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HD1142FPennsylvania Statewide Immunization Information System User Agreement Acknowledgement (School) All information within the records maintained in the Pennsylvania Statewide Immunization Information
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What is authorization to release immunization?
Authorization to release immunization is a form that allows an individual to release their immunization records to a specific organization or person.
Who is required to file authorization to release immunization?
Anyone who needs to provide their immunization records to a certain entity, such as a school or employer, is required to file authorization to release immunization.
How to fill out authorization to release immunization?
To fill out the authorization to release immunization form, one must provide their personal information, specify who the records should be released to, and sign the form to authorize the release of the information.
What is the purpose of authorization to release immunization?
The purpose of authorization to release immunization is to ensure the confidentiality of an individual's immunization records while allowing them to be shared with authorized parties.
What information must be reported on authorization to release immunization?
The authorization to release immunization form typically requires the individual's name, date of birth, contact information, the name of the organization receiving the records, and the signature of the individual.
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