WitrynaUpon completion, please fax or mail form to the DSHS ImmTrac Group or a registered Health-care provider. Questions? (800) 252-9152 • (512) 776-7284 • Fax: (866) 624-0180 • www.ImmTrac.com Stock No. C-7 Texas Department of State Health Services • ImmTrac Group – MC 1946 • P.O. Box 149347 • Austin, TX 78714-9347 Witrynato release information from the Registry at any time by written communication to the Texas Department of State Health Services, ImmTrac Group – MC 1946, P. O. Box 149347, Austin, Texas 78714-9347. By my signature below, I GRANT consent for registration. I wish to INCLUDE my child’s information in the Texas immunization …
IMMUNIZATION REGISTRY (ImmTrac2) Minor Consent Form
WitrynaTexas Immunization Registry (ImmTrac 2) Disaster Information Retention Consent Form (Please print clearly) PRIVACY NOTIFICATION: With few exceptions, you have the right to request and be informed about information that the State of Texas collects about you. You are entitled to receive and review the information upon request. WitrynaUpon completion, please fax or mail form to the DSHS ImmTrac2 Group or a registered Health-care provider. Questions? (800) 252-9152 • (512) 776-7284 • Fax: (866) 624 … simple past memory game online
Texas Department Of State Health Services Immtrac: Fillable, …
WitrynaADULT CONSENT FORM (Please print clearly) First Name Middle Name Last Name Address Apartment # / Building # ... (512) 776-7284 • Fax: (866) 624-0180 • www.ImmTrac.com Texas Department of State Health Services • ImmTrac2 Group – MC 1946 • P. O. Box 149347 • Austin, TX 78714-9347 PROVIDERS REGISTERED WITH … WitrynaUpon completion, please fax or mail form to the DSHS ImmTrac Group or a registered Health-care provider. Questions? (800) 252-9152 • (512) 776-7284 • Fax: (866) 624-0180 • www.ImmTrac.com ImmTrac FR/FM Stock No. EF11-12955 ... ImmTrac, the Texas immunization registry, is a free service of the Texas Department of State Health … WitrynaFORMS; REGISTRATION; USER TRAINING; Main Content. Hot Topics: HT-1: HT-2: HT-3: HT-4: HT-5: HT-6: HT-7: Vaccine Adverse Event Reporting System (VAERS) … simple past meaning