How to rescind CIIS opt-out

 
While you can choose to exclude your/your child’s immunization record from CIIS, you also can change your mind and rescind the opt-out. 
 
How to rescind CIIS opt-out
 
1. When you ask to rescind a CIIS opt-out, your health care provider should:
  • Direct you to a CIIS Rescind Opt-Out Form (English | Spanish | Vietnamese | Arabic)
  • Attach one signed copy of the form to your/your child’s medical record in the location usually reserved for the immunization record, if applicable or practical for clinic work flow.​
2. To complete the  rescind opt-out, it's your responsibility to:
  • Mail or fax one signed copy of the CIIS Rescind Opt-Out Form to the CIIS office at the address on the bottom of the form.
  • Keep one signed copy of the form for your records.​