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Immunization agreement

Immunization agreement 2026

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The document is a user agreement for the Wisconsin Immunization Registry (WIR) that outlines the responsibilities and obligations of users regarding the security and confidentiality of immunization data. It emphasizes compliance with organizational protocols, accurate data handling, safeguarding access credentials, and restrictions on accessing or sharing information. Users consent to monitoring and acknowledge potential penalties for violations.

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Click ‘Get Form’ to open the immunization agreement in the editor.
Begin by entering the Organization or School/District Name and Address. Ensure that all details are accurate to avoid any issues with processing.
Fill in your User Name, Title, Telephone Number, and Email Address. This information is crucial for identification and communication purposes.
Review the compliance statements carefully. By signing, you agree to adhere to the Wisconsin Immunization Registry protocols. Make sure you understand each point before proceeding.
Sign the document electronically in the designated area for User Signature and include the Date Signed. This confirms your commitment to maintaining confidentiality.
If applicable, have the Site Administrator or Principal/Superintendent sign as well, ensuring their Print Name and Title are included along with their Date Signed.

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