Get Immtrac Authorization To Release Official Immunization History. Use This Form To Authorize Release

The ImmTrac Authorization To Release Official Immunization History form is a vital document for individuals seeking to access their immunization records. This guide provides step-by-step instructions on how to complete the form accurately and efficiently, ensuring a smooth process for obtaining your official immunization history.

Follow the steps to complete the form effectively.

1. Press the ‘Get Form’ button to open your form and make it accessible for editing.
2. In the 'Client’s Name' section, enter the last name, first name, and middle name of the individual whose immunization history is being requested.
3. Indicate the individual’s date of birth by filling in the month, day, and year in the designated fields.
4. Provide the current address of the client, including street, city, state, and zip code.
5. Specify how and where to send the official immunization record by detailing the name or organization that will receive the records, along with their address and phone number.
6. Choose how the immunization record should be sent by selecting one of the options: Walk-in/In-person, Mail to address above, or Fax Number.
7. Complete the Requestor Information section clearly. Print the name of the client or their authorized representative, and provide their address and email address if available.
8. Ensure that the signature of the client or their authorized representative is provided, along with the date of the signature.
9. Review all information entered for accuracy and completeness.
10. Upon completion, save changes, and choose to download, print, or share the form as needed.

Complete your ImmTrac Authorization To Release form online today for easy access to your immunization records.