment shall administer and enforce the immunization requirements.

(2) All rule-making authority granted to the state board of health under the provisions of this article is granted on the condition that the general assembly reserves the power to delete or rescind any rule of the board. All rules promulgated pursuant to this subsection (2) shall be subject to sections 24-4-103 (8) (c) and (8)(d) and 24-4-108, C.R.S.

• NVIC Testimony on HB 22-110 to Prohibit Discrimination on COVID-19 Vaccine Status - Apr. 6, 2022.
• NVIC Testimony on SB 21-016 relating to minor consent to vaccination - May 26, 2021.