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Date:  April 20, 2014  

Home    |     Announcements   |     Documents     |    Help Desk     |   Training      
Health
Care Providers
Public
School Districts
Private
Schools
Head Start
and ECEAP Programs


  • Information Sharing Agreement
  • Please print the entire Information Sharing Agreement, sign and date, and send it to the address provided in the agreement and below under mailing address. We will sign the original and send an electronic document to you. If you require a signed original, please print two originals, sign and date, and return both originals and a self-addressed envelope. Please do not fax or email the agreement as our office requires original hard copies. A fully executed copy will be returned to you.  MAILING ADDRESS

  • Account Application
  • Complete and sign one copy of the Account Application and mail with the Information Sharing Agreement.   Account Application

  • User Account Request Form and Instructions
  • Use to obtain user names and passwords for staff that will be accessing Washington State Immunization Information System. Form may be faxed if contract has already been received at the Washington State Immunization Information System office. Instructions and Single Account RequestMultiple Accounts Request

  • If you donít know if your medical organization has an Immunization Information System account, please call the Help Desk at 1-800-325-5599.



  • Information Sharing Agreement for School Districts
  • Please print the entire information sharing agreement, sign and date, and send it to the address provided in the agreement and below under mailing address. We will sign the original and send an electronic document to you. If you require a signed original, please print two originals, sign and date, and return both originals and a self-addressed envelope. Please do not fax or email the agreement as our office requires original hard copies. A fully executed copy will be returned to you.    MAILING ADDRESS

  • Account Application for School Districts
  • Complete and sign one copy of the Account Application for Schools and mail with the Information sharing Agreement.

  • Confidentiality Statement
  • The Confidentiality Statement must be signed by employees who are not licensed health professionals and who have been assigned by the school nurse to access the Washington State Immunization Information System. Signed originals must be kept on file at the school district.

  • School User Account Request Form
  • Use to obtain user name and password for staff that will be accessing Washington State Immunization Information System. School User Account Request (multiple)

  • Please visit www.childprofile.org for a guide to accessing the Washington State Immunization Information System and requirements for Registry participation by public school districts or call the Help Desk at 1-800-325-5599.

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  • For Private Schools and Headstart/ECEAP programs, call 866-397-0337 or email: oicp@doh.wa.gov and ask for IIS contracts information to learn about Washington State Immunization Information System participation requirements and get a copy of the Information Sharing Agreement.

    


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