Get Kyir

Completing the Kentucky Immunization Registry Enrollment Form is essential for establishing your clinic's involvement in immunization efforts. This guide will provide you with clear and supportive instructions on how to fill out the Kyir form online, ensuring a smooth process.

Follow the steps to complete the Kyir form online successfully.

1. Click ‘Get Form’ button to access the enrollment form and open it in the editor.
2. On Page 1, review the instructions carefully. Complete one KYIR Enrollment form and one KYIR User Confidentiality Agreement per clinic or facility. Also, ensure that each log-in user completes a CHFS 219 form.
3. Move to Page 2 and fill in your provider details. Ensure that you complete all fields, including the provider name, mailing address, contact person, title, business phone, fax number, and email address. If uncertain about any part of the form, reach out to the Kentucky Immunization Registry Help Desk for assistance.
4. On Page 3, establish user accounts by filling out the user details. Each staff member who needs access to Kyir must complete their CHFS 219 form. Remember to keep a blank form for any future additional users and submit the signed forms via mail or fax as instructed.
5. Designate a provider contact who will be responsible for future correspondence. Have them sign and date Page 3 before submission.
6. To submit your application, mail or fax the completed forms to the appropriate address or fax number indicated on Page 3. Allow 10 business days for processing after your forms have been submitted.

Complete your KYIR documents online today to ensure your clinic's participation in immunization efforts!