(MIIX) USER AGREEMENT - Mississippi State Department of Health - msdh state ms 2025

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The document is a User Agreement for the Mississippi Immunization Information eXchange (MIIX), outlining the requirements and responsibilities for clinics, facilities, or schools to access immunization records. It details the process for assigning user IDs and passwords, emphasizes confidentiality and proper use of the system, and mandates that all personnel must sign the agreement. The document also specifies conditions under which access may be terminated and the importance of timely submission of immunization data.

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Click ‘Get Form’ to open it in the editor.
Begin by entering the Clinic/Facility or School Name at the top of the form. This identifies your organization.
Fill in the Contact Person(s) details, including their address, city, state, zip code, phone number, and email address. Ensure accuracy for effective communication.
List all employees requesting access by filling in their first name, last name, email address, position/title, and selecting an access level (Data Entry or Read Only).
Each user must sign next to their information to acknowledge understanding of the agreement terms.
Complete the signatures required from the Clinic/Facility Manager or authorized designee and MIIX representatives at the bottom of the form.
Once completed, save your document and return it as instructed. You can easily fax it using our platform for quick submission.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (62 Votes)
2009	4.4 Satisfied (329 Votes)

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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 is the Mississippi State Department of Health (MSDH) suitability letter?

The Letter of Suitability for Employment issued by the Mississippi State Department of Health verifies that a criminal records check, sex offender registry, and child abuse central registry check has been conducted on an individual.

Can I get a copy of my immunization records online MS?

MyIR: Get Immunization Records and Forms Online. MyIR provides easy, one-stop access to immunization records for you and your family. Immunization records and the Mississippi school immunization entry form (Form 121) used to require a trip to your doctor or a county health department.

Can I get my immunization record from 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.

How can I find my old vaccination records?

have centralized registries of vaccine records. These may not include all ages or all records, but this is a good place to check. The Centers for Disease Control and Prevention (CDC) lists registry contacts and websites at .cdc.gov/vaccines/programs/iis/contacts-locate- records.