AUTHORIZATION TO RELEASE IMMUNIZATION RECORDS - Chirp - chirp in 2026

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The document is an authorization form for the release of immunization records from the Children and Hoosiers Immunization Registry Program (CHIRP) in Indiana. It requires completion of patient details, guardian information if applicable, and specifies how the records will be sent to a designated person or agency. The authorization is valid for 60 days and can be revoked at any time. It also includes instructions for submitting the form and contact information for support.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the patient's name, including last, first, and middle names in the designated fields.
Fill in the date of birth using the format month, day, year.
If applicable, provide any previous names of the patient.
For patients under eighteen, enter the parent or guardian's name and their contact information including address and telephone number.
In the receiving agency information section, specify who will receive the records along with their fax number, telephone number, and email address.
Sign and date the authorization at the bottom of the form. Ensure that you include your relationship to the patient if signing on their behalf.

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is CHIRP access?

Chirp is a smart access solution for individuals living in multifamily and student housing communities. Chirp enables you to open any door, gate or garage using a mobile device and makes it easy to remotely grant access to friends, guest and service providers.

What is chirp permission?

All schools that are accredited under the Indiana Department of Education use CHIRP to review and update student immunization records. Schools must; however, have parent permission under the Family Educational Rights Privacy Act (FERPA) prior to entering any immunization records into the registry.

What is CHIRP on Garmin?

A chirp is a small Garmin accessory that is programmed and left in a geocache. You can use your device to find a chirp in a geocache. For more information about the chirp, see the chirp Owners Manual at .garmin.com. Child Topics: Enabling chirp Searching.

How do I access my vaccination records in Indiana?

MyVaxIndiana is a portal created by the Indiana Department of Health (IDOH) that allows you to access your vaccine record(s) (and those of your dependents) online.

What is the quickest way to get immunization records?

How to Contact Your Jurisdictions IIS contact the IIS in your state or in the state where you or your child received their last shots to see if they have records. contact your immunization provider directly or your local or state immunization program through your states health department.

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What is CHIRP in Google Cloud?

Chirp is the next generation of Googles speech-to-text models. Representing the culmination of years of research, the first version of Chirp is now available for Speech-to-Text. We intend to improve and expand Chirp to more languages and domains.

What is CHIRP software used for?

CHIRP is a widely-used radio programming software designed to simplify the process of programming amateur radio transceivers and scanners.

How do I opt out of chirp in Indiana?

An individual, parent or guardian may also request to permanently opt out or be excluded from Indianas state immunization registry. To submit for one or more exclusions, please complete and submit. For more information about the CHIRP requirements, please the CHIRP Help Desk at 888-227-4439 or chirp@health.in.gov.

AUTHORIZATION TO RELEASE IMMUNIZATION RECORDS - Chirp - chirp in 2026

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Got questions?

What is CHIRP access?

What is chirp permission?

What is CHIRP on Garmin?

How do I access my vaccination records in Indiana?

What is the quickest way to get immunization records?

Security and compliance

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What is CHIRP in Google Cloud?

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