Get New Jersey Immunization Information System Njiis Consent - Ewingnj

This guide provides a clear and supportive process for filling out the NEW JERSEY IMMUNIZATION INFORMATION SYSTEM NJIIS CONSENT form online. By following these instructions, users will efficiently complete the form required for immunization participation.

Follow the steps to complete the NJIIS consent form.

1. Click the ‘Get Form’ button to access the NJIIS consent form and open it in a suitable editor.
2. Begin by filling in the registrant's name in the 'Registrant Name' section. Ensure the name is written clearly.
3. Next, provide the date of birth of the registrant in the designated field.
4. Enter the full address of the registrant, including the city, state, and zip code.
5. Select the registrant's country of birth from the provided options.
6. Fill in the name of the primary health care provider responsible for the registrant's care.
7. Indicate the relationship to the registrant, such as parent or guardian.
8. Specify the type of health insurance held by the registrant, selecting the relevant option.
9. Read the consent information carefully, ensuring understanding of the NJIIS program purpose and sharing provisions.
10. Choose one of the options to indicate whether you or your child would like to participate in the NJIIS program by selecting 'Yes' or 'No'.
11. Provide the signature of the registrant or a parent/guardian if the registrant is under 18 years of age.
12. Enter the name of the NJIIS enrollment site, which in this case is the Ewing Township Health Department.
13. Fill in the date when the form is being completed.
14. If applicable, include the registry ID number in the specified field.
15. Finally, save your changes, then download, print, or share the completed consent form as needed.

Complete your NJIIS consent form online today to ensure your immunization records are up-to-date.