Utah DHHS Immunization data requests

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Complete this form to describe in detail the immunization data that you're requesting. This will help us understand your data needs and the best way provide the information you want. This form is to be used for simple data requests that do not require a data sharing agreement (DSA).

This form is for requesting population-based immunization data and not for accessing the personal immunization records of individuals. Ways to access your own immunization record are outlined on this webpage: https://immunize.utah.gov/usiis-parents-individuals/

Requester's name: *

Requester's email: *

Requester's phone: *

Requester's organization name: *

Organization type: *

** Any data request from the media will be coordinated through the Office of Public Affairs and Education at (801) 597-2775

State or local public health agency

Non-profit organization or community based organization

Private sector agency

Healthcare provider (e.g., clinic)

Academic institution

Media/press**

Other:

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