Get Ricair

The Ricair COVID-19 immunization record correction request form is essential for ensuring that your immunization information is accurate in the Rhode Island Child and Adult Immunization Registry. This guide provides step-by-step instructions to assist you in completing the form online with ease and confidence.

Follow the steps to correctly complete the Ricair form.

1. Click the ‘Get Form’ button to obtain the Ricair form and open it in the online editor.
2. Enter the patient's information by filling in the following fields: Patient Name, Date of Birth, Gender, Email, Phone Number (cell preferred), Street Address, City, State, and ZIP code.
3. Specify the change requested in the designated section. Ensure that you include a copy of the COVID-19 Vaccination Record Card or an alternative official immunization record as an attachment.
4. If the immunization was administered at a clinic or doctor's office outside of Rhode Island, check the appropriate box and provide the name of the practice or location where the vaccine was given.
5. Complete the authorization section by certifying that you are the person identified on the form or have explicit permission from the individual to complete it on their behalf. Ensure you agree that the information provided may be entered into the RICAIR for care coordination and monitoring.
6. Sign electronically in the designated field and include the date of signature.
7. After reviewing all entries for accuracy, proceed to save your changes, download, print, or share the completed form as needed. Finally, submit the form and required attachments to the appropriate email or mailing address provided.

Take action now and complete your Ricair document online!