How to Complete and Submit the Maryland ImmuNet Records Request Form

To get your vaccination history from the state when you can’t or don’t want to use the online portal, download the Maryland ImmuNet records request form from the Maryland Department of Health’s immunization forms page, fill it in, attach a copy of your government-issued photo ID, and send it to the Center for Immunization by mail or fax.¹ The Department processes the request and mails the records back to the address you list on the form.

When the Paper Form Is the Right Route

Most people can skip the paper process entirely. The free MyIR portal at MD.MyIR.net pulls records directly from ImmuNet and lets you view and print them on demand, including the Maryland Certificate of Immunization (Form MDH 896) that schools require.²

The paper form is the fallback in three situations: you can’t register for MyIR, your information doesn’t match during the portal’s identity verification, or you have previously opted out of ImmuNet. Anyone who has opted out loses MyIR access entirely and must submit a paper records request each time they need documentation.³

What to Put on the Form

The form asks for the information ImmuNet staff need to locate the right record. For the person whose records are being requested, provide:

Full legal name as it appeared at the time of vaccination
Date of birth
Current mailing address (this is where the records will be sent)
A primary phone number

The name and date of birth matter more than any other fields. Staff search the database on those, and even a small mismatch can delay or defeat the request. Spell out full legal names rather than nicknames, and double-check the birth date before you sign.

If you are requesting records for a minor child, the parent or legal guardian also enters their own full name and signs the form. The signature confirms that the requester is authorized to receive the child’s protected health information.

ID and Supporting Documents to Include

Attach a clear copy of a valid government-issued photo ID. A driver’s license, state-issued identification card, or passport all work. The copy must be legible enough that staff can read the printed text and see the photograph. This is a privacy safeguard, not a formality, and an unreadable ID is one of the most common reasons requests get sent back.

If the name on your ID doesn’t match the name in ImmuNet because of a marriage, divorce, or legal name change, include a document that connects the two. A marriage certificate or a court order changing your name is usually enough to resolve the discrepancy.

Requesting Records for Someone Else

A parent or legal guardian can request a minor child’s records by signing the form as described above. Requesting records for another adult is a different matter. You generally need written authorization signed by the person whose records you want. Under federal HIPAA rules, a covered entity may release protected health information to a third party who presents a valid signed authorization or, in certain legal contexts, a court order or subpoena.⁴ If you are acting under a power of attorney or other legal authority, include a copy of that document with the form.

How to Submit the Form

The Department accepts the completed form and ID copy through several channels. Mail and fax are the standard options.¹

Mail: Maryland Department of Health, Center for Immunization – ImmuNet, 201 West Preston Street, 3rd Floor, Baltimore, MD 21201.⁵
Fax: (410) 333-5893.³
Secure email: Do not send the completed form through a standard email account. The Department cautions against emailing documents containing personal health information unless they are sent through an encrypted service. Contact ImmuNet Support first to request a secure email link.¹

General questions can go to the Center for Immunization at mdh.mdimmunet@maryland.gov.⁵ The Department has announced plans to relocate from the Preston Street address by the end of 2026, so confirm the mailing address on its website before you send anything by mail.

What to Expect After You Submit

The Department mails completed vaccination records to the address listed on the form. Turnaround varies with volume. Late summer, when families are meeting school enrollment deadlines, is the slowest stretch. Submitting a complete, legible form with a clear ID copy on the first try is the single best way to avoid delay. Missing fields and unreadable photocopies are the most common reasons requests bounce back.

If You Need the Record for School Enrollment

Maryland requires students to show proof of age-appropriate immunizations before a school or child care facility can admit or retain them. The required vaccines include tetanus, diphtheria, polio, measles, mumps, rubella, hepatitis B, varicella, and meningitis, with additional requirements for younger children.⁶

The document schools accept is the Maryland Immunization Certificate, Form MDH 896, not a plain vaccination history printout. Once you receive your records back from ImmuNet, you can bring them to your child’s doctor or the local health department and have them transcribe the dates onto an MDH 896 and sign it. A medical provider, local health department official, school official, or child care provider can certify dates from another authenticated record.⁶ If records have been lost, most vaccination dates can be reconstructed, but varicella, measles, mumps, and rubella cannot: those require either a new dose or a blood test showing immunity.

1
Maryland Department of Health. Center for Immunization – ImmuNet Forms
2
Maryland Department of Health. ImmuNet MyIR Mobile User Guide
3
Maryland Department of Health. ImmuNet Printable Opt-Out Form
4
Centers for Disease Control and Prevention. HIPAA and Access to Patient Records During IQIP and VFC Visits Frequently Asked Questions
5
Maryland Department of Health. Contact Us – Center for Immunization
6
Maryland Department of Health. Maryland Department of Health Immunization Certificate