CIIS opt-out procedures

 
Under Colorado law you have the option to exclude your/your child’s immunization information from the Colorado Immunization Information System at any time. If you change your mind, you can always have your health care provider re-enter your/your child’s immunization record into CIIS at a later time. If you choose not to participate in CIIS, you're responsible for keeping track of your/your child’s shot record.
 
Opt-out procedure
If you choose to opt out of the Colorado Immunization Information System, please read the following instructions and follow all steps to ensure that your/your child’s immunization information is excluded from CIIS.
 
Upon your request to exclude immunization information from CIIS, your health care provider must:
  • Supply you with a Colorado Immunization Information System Opt-Out Form.
  • Have you complete and sign three copies of the form.
  • Attach one signed copy of the form to your/your child’s medical record in the location usually reserved for the immunization record.
  • Give the other two signed copies of the form to you.
 

CIIS Opt-Out Form | In Russian | In Spanish | In Vietnamese

 
To complete the opt-out procedure, it's your responsibility to:
  • Mail or fax one signed copy of the CIIS Opt-Out Form to the CIIS office at the address found on the bottom of the form.
  • Keep one signed copy of the form for your records.