NDIIS Adult Opt Out

The North Dakota Immunization Information System (NDIIS)is a secure, computer system that allows authorized users, such as health care providers, pharmacies, and long-term care facilities, to view and enter immunization records. North Dakota state century code mandates that childhood immunizations are reported to the NDIIS so children cannot be opted out. Adults 19 and older have the right to opt out of the NDIIS. By opting out, you are indicating that you do not want any of your immunizations, including both past immunizations as well as newly administered immunizations, to be entered in the NDIIS. By choosing not to have your immunizations in the NDIIS, you are not allowing any health care provider that you see to be able to view your immunization history in the NDIIS, which could lead to additional, unnecessary immunizations. You also may be unable to find your immunization record for future school or employment. Once you have opted out of the NDIIS, you can choose to opt back in to the NDIIS, however there may be information missing from your immunization history. To opt out of the NDIIS or to opt back in, fill out and submit the online form below or print and complete the paper form to be mailed or faxed to the ND Department of Health immunization program.

NDIIS Adult Opt Out Form Adult Opt Out (paper form) (pdf)

First NameLast NameDate of Birth
    
Address
CityStateZip