ImmuNet Forms
ImmuNet is Maryland’s Immunization Information System (IIS). It is a secure web-based registry operated by the Center for Immunization at the Maryland Department of Health (MDH). ImmuNet information is confidential and available only to authorized users.
For Public
Vaccination Records Request form - Use this form to request vaccination records for yourself or your dependent(s).
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Opt-Out form - Use this form if parents or guardians do not wish to share their or their child’s vaccination record with providers in ImmuNet. Hard copies (here) can be downloaded for printing and distribution.
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Rescind Opt-Out form - Submit this form if you change your mind and wish to allow your/your child’s vaccination records made available to your/your child’s provider(s). Hard copies (here) can be downloaded for printing and distribution.
For Providers
Note: If you complete a hard copy of any form, please mail or fax the completed form. Do not email the completed form as it places you at risk for exposing your sensitive information. Emailed forms will not be accepted unless you are able to use a secure email service.
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