Vaccine Information Statements (VIS)Florida Department 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the patient's name in the designated fields, ensuring accuracy with both first and last names.
3. Fill in the patient’s date of birth using the format provided. This is crucial for identifying immunization records.
4. Provide the patient’s county of residence. This information helps in local record management.
5. Optionally, include the patient’s Social Security Number and mother’s maiden name for additional identification.
6. Indicate the sex of the patient by selecting M or F as applicable.
7. If available, enter the State Immunization ID Number to link existing records.
8. Ensure that a guardian or patient over 18 signs and dates the form at the bottom, acknowledging their decision to opt-out.

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