North carolina immunization records online 2025

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52 votes

The document is a North Carolina Immunization Registry Mass Clinic Form used to collect patient information and authorize the receipt of vaccines. It includes fields for personal details, medical history, and consent for vaccination, along with sections for healthcare workers to document eligibility and vaccine administration.

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Click ‘Get Form’ to open the North Carolina Immunization Registry Mass Clinic Form in our editor.
Begin by filling in the 'Name of Organization' and 'Chart Number' at the top of the form. Ensure all fields are completed as this information is crucial for documentation.
Next, provide the patient's details including their name, gender, date of birth, ethnicity, and race. Be sure to check all applicable boxes for ethnicity and race.
Fill in the parent or guardian's information, including their name, relationship to the patient, address, and contact numbers. This section is vital for communication regarding immunizations.
Answer all health-related questions regarding pregnancy status, employment as a healthcare worker, medical conditions, and allergies. These responses help assess eligibility for vaccination.
Finally, review the authorization statement carefully before signing. Ensure that you understand the vaccine information provided and complete the signature section along with the date signed.

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Versions	Form popularity	Fillable & printable
2017	4.3 Satisfied (57 Votes)
2009	4 Satisfied (52 Votes)

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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 I get a copy of my immunization records online SC?

People who receive immunizations from South Carolina providers can access their immunization record through the SIMON public portal. As of Jan. 1, 2017, all immunization providers are to report all administered doses of vaccines to the state immunization registry.

How do I get my NC immunization records?

Locate Your Immunization Record Check with your vaccination provider. Your provider can check the North Carolina Immunization Registry. Check school or military records. Most K-12 schools, colleges and universities keep student vaccine records on file. Check your family records.

How do I log in to Ncir?

1. Go to: 2. Enter your username and password and click Login.

What is a copy of your immunization records?

Vaccination records (sometimes called immunization records) provide a history of all the vaccines you or your child received. This record may be required for certain jobs, travel abroad, or school registration.

Are vaccines mandatory in North Carolina?

How to Request an Immunization Record Fax: 785-559-4227. Email. Mail: Kansas Department of Health and Environment. Attn: Kansas Immunization Registry. 1000 SW Jackson. Suite 210. Topeka, KS 66612.