Get Mi Request For Immunization Record 2009

This guide provides clear instructions for individuals seeking to complete the MI Request for Immunization Record online. Whether you are filling this out for yourself or on behalf of someone else, this step-by-step process will help ensure that you submit a complete and accurate request.

Follow the steps to successfully complete your request.

1. Click ‘Get Form’ button to obtain the form and open it in an editable format.
2. In the 'Requested Immunization Record Information' section, print clearly and legibly your last name, first name, middle name, and date of birth. Make sure to use the correct format: Month, Day, Year.
3. Indicate your maiden name if applicable, and select your gender by marking either 'Male' or 'Female'.
4. In the 'Requestor’s Information' section, provide your name and specify your relationship to the individual whose record you are requesting, if they are under 18 years old.
5. If the request is for a person aged 18 or older, note that only they can request their record. If you are representing a social services agency, include a formal request that includes the signature of the parental or legal guardian, along with copies of identification.
6. Provide your current address, and if you have moved recently, include both your old and new addresses to ensure correct processing.
7. If your telephone number has changed, include both the old and current numbers.
8. Sign and date the form to confirm your submission. Ensure that all information is complete before finalizing your request.
9. Once all the required fields are filled out, save your changes, and proceed to print or share the completed form as needed.
10. After printing, mail the completed request to the Michigan Department of Community Health Immunization Program at the address provided on the form. Be sure to allow 14 business days for processing.

Start filling out your MI Request for Immunization Record online today to ensure you receive your documents promptly.