Forms and Documents


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Find the Document You're Looking for:

Forms for the General Public

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

First Responders

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

Providers and Organizations

  • Newborn Registration Form
  • Manuals for Providers and Organizations

Print or order in quantity at For assistance, call the Immunization Unit at (800) 252-9152. 

ImmTrac2 Forms & Documents

Stock #           Title
Consent Forms for Minors and Adults:
Immunization Registry (ImmTrac2) - Minor Consent Form (rev. 09/2017) 
Use this form to register your child, aged 17 and younger, in ImmTrac2.
Birth registrars: DO NOT use this form. See F11-11936 below.

Registro de Inmunización (ImmTrac2) - Formulario de Consentimiento Para Menores (rev. 03/2017)
Immunization Registry (ImmTrac2) - Adult Consent Form - Bilingual (rev. 04/2019)
Use this form to register as an adult (aged 18 and older) in ImmTrac2.
Request and Immunization Record:
Immunization Registry (ImmTrac2) Authorization to Release Official Immunization History (rev. 03/2017)
Use this form to authorize the release of your or your child's ImmTrac2 records.
 ImmTrac2 Withdrawal Forms:
Immunization Registry (ImmTrac2) - Withdrawal of Consent and Confirmation Form (rev. 03/2017)
Use this form to withdraw your child or yourself from participation in ImmTrac2. 
Registro de Inmunización (ImmTrac2) - Retiro de Consentimiento y Confirmación (rev. 03/2017)

Stock #            
Immunization Registry (ImmTrac2) First Responder/First Responder Family Member Consent Form (rev. 03/2017)
For the First Responder/First Responder Family Member consent form, refer to the Immunization Registry (ImmTrac2) – Adult Consent Form (EF11-13366) under the “For General Public” section.
Registro de Inmunización (ImmTrac2) - Formulario de Solicitud de Personal de Primera Respuesta / Un Familiar (rev. 03/2017)
Immunization Registry (ImmTrac2) Disaster Information Retention Consent Form (rev. 03/2017)
Use this form to retain your disaster-related information beyond 5 years.
Registro de Inmunización (ImmTrac2) - Formulario de Consentimiento de Retención de Información Sobre el Desastre (rev. 03/2017)

Stock #          
Newborn Consent Form:
F11-11936ImmTrac2 Newborn Registration Form - Bilingual (rev. 03/2017)
Use this form to grant or deny newborn registration in ImmTrac2.
For use by birth registrars only.
Data Exchange Resources:
11-15231 Electronic Data Exchange Resource Guide
11-14972 ImmTrac2 Implementation Guide for Immunization Messaging: HL7 Version 2.5.1 (rev. 01/2017)
11-15236 Secure File Transfer Protocol Specifications
E11-13415 Electronic Standards for Affirmation of Registry Consent (rev. 7/2019)
Manuals and Guides:
 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.
 ImmTrac2 Provider Online Enrollment Manual (rev. 02/2017)
The Provider Online Enrollment Manual provides information on the ImmTrac2 registration and renewal processes.
11-15252 ImmTrac Site Renewal Guide (rev. 11/2019)
Coming Soon:
ImmTrac2 Consent Guidelines for Providers
Frequently Asked Questions (FAQs) for Healthcare Providers
New User Welcome Kit
ImmTrac2 Consent Withdrawal Process for Providers Who Affirm Consent
  HL7 Error Guide
  Data Quality Guide
  Texas Immunization Provider Summary (TIPS) Guide
  Creating a List of Active Clients with the Ad Hoc List Report Quick Guide
  Guide to the Reminder/Recall Report


Last updated January 7, 2020