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Authorization to Release Immunization Records Illinois Department of Public Health, Immunization Section CARE: Illinois Comprehensive Automated Immunization Registry ExchangeINSTRUCTIONS: 1. Complete
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How to fill out authorization to release immunization

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How to fill out authorization to release immunization

01
To fill out authorization to release immunization, follow these steps:
02
Start by writing the full name of the person giving authorization.
03
Include the date of birth of the person giving authorization.
04
Write down the name of the immunization that authorization is being given for.
05
Specify the date or period for which the authorization is valid.
06
Provide details about the healthcare provider or facility authorized to release immunization records.
07
Sign and date the authorization form.
08
If applicable, get the form notarized for added authenticity.
09
Keep a copy of the completed form for your records.

Who needs authorization to release immunization?

01
Authorization to release immunization is typically needed by individuals or parents/guardians of minors who want their immunization records to be shared with specific healthcare providers, schools, or organizations.
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Authorization to release immunization is a form that allows a healthcare provider to share a patient's immunization records with a third party, such as a school or employer.
Parents or legal guardians of minors are usually required to file authorization to release immunization on behalf of their children. Adults can also file it for themselves.
To fill out authorization to release immunization, you need to provide basic information about the patient, specify who the records should be released to, and sign and date the form.
The purpose of authorization to release immunization is to ensure that the patient's immunization records are shared only with authorized individuals or organizations for specific purposes, such as enrollment in school or employment.
The information that must be reported on authorization to release immunization includes the patient's name, date of birth, immunization history, the reason for the release of records, and the recipient of the information.
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