Immunization Record Request
The North Dakota Immunization Information System (NDIIS) is a confidential, electronic system that collects immunization data for all North Dakotans. Your
local public health unit or primary healthcare provider can also access the NDIIS and provide you with an immunization record. Children are entered into
the NDIIS at birth through a linkage with electronic birth records. An NDIIS immunication record can also be intiated by a healthcare provider at the time of
the child's first immunizations. The NDIIS has the capability of collecting vaccination data on adult patients as well as children, however it was not created
until 1996 so most adults will not have their childhood immunizations in the NDIIS. Most North Dakota children and adults will have at least a partial
immunization record in the NDIIS.
To submit an immunization record request, download and complete the form below in its entirety. The form and required supporting documentation must be mailed or faxed
to the North Dakota Department of Health (NDDOH) Immunization Program in order for the request to be processed. Contact the Immunization Program at 701.328.3386
or 800.472.2180 if you have questions.
Please Note: Anyone over the age of 18 must request their own immunization record.
All submitted copies of a state-issued driver's license or picture I.D. must be have a clearly visible picture and legible name and birthdate.
Record requests submitted without the required supporting documentation (i.e. photocopy of the requestor's driver's license) or with supporing documentation
that does not have a clearly visible photo, name, birthdate and/or signature will not be processed.
Please allow up to 10 business days for your record request to be processed.
Request for Immunization Records form