Texas Immunization Registry (Immtrac2) - Withdrawal of Consent and Confirmation Form - Texas (English / Spanish)

Texas Immunization Registry (Immtrac2) - Withdrawal of Consent and Confirmation Form - Texas (English / Spanish)

Texas Immunization Registry (Immtrac2) - Withdrawal of Consent and Confirmation Form is a legal document that was released by the Texas Health and Human Services - a government authority operating within Texas.

FAQ

Q: What is the Texas Immunization Registry?
A: The Texas Immunization Registry (Immtrac2) is a centralized system that stores and manages immunization records for residents of Texas.

Q: What is the Withdrawal of Consent and Confirmation Form?
A: The Withdrawal of Consent and Confirmation Form is a document that allows individuals or parents/legal guardians to withdraw consent for their immunization records to be stored in the Texas Immunization Registry.

Q: What languages is the form available in?
A: The form is available in both English and Spanish.

Q: Why would someone want to withdraw consent for their immunization records in the registry?
A: There could be various reasons, such as privacy concerns or personal choice.

Q: How can someone withdraw consent for their immunization records to be stored in the registry?
A: They can do so by completing the Withdrawal of Consent and Confirmation Form, either in English or Spanish.

Q: Is there a deadline for submitting the form?
A: There is no specific deadline for submitting the form. However, it is recommended to submit it as soon as possible if consent withdrawal is desired.

Q: What happens after the form is submitted?
A: Once the form is submitted, consent to store immunization records in the Texas Immunization Registry will be withdrawn.

Q: Can consent be reinstated after it has been withdrawn?
A: Yes, consent can be reinstated by completing a new Consent and Confirmation Form.

Q: Are there any consequences of withdrawing consent for immunization records in the registry?
A: Withdrawing consent may make it more difficult to track and manage immunization records in the future, especially during public health emergencies.

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Form Details:

  • Released on February 1, 2022;
  • The latest edition currently provided by the Texas Health and Human Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of the form by clicking the link below or browse more documents and templates provided by the Texas Health and Human Services.

Download Texas Immunization Registry (Immtrac2) - Withdrawal of Consent and Confirmation Form - Texas (English / Spanish)

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