Get Nd Doh Sfn 58454 2019-2025

Filling out the ND DoH SFN 58454, also known as the immunization record request form, is an important step in obtaining vital health information. This guide aims to provide you with straightforward instructions to successfully complete this form online.

Follow the steps to complete the ND DoH SFN 58454 online.

1. Click ‘Get Form’ button to obtain the form and open it in the designated editor.
2. Fill in the requested immunization record information. Provide the first name, middle name (if applicable), maiden name (if applicable), last name, date of birth, and gender. Ensure that all fields are completed accurately to avoid processing delays.
3. Next, provide the requestor’s information. Fill in the requestor's last name, first name, relationship to the individual whose records are being requested, street address, city, state, telephone number, ZIP code, and email address if you prefer receiving the records via email.
4. Indicate the supporting documentation you are attaching to your request. You must check the appropriate box to confirm that you are providing a photocopy of your driver’s license, a release of information form, or a court order granting guardianship.
5. Sign the form electronically by checking the box and typing your name at the designated section. This signature is legally binding and confirms the validity of your request.
6. After completing all sections, review the form for accuracy. Ensure you have included all necessary supporting documents.
7. Finally, save your changes. You may then download, print, or share the completed form as needed. Remember to submit the form and all supporting documentation either by mail or email to the North Dakota Department of Health.

Begin your request for immunization records online today by following these steps.