ImmTrac2 Forms and Documents

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.  
 

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. 

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: 
 

11-16666

Bidirectional Data Exchange Onboarding Guide v.13 (rev. 04/2023)

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) 

11-15702  

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)  

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 

F11-12956 
 

Immunization Registry (ImmTrac2) Disaster Information Retention Consent Form  (Bilingual) (rev. 02/2022) 
Use this form to retain your disaster-related information beyond 5 years. 
 

11-15954 

 ImmTrac2 Disaster Consent Overview (rev. 12/2020)