Get Immtrac, The Texas Immunization Registry, Is A Free Service Of The ... - Dshs State Tx

This guide provides clear instructions on how to fill out the ImmTrac form for inclusion in The Texas Immunization Registry. The Texas Department of State Health Services offers this free service to help individuals and their families maintain accurate immunization records.

Follow the steps to complete the ImmTrac form online.

1. Click the ‘Get Form’ button to obtain the ImmTrac form and navigate to the editor.
2. Enter the client’s last name, first name, and middle name in the designated fields. Ensure that the information is accurate to avoid any discrepancies.
3. Select the client's gender from the available options: Male or Female.
4. Input the client’s date of birth in the required format to ensure clarity.
5. Fill in the client’s address, including apartment number (if applicable), city, state, and zip code.
6. Provide the client’s telephone number and county to facilitate communication.
7. Indicate whether the client is a First Responder or an Immediate Family Member over 18 years of age by marking the appropriate box.
8. Ensure the printed name, date, and signature of the client are included to authenticate the request.
9. After completing the form, you may fax or mail it to the DSHS ImmTrac Group or a registered healthcare provider.

Complete your ImmTrac form online today to ensure your immunization records are accurately maintained and easily accessible.