Imm 45 2026

1. Click ‘Get Form’ to open the imm 45 in the editor.
2. 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.
3. Enter the 'Date of Birth' and 'Street Address' of the registrant. This information is crucial for locating their immunization records.
4. If known, provide the 'NJIIS Registry ID Number'. This will expedite your request process.
5. Complete the contact details including 'City', 'State', 'Zip Code', and 'Daytime Telephone Number'.
6. Fill in the 'Name of Parent/Guardian' and their relationship to the registrant, ensuring that all fields are accurately completed.
7. Specify who will receive the copy of the immunization record by filling out their name and address details.
8. Finally, sign and date the form at the bottom, confirming your authorization for release of information.

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