How to Report
There are four ways providers can report:
Paper
Electronic
Online (No more dial-up connection required,
simply click the Registry button to the left!)
For instructions on opening, saving, and printing the PDF files
below, click here.
Paper
Immunizations are to be reported within 14 days of administration
according to the NYC health code. Providers fill out demographic and
immunization information and mail original (white copy) reporting
forms with a completed Batch
Submittal Form. Please use the contact information below to send
completed immunization registry reporting forms and to order forms
for your office.
New York Citywide Immunization Registry
P.O Box 90490
Binghamton, NY 13902
Email:
cirforms@srcp.com
Tel:
(800) 238-0130
Fax: (212)
208-4641
-or-
Order Online
Electronic
Information is extracted from an encounter, billing or clinical management
system and sent via a secure electronic file transfer to the Web File
Repository (WFR), or downloaded onto a diskette and mailed to the
CIR. The Universal Provider Interface Format (UPIF) defines the format
that the information must be in to be accepted by the Registry. See
the UPIF
Specifications (PDF file: 614 KB, 47 pages) and Web
File Repository Guide (WFR) (PDF file: 269 KB, 3 pages) for uploading
data. For more information call (212) 676-2323.
Online
(Now with Lead Test Results!)
Accessing immunization
and lead test histories is easier than ever! Online access to your
patients' records is available if you are registered
with us. You may use the Online Registry to report immunizations
to assess the immunization status and lead test histories of your
patients, and to generate official printed immunization and blood
lead test records for providers and parents. The provider printable
report includes:
- a history of the child's immunization with recommendations of
vaccines due
- blood lead status with recommendations for lead testing and
follow-up of your patients
The parent (public) printable report lists only the immunizations
and dates they were administered to the child, and the date of the
last blood lead test with a message for parents to contact their
doctor for further details. The Online Registry also saves you time
by providing the public report as an official record that is accepted
by WIC, day care programs, schools, and summer camps. If there is
any difficulty having a form generated by the Online Registry accepted
please print and attach the memos below to the appropriate form.
- School Form Memo view
- Day Care Form Memo view
For Private Practices:
For Facilities (such as hospitals and clinics):
Mail:
New York City Department of Health and Mental Hygiene
Citywide Immunization Registry
125 Worth Street, CN #64R
NY, NY 10013-4089
Phone: (212)
676-2323
FAX: (212) 676-2314
To Order Immunization
Registry Reporting Forms IMM30C (9/05)
Mail:
New York Citywide Immunization Registry
P.O Box 90490
Binghamton, NY 13902
Email:
cirforms@srcp.com
Phone:
(800) 238-0130
FAX: (212)
208-4641 
