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Dedicated to protecting and improving the health and environment of the people of Colorado Request to Release Immunization Record from the Colorado Immunization Information System A patient may request

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How to fill out request to release immunization

How to fill out a request to release immunization:

01

Start by obtaining the required form for requesting the release of immunization records. You can typically find this form on the website of the relevant healthcare provider or educational institution.

02

Begin by entering your personal information accurately. This usually includes your full name, date of birth, contact information, and any identification numbers provided by the healthcare provider or educational institution.

03

Fill in the details regarding the specific immunization records you are requesting. This may involve specifying the type of immunization (e.g., measles, tetanus), the dates received, and any additional relevant information, such as booster shots.

04

Include any necessary supporting documentation. This may include a photocopy of your identification documents, such as a driver's license or passport, to verify your identity.

05

If the request is being made on behalf of someone else, such as a child or dependent, provide their relevant personal information and relationship to you. Make sure to also include any necessary authorization forms or legal documentation.

06

Review the completed form for accuracy and ensure all required fields have been filled out. Double-check that all information is legible and correctly entered.

07

Sign and date the form, confirming that you understand and agree to the terms and conditions outlined on the request form.

Who needs a request to release immunization?

01

Individuals applying for schools or educational institutions may need to provide proof of immunizations. This request allows them to obtain their immunization records for submission during the enrollment process.

02

Healthcare professionals and organizations may also require immunization records to ensure the safety and well-being of their staff and patients. By submitting a request, individuals can provide these records to meet the requirements of their workplace or healthcare provider.

03

Additionally, individuals who are traveling or immigrating to another country might need to show proof of certain vaccinations. A request to release immunization records allows them to collect the necessary documentation for compliance with travel or immigration regulations.

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