Adph imm 2026

See details

4 out of 5

44 votes

The document is a Vaccine Administration Form from the Alabama Department of Public Health, used to collect personal information and consent for vaccine administration. It includes sections for patient details, insurance information, vaccine types, and privacy rights. The form also outlines that vaccines provided in school clinics are free, while an administration fee may be billed to insurance. Additionally, it captures income assessment and family size for potential fee waivers.

Here's how it works

01. Edit your immprint login online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send immprint alabama login via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out adph imm with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the adph imm in the editor.
Begin by filling in your Last Name, First Name, and Middle Initial in the designated fields. Ensure that all names are printed clearly.
Next, provide your Gender and Race information as required. This data is essential for demographic purposes.
Enter your Insurance Policy Number, Medicaid Number, or Medicare Number if applicable. If you do not have insurance, you can leave this blank.
Fill in your Date of Birth and Age accurately to ensure proper identification.
Complete your Street Address, Phone Number, City, County, State, and Zip Code to facilitate communication regarding your vaccination.
Indicate your consent for vaccination by checking the appropriate box and signing where indicated. Make sure to date the form as well.
If applicable, provide additional information regarding pregnancy or other vaccines received by filling out the relevant sections at the bottom of the form.

Start using our platform today to fill out your adph imm form online for free!

See more adph imm versions

We've got more versions of the adph imm form. Select the right adph imm version from the list and start editing it straight away!

Versions	Form popularity	Fillable & printable
2011	4 Satisfied (44 Votes)
2003	4.8 Satisfied (123 Votes)

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

What does adph stand for?

The Alabama Department of Public Health (ADPH) is the states primary health agency.

What is a certificate of immunization?

If you need your immunization record or Certificate of Immunization (COI), please contact the provider or county health department that administered your vaccines. You can also ask your current provider if they have access to Alabamas immunization registry, ImmPRINT, to locate your record.

How to get a Religious Exemption for vaccines in Alabama?

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.