Patient Forms

Immunization Registry Notice to Patients and Parents (Disclosure Form, revised 04/03/2019)

Request to Lock or Unlock My CAIR Record

Per California Immunization Registry law (Health and Safety Code, Section 120440), all patients/parents must be disclosed that California medical providers are authorized to submit patient vaccination records and tuberculosis (Tb) test results to CAIR for access by medical care providers and other authorized CAIR users.

Patients/parents have the right to review records for accuracy but also to decline to share (‘lock’) records with other CAIR users if they desire, while retaining access to their record through their own medical provider. If a patient/parent changes their mind about limiting access, they can request the record be ‘unlocked’ at any time. See the Immunization Registry Notice to Patients and Parents (above) for further details on patient’s rights.

Please note that you should check with your medical care provider before completing the forms below as your doctor may already be sending your sharing status to CAIR2 electronically.

To request that your/your child’s record in CAIR be ‘locked’ or ‘unlocked’, click your preferred language below.

Immunization Record Release Authorization Form

In order to increase processing efficiency and decrease wait times, CAIR2 has converted the previous downloadable Authorization to Release Healthcare Information form to an online web form. The new online form allows patients/parents to first determine whether a matching patient record exists in CAIR2 and then if a matching record exists, to complete the full request. In order for the record to be released, the requestor will need to upload a file containing a scanned driver’s license or other official picture ID and any other relevant documentation authorizing release of the requested record. Please have these files ready to upload as the form must be completed in a single session. Please note that finding a matched patient in the initial search does not guarantee that the requested patient record will be found in CAIR. FAXed or emailed paper forms will no longer be accepted after June 1, 2019.

 

Permission to Share Your Child’s School Immunization Information with CAIR (for Schools only)