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

Providers and Organizations

  • Newborn Registration Form
  • Manuals for Providers and Organizations

Disaster Information Retention Consent Forms

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


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

ImmTrac2 Forms & Documents

table-1
Stock #            Title
Consent Forms for Minors and Adults:
C-7
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.

C-7A
Registro de Inmunización (ImmTrac2) - Formulario de Consentimiento Para Menores (rev. 03/2017)
EF11-13366            
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:
F11-11406 
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:
C-8
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. 
C-8A
Registro de Inmunización (ImmTrac2) - Retiro de Consentimiento y Confirmación (rev. 03/2017)

table-3
Stock #          
Title
Newborn Consent Form:
F11-11936 ImmTrac2 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 (rev. 12/2019)
11-14972 Texas Immunization Registry HL7 2.5.1 Implementation Guide (rev. 10/2020)
11-15235Bidirectional Readiness Checklist  (rev. 6/2020)
    11-15236 Secure File Transfer Protocol Specifications (rev. 4/2020)
    11-15702 Texas Immunization Registry - Consent Overview (rev. 3/2020)
    11-15703Texas Immunization Registry HL7 2.5.1 Error Guide (rev. 6/2020)
    11-15773Affirmation of Registry Consent via Health Level Seven (rev. 9/2020)
    E11-13415  Electronic Standards for Affirmation of Registry Consent (rev. 6/2020)
    Manuals and Guides:
    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.
    11-15175ImmTrac2 Site Registration Guide (rev. 10/2020)
    11-15226Quick Guide - Creating a List of Active Clients with the Ad Hoc List Report (11-2019) PDF
    11-15232Data Quality Guide - Common Issues of Inaccurate Report Data (rev. 10/2019) 
    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. 4/2020)
    11-15951ImmTrac2 Manage Client Status Criteria (rev. 10/2020)
    11-15952Texas DSHS Immunization Portal Registration Guide (rev. 11/2020)
    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
    Stock #            
    Title
    F11-12956
    Immunization Registry (ImmTrac2) Disaster Information Retention Consent Form (rev. 03/2017)
    Use this form to retain your disaster-related information beyond 5 years.
    F11-12956A
    Registro de Inmunización (ImmTrac2) - Formulario de Consentimiento de Retención de Información Sobre el Desastre (rev. 03/2017)



    Last updated November 25, 2020