Parent Upload Portal – MyStudentHealthHub

Who are you submitting forms for?

K–12 – Required steps

Complete the Emergency Contact tab for this student.
Upload your student's Immunization Record.
You may use the official Arizona form (fillable):
Arizona School Immunization Record (ASIR 109R)
Upload the student's Physical Form if required by your school.

Student First Name Student Last Name Date of Birth Grade Level Campus Upload Immunization Form (PDF/Image) Accepted formats: PDF, JPG, PNG. Upload Physical Form (PDF/Image) If you don't have this yet, you can return later and upload it separately.

Having trouble with this form? Please contact your school's office or nurse for assistance.

Emergency Contacts

Provide at least one emergency contact for this student. This will be linked to the same school and campus as the upload form above.

Student First Name Student Last Name Date of Birth Grade Level (optional for daycare)

Contact 1 (required)

Name Relationship Primary Phone Email (optional) Can this contact pick up the student?

Contact 2 (optional)

Name Relationship Primary Phone Email (optional) Can this contact pick up the student?

Immunization Forms (Fill Out Online)

These links open the official Arizona fillable PDF forms in a new tab. You can type directly into the form, then use the PDF toolbar to save or print to PDF. After saving, come back to the Medical documents tab to upload the file.

K–12 School Immunization Record (ASIR 109R)

For K–12 students. Childcare programs may also choose to use this form as the child's immunization record if preferred.

Childcare Emergency & Immunization Record Card

For childcare/daycare programs. After filling out the form in the new tab, click Print in the PDF viewer or your browser, then choose “Save as PDF” to save the completed form to your device. Once saved, return to the Medical documents tab to upload it.

Student Medical Document Upload