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Nj immunization record form

Imm 45 2025

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The document is a request form from the New Jersey Department of Health for obtaining a copy of an individual's immunization record from the New Jersey Immunization Information System (NJIIS). It outlines the necessary identification documents required for the request, details needed about the registrant and requestor, and includes an authorization section for releasing the information.

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Click ‘Get Form’ to open the imm 45 in the editor.
Begin by filling in the 'Name of Registrant' field with the individual's name as it appears in the NJIIS. Ensure accuracy for proper identification.
Enter the 'Date of Birth' and 'Street Address' of the registrant. This information is crucial for locating their immunization records.
If known, provide the 'NJIIS Registry ID Number'. This will expedite your request process.
Complete the contact details including 'City', 'State', 'Zip Code', and 'Daytime Telephone Number'.
Fill in the 'Name of Parent/Guardian' and their relationship to the registrant, if applicable.
Provide details about the current primary health care provider, including their name and telephone number.
In the section for 'Individual or Entity to Receive Copy', enter their name, address, city, state, and zip code.
Finally, complete the authorization section by signing and dating where indicated before submitting your form along with any required identification documents.

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Versions	Form popularity	Fillable & printable
2012	4.8 Satisfied (171 Votes)
2010	4.9 Satisfied (58 Votes)

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Got questions?

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

Can you get immunization records from MyChart?

Go to My Record Health Summary and select the Immunizations tab. You can see the immunizations youve received and the dates on which you received them. Click the immunization name to learn more. If your immunizations are not up to date, please reach out to your clinic directly to have your information updated.

Can I get a copy of my immunization records online in NJ?

Docket simply allows you to digitally access your immunization records, including COVID-19, to use at your own discretion. Use of Docket is 100% optional.

Can I get a copy of my immunization records online from NJ?

3. I need proof of mine or my family members immunization records, including COVID-19. Where can I find this information? You can access your official immunization reports directly from the Docket app.

What is immunization information system?

Immunization information systems (IIS) are confidential, population-based, computerized databases that record all immunization doses administered by participating providers to persons residing within a given geopolitical area.

What is the New Jersey immunization information system?

What is NJIIS? A free, confidential, population-based online system, operating since 1997, that collects and consolidates vaccination data for New Jerseys children, adolescents, and adults.

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How long do pediatricians keep immunization records?

Doctors and health clinics keep records of the vaccines they give to your child. Keep in mind that they may save records for only a few years. If your child has gotten vaccines at different locations, you may have to contact each of them to get your childs records.

What is the immunization system?

Immunization is the process whereby a person is made resistant to a disease, typically by the administration of a vaccine. Vaccines stimulate the bodys own immune system to protect the person against subsequent infection or disease.

Are vaccines mandatory in New Jersey?

To prevent some of the most serious infections, the New Jersey school immunization rules, Immunization of Pupils in Schools (N.J.A.C. 8:57-4) require students to receive a series of immunizations prior to attendance at school.

Imm 45 2025

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Got questions?

Can you get immunization records from MyChart?

Can I get a copy of my immunization records online in NJ?

Can I get a copy of my immunization records online from NJ?

What is immunization information system?

What is the New Jersey immunization information system?

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How long do pediatricians keep immunization records?

What is the immunization system?

Are vaccines mandatory in New Jersey?

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