Emergency information and immunization record card: Fill out & sign online

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Click ‘Get Form’ to open the emergency information and immunization record card in the editor.
Begin by entering your child's name and date of enrollment at the top of the form. Ensure accuracy as this information is crucial for identification.
Fill in the address details, including street, city, state, and zip code. This helps in case of emergencies requiring location verification.
Provide contact information for both parents or guardians, including home and cell phone numbers. This ensures that you can be reached quickly if needed.
Complete the medical care section by listing your child's doctor and hospital details. This is vital for immediate medical assistance.
List authorized individuals who can pick up your child in case of an emergency. Include their relationship to your child for clarity.
In the immunization section, accurately document required vaccine doses by age. Attach any necessary official documents as indicated.
Finally, review all entries for completeness and accuracy before signing at the bottom of the form to confirm its validity.

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Does NYS have an immunization registry?

The New York State Immunization Information System (NYSIIS) is an electronic registry that maintains immunization records for New York State children and adults.

Can you download documents from mychart?

When you download your health or visit summary documents, several files are compressed into a single ZIP file so they can be transferred quickly. You need to uncompress (unzip) this file before you can view your documents.

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.

Can I see my immunization records on 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 docHub out to your clinic directly to have your information updated.