MyVaxIndiana

Note: All information entered is validated against the Indiana Department of Health's CHIRP database.

Step 1: Enter Your Information

Patient First Name*

Patient Last Name*

Patient Date of Birth*

Step 2: Enter Security Info & Agree

Authentication Type*

Cell Phone

Generate New Image

Type the code from the image*

By checking this box, I agree to patient confidentiality.*

I declare under the penalty of perjury under the laws of the State of Indiana that the foregoing is true and correct.
I understand that the immunization record to be disclosed will be disclosed in accordance with this authorization and within Indiana Code 16-38-5-3.
I am authorized to view this record as an individual or as the guardian of the record I am requesting.

The information The information provided by MyVaxIndiana is obtained from the Children and Hoosier’s Immunization Registry Program(CHIRP).To verify/update patient info including phone number, email, address and missing or incorrect vaccine dates, please contact your Medical Provider, Local Health Department, or the IDOH Immunization Program.