New Jersey Department of Health Vaccine Preventable Disease Program P.O. Box 369, Trenton, NJ 086250369 6098264860 (Fax 6098264866) www.njiis.nj.gov NEW JERSEY IMMUNIZATION INFORMATION SYSTEM (NJIIS)CONSENT.
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How to fill out the Njiis Consent To Participate Form online
Completing the Njiis Consent To Participate Form online is a straightforward process designed to facilitate your or your child's participation in the New Jersey Immunization Information System. This guide provides clear and supportive steps to ensure you successfully fill out and submit the form.
Follow the steps to complete the form accurately.
- Press the ‘Get Form’ button to obtain the Njiis Consent To Participate Form and open it in your preferred editor.
- Begin by entering the registrant’s information. Fill in the registrant's name, date of birth, and address, ensuring accuracy for all details. Include the country of birth and city, state, and zip code.
- Next, provide the name of the primary health care provider associated with the registrant. Also, identify your relationship to the registrant, such as parent or guardian.
- Read the information about the New Jersey Immunization Information System carefully. Confirm your understanding of the purpose and benefits of the program.
- Indicate your decision regarding participation in the program by checking either 'Yes, I would like to participate' or 'No, I do not want to participate'.
- If the registrant is under 18 years of age, ensure that the parent or guardian signs the form in the designated area.
- Fill in the name of the NJIIS Enrollment Site, the registry ID number, and the medical record number, if available.
- Review all filled information for accuracy, then proceed to save changes. Options to download, print, or share the form will be available, allowing you to retain a copy for your records.
Complete your Njiis Consent To Participate Form online today to ensure your or your child's immunization records are well managed.
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How do I register with Njiis?
All children born in New Jersey on or after January 1, 1998, are automatically enrolled in NJIIS. If you were born prior to 1998 and would like to enroll, you must complete an “NJIIS Consent to Participate” form at your provider's office. The form is also available on the NJIIS website.
What does Njiis stand for?
New Jersey Immunization Information System (NJIIS) is the official state-wide immunization registry that allows users to ensure that all children within New Jersey are protected against vaccine preventable diseases.
Should I participate in Njiis?
Clinicians who administer vaccines to adolescents and adults are strongly encouraged to become NJIIS users. By using NJIIS for all patients, regardless of age, you can have a single source for all immunizations administered.
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