WitrynaFor a family member younger than 18 years of age, a parent, legal guardian, or managing conservator may grant consent for participation as an “ImmTrac2 child” by completing the Immunization Registry (ImmTrac2) Consent Form (# C-7). Please mark the appropriate box to indicate whether you are a First Responder or an Immediate … WitrynaTexas Department of State Health Services ImmTrac Group MC 1946 P. O. Box 149347 Austin, TX 78714-9347 PROVIDERS REGISTERED WITH ImmTrac2: Please enter client information in ImmTrac2 and affirm that consent has been granted. DO NOT fax to ImmTrac2. Retain this form in your client's record. Stock No. Fl 1-13366 Revised …
TEXAS IMMUNIZATION REGISTRY (ImmTrac2) ADULT CONSENT …
WitrynaUse this form to register your child, aged 17 and younger, in ImmTrac2. Birth registrars: DO NOT use this form. See F11-11936 below. F11-13366. Immunization Registry (ImmTrac2) - Adult Consent Form (Bilingual) (rev. 02/2024) Use this form to register as an adult (aged 18 and older) in ImmTrac2. C-8. Immunization Registry (ImmTrac2) - … WitrynaAustin Community Health offers free COVID-19 cervical to all eligible populations.Vaccines are administered by schedule only. Dial 512-972-5520 to make in appointment. b e2 value
REGISTRO DE INMUNIZACIÓN DE TEXAS (ImmTrac2) …
WitrynaImmTrac Forms and Documents. Use this form to register your child, aged 17 and younger, in ImmTrac. Birth registrars: DO NOT use this form. See F11-11936 below. Use this form to register as an adult (aged 18 and older) in ImmTrac. Use this form to register as a first responder and first responder family members, aged 18 and older. Witryna(800) 252-9152 • (512) 776-7284 • Fax: (866) 624-0180 • www.ImmTrac.com Texas Department of State Health Services • ImmTrac Group – MC 1946 • P. O. Box 149347 • Austin, TX 78714-9347 PROVIDERS REGISTERED WITH ImmTrac2: Please enter client information in ImmTrac2 and affirm that consent 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) 624-0180 • www.ImmTrac.com Texas Department of State Health Services • ImmTrac2 Group – MC 1946 • P. O. Box 149347 • Austin, TX 78714-9347 bd visa online