Immunization record request
If you are unable to use the online system, you may submit a Paper Immunization Record request to receive a paper copy of your immunization record in the MIIS by completing the form below. Note, these forms must be mailed or faxed.
Language | RTF | |
---|---|---|
English | MIIS Immunization Record Request | (RTF) |
Spanish | MIIS Immunization Record Request - Spanish/español | (RTF) |
Record amendment request
If you accessed your MDPH Immunization Record and found a discrepancy you may submit an online form for MDPH to investigate the issue at the following link: Online Record Amendment Request
If you're unable to use the online system, you may submit a Paper Record Amendment Request for MDPH to investigate the concern. Note, these forms must be mailed or faxed.
Language | RTF | |
---|---|---|
English | MIIS Clinical Immunization Amendment Request | (RTF) |
Spanish | MIIS Clinical Immunization Amendment Request - Spanish/español | (RTF) |
Language | RTF | |
---|---|---|
English | MIIS Demographic Amendment Request | (RTF) |
Spanish | MIIS Demographic Amendment Request - Spanish/español | (RTF) |
Record not found amendment request
If you attempted to use MyVaxRecords and received a “match was not found” message, you may submit an online form for MDPH to investigate the issue at the following link: Online Record Not Found Amendment Request
If you are unable to use the online system, you may submit a Paper Record Not Found Amendment Request Note, these forms must be mailed or faxed.
Language | RTF | |
---|---|---|
English | MIIS Record Not Found Amendment Request | (RTF) |
Spanish | MIIS Record Not Found Amendment Request - Spanish/español | (RTF) |
Objection (or withdrawal of objection) form
The law requires that immunizations are reported to the MDPH through the MIIS. There is no option to “opt-out” of the MIIS. Your records will only be available to those involved in your or your child's care, who have a reason to know about them. The MIIS enables a new health care provider to check what shots you or your child have received in the past from other providers. If you prefer that you or your child’s immunization history not be shared in this way, you have the right to object to sharing your or your child’s immunization information.
If you object to data sharing, your or your child’s immunization information will still be in the MIIS, but only the provider(s) who administers your vaccines and the Department of Public Health will be able to see it. Please note: you will need to keep track of your or your child’s immunization records in the event that you change doctors or get immunizations from other health care providers.
To object to data sharing, you must complete the MIIS Objection (or Withdrawal of Objection) Form. If you change your mind, you can fill out the same form to have your or your child's immunization information shared in the MIIS.
If you have changed your mind or if you change your mind in the future and decide to share the information with more healthcare providers, you will need to Withdraw your previous objection to sharing your or your child’s immunization information.
To limit data sharing, please complete the form below. Note, these forms may only be mailed or faxed.
Language | RTF | |
---|---|---|
English | English - MIIS Objection (or Withdrawal of Objection) Form | (RTF) |
Chinese | 異議(或撤回異議)表 | (RTF) |
Haitian Creole | Fòm Pou Refize (oswa Anile Refi) | (RTF) |
Khmer | ទ្រមង់ែបបបទៃនករជំទស (់ ឬករដកហតករជ ូ ំទស) | (RTF) |
Portuguese | Formulário de Objeção (ou Retirada de Objeção) | (RTF) |
Russian | Возражение (или снятие возражения) | (RTF) |
Spanish | Formulario de objeción (o retiro de objeción) | (RTF) |
Vietnamese | Biểu Mẫu Phản đối (hay Rút lại Phản đối) (PDF) | (RTF) |