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Click ‘Get Form’ to open the Philadelphia Kids Immunization Registry in the editor.
Begin by entering the Provider Name and Address at the top of the form. This information is crucial for identifying where the immunizations are administered.
Fill in the Patient Name, Date of Birth, and Record Number. Ensure accuracy as this data is essential for tracking immunization history.
Provide Parent/Guardian details including their name and contact information. This section ensures that caregivers are informed about their child's vaccinations.
In the vaccine administration section, list each vaccine given along with its Date Given, Site of administration, Manufacturer, Lot Number, and VIS Publication Dates. Be meticulous to ensure compliance with health regulations.
Finally, have the Vaccine Administrator sign and date the form to certify that all information provided is accurate and that appropriate Vaccine Information Statements were given.
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Check with your high school and/or college health services for dates of any immunizations. Keep in mind that generally records are kept only for 1-2 years after students leave the system. Check with previous employers (including the military) that may have required immunizations.
Can I get a copy of my immunization records online in Pennsylvania?
As a Pennsylvania resident, you can request a copy of your immunization records online at no cost. Request a copy of your immunization records online in 2 easy steps: Fill out the Authorization for Release of Immunizations Records Form. Upload a copy of your photo ID.
Does the state keep immunization records?
Your states immunization registry States and some large cities have secure immunization information systems (IIS) that keep vaccination records for the people in the state or city. However, some peoples records may not be complete.
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.
Are immunization records confidential?
Q: How is my immunization record and information protected? A: State or jurisdictional law requires that information in the IIS be kept confidential. Only you, your doctor, or healthcare workers who assist you have access to the information. The information will not be shared with any other people or any other agency.
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Most schools keep vaccination records on file. Schools may keep records for a year or two after a student leaves or graduates. Contact your childs school for more information.
What is the vaccines for children program Philadelphia?
Vaccines for Children (VFC) is a federal program that provides vaccines at no cost to eligible children. A child is eligible for the VFC Program if they are younger than 19 years of age and are one of the following: Uninsured. Medicaid-eligible or Medicaid-enrolled.
How do I find my immunization records in Michigan?
Option 1: The State of Michigan has an online portal for residents age 18 or older who were vaccinated within Michigan to obtain their MCIR vaccine records electronically. You will create an account/profile and upload your ID to access your records. You will be able to download, print and save a file with your records.
Related links
Request your immunization record | Services
Call (215) 685-5488 or email publichealthinfo@phila.gov with questions.
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