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F11 11406 2026
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- Click ‘Get Form’ to open the f11 11406 in the editor.
- Begin by entering the client's name in the designated fields: Last, First, and Middle. Ensure accuracy for proper identification.
- Fill in the Date of Birth section by selecting the Month, Day, and Year. Indicate the client's gender by checking either Male or Female.
- Provide the client's address, including Street, City, State, and Zip code. This information is crucial for record delivery.
- Specify how and where to send the official immunization record by filling out the Name/Organization and Address sections.
- Complete the Requestor Information section fully. This includes printing your name (or that of a guardian), address, email (if available), and phone number.
- Sign and date the form at the bottom to authorize release of records. Ensure all fields are filled before submission.
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Related links
F11. 2919, Anessa E, Diaz, 7070000, 0, 32061200, PH-DISTANCE CAMPUS-JAX. 2920 11406, Lashand D, Williams, 28011401, 0. 11407, Liane M, Dillon, 28011401, 0.Read more
F11-11406. Rev. 02/2026. Texas Immunization Registry (ImmTrac2). Authorization to Release Official Immunization History. For Office Use Only. ImmTrac2 IDRead more