Colorado Department of Public Health and Environment

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Individuals

Opt-Out Procedure

 

Under Colorado law you have the option to exclude your/your child’s immunization information from the Colorado Immunization Information System at any time. If you change your mind, you can always have your healthcare provider re-enter your/your child’s immunization record into CIIS at a later time. If you choose not to participate in CIIS, you are responsible for keeping track of your/your child’s shot record. To read the CIIS Opt-Out Policy, click here portable document format

 

Opt-Out Procedure


If you choose to opt out of the Colorado Immunization Information System, please read the following instructions and follow all steps to ensure that your/your child’s immunization information is excluded from CIIS.

 

Upon your request to exclude immunization information from CIIS, your healthcare provider must:

 

  • Supply you with a Colorado Immunization Information System Opt-Out Form
  • Have you complete and sign three copies of the CIIS Opt-Out Form
  • Attach one signed copy of the CIIS Opt-Out Form to your/your child’s medical record in the location usually reserved for the immunization record
  • Give the other two signed copies of the CIIS Opt-Out Form to you

 

To complete the opt-out procedure, it is your responsibility to:

 

  • Mail or fax one signed copy of the CIIS Opt-Out Form to the CIIS office at the address found on the bottom of the CIIS Opt-Out Form
  • Keep one signed copy of the CIIS Opt-Out Form for your records

 

 

Rescind Opt-Out Procedure


While you can choose to exclude your/your child’s immunization record from the Colorado Immunization Information System, you can also change your mind – and have your/your child’s shot record re-entered into CIIS.

 

Upon your request to have your/your child’s immunization information re-entered into CIIS, your healthcare provider must:

 

  • Supply you with a Colorado Immunization Information System Rescind Opt-Out Form
  • Have you complete and sign three copies of the CIIS Rescind Opt-Out Form
  • Attach one signed copy of the CIIS Rescind Opt-Out Form to your/your child’s medical record in the location usually reserved for the immunization record
  • Give the other two signed copies of the CIIS Rescind Opt-Out Form to you

 

To complete the rescind opt-out procedure and ensure that your/your child’s shot record gets put back into CIIS, it is your responsibility to:

 

  • Mail or fax one signed copy of the CIIS Rescind Opt-Out Form to the CIIS office at the address found on the bottom of the CIIS Rescind Opt-Out Form
  • Keep one signed copy of the CIIS Rescind Opt-Out Form for your records

 

You can download both the CIIS Opt-Out Form and the CIIS Rescind Opt-Out Form below:

 

CIIS Opt-Out Forms

 

CIIS Rescind Opt-Out Forms