ImmTrac2 Forms and Documents

Texas law requires written consent by individuals to participate in the registry.

Our Materials

The following are the types of forms and documents to explore:

1. Forms for the General Public

Consent Forms for the Public – Minors and Adults
Immunization Record Request
Withdrawal Form

2. Providers and Organizations

Newborn Registration Form
Manuals for Providers and Organizations

3. Disaster Information Retention Consent Forms

Consent Form for First Responders and Family Members
Disaster Information Retention Form

Explore Our Forms & Documents

For General Public

C-7	Immunization Registry (ImmTrac2) - Minor Consent Form (Bilingual) (rev. 02/2022) Use this form to register your child, aged 17 and younger, in ImmTrac2. Birth registrars: DO NOT use this form. See F11-11936 below.
F11-13366	Immunization Registry (ImmTrac2) - Adult Consent Form (Bilingual) (rev. 02/2022) Use this form to register as an adult (aged 18 and older) in ImmTrac2.
C-8	Immunization Registry (ImmTrac2) - Withdrawal Letter (Bilingual) (rev. 01/2023) Use this form to withdraw consent for participation and inclusion in the Texas Immunization Registry for an individual.
Request an Immunization Record:
F11-11406	Immunization Registry (ImmTrac2) Authorization to Release Official Immunization History (Bilingual) (rev. 02/2022) Use this form to authorize the release of your or your child's ImmTrac2 records.
ImmTrac2 Withdrawal Forms:
C-8	Immunization Registry (ImmTrac2) - Withdrawal of Consent and Confirmation Form (Bilingual) (rev. 02/2022) Use this form to withdraw your child or yourself from participation in ImmTrac2.

Providers & Organizations

Newborn Consent Form:
F11-11936	ImmTrac2 Newborn Registration Form (Bilingual) (rev. 02/2022) Use this form to grant or deny newborn registration in ImmTrac2. For use by birth registrars only.
Data Exchange Resources:
11-16626	COVID-19 Data Exchange Reporting FAQ (rev. 02/2022)
11-15231	Electronic Data Exchange Resource Guide (rev. 12/2019)
11-14972	Texas Immunization Registry HL7 2.5.1 Implementation Guide (rev. 04/2021)
11-15235	Bidirectional Readiness Checklist (rev. 02/2021)
11-15236	Secure File Transfer Protocol Specifications (rev. 01/2021)
1 1-15702	Texas Immunization Registry - Consent Overview (rev. 03/2020)
11-15703	Texas Immunization Registry HL7 2.5.1 Error Guide (rev. 06/2020)
11-15773	Affirmation of Registry Consent via Health Level Seven (rev. 04/2022)
E11-13415	Electronic Standards for Affirmation of Registry Consent (rev. 06/2020)
11-15957	Informational Guide on Bidirectional Data Exchange (rev. 01/2021)
Manuals and Guides:
11-16619	Single Sign-On Quick Guide (rev. 02/2022)
11-14955	ImmTrac2: Texas Immunization Registry User Manual (rev. 03/2017) The ImmTrac2 User Manual provides information on the new system and how to navigate through the system.
11-15175	ImmTrac2 Site Registration Guide (rev. 11/2021)
11-15226	ImmTrac2 Guide to the Ad Hoc List Report (rev. 02/2021)
11-15230	Texas Immunization Provider Summary (TIPS) Guide (rev. 08/2019)
11-15232	Data Quality Guide - Common Issues of Inaccurate Report Data (rev. 10/2019)
11-15234	Guide to the Reminder-Recall Report (rev. 08/2019)
11-15252	ImmTrac2 Site Renewal Guide (rev. 07/2020)
11-15026	ImmTrac2 Quick Guide - Change Password (rev. 10/2020)
11-15714	Quick Guide_How to Merge Clinicians in ImmTrac2 (rev. 04/2020)
11-15951	ImmTrac2 Manage Client Status Criteria (rev. 10/2020)
11-15952	Texas DSHS Immunization Portal Registration Guide (rev. 1/2021)
Educational Materials:
11-15326	ImmTrac2 Reminder for Providers
11-15325	Benefits for Participating in ImmTrac2
11-15324	Provider Benefits of Using ImmTrac2

Disaster Information Retention Consent Forms

Immunization Materials