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Utah Department of Health Immunization and US IIS Programs PO Box 142012, Salt Lake City, UT 841142012 Phone: (801) 5389450 Fax: (801) 5389440 Email: immunize Utah.gov RELEASE OF IMMUNIZATION RECORD

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How to fill out immunization record release17doc

01

Get a copy of the immunization record release17doc form.

02

Fill out the form by providing your personal details, including your full name, date of birth, and contact information.

03

Enter the immunization details accurately, including the name of the vaccine, the date it was administered, and the healthcare professional or facility that administered it.

04

Make sure to sign and date the form.

05

Review the completed form to ensure all necessary information is provided.

06

Submit the filled-out immunization record release17doc form to the appropriate authority or institution as instructed.

Who needs immunization record release17doc?

01

Anyone who has received immunizations and needs to release their immunization records may use the immunization record release17doc form.

02

This form is typically required by schools, colleges, employers, and other organizations that require proof of immunization.

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What is immunization record release17doc?

Immunization record release17doc is a document used to release immunization records of an individual.

Who is required to file immunization record release17doc?

Parents or guardians of minors, healthcare providers, and educational institutions are required to file immunization record release17doc.

How to fill out immunization record release17doc?

Immunization record release17doc can be filled out by providing the required personal information, dates of vaccinations, and signatures where necessary.

What is the purpose of immunization record release17doc?

The purpose of immunization record release17doc is to allow the release of immunization records for various purposes such as school enrollment, healthcare services, and travel.

What information must be reported on immunization record release17doc?

Information such as name, date of birth, vaccination dates, types of vaccines administered, and signatures must be reported on immunization record release17doc.

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