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The information in the San Diego Regional Immunization Registry is confidential. Only authorized Registry members may review it. Authorized member organizations include local or state health departments, medical care providers, and those agencies who need to know what immunizations your child has had (schools, child care facilities, family child care homes, WIC programs, health care plans, the County Health and Human Services Agency, CalWORKS). We will not give this information to any other person or group.
| | Name
Date of birth |
| Sex (male or female) |
| | Current address and phone |
| | Other information that may help identify your child accurately |
| | Names of parents or guardians |
| | Types of vaccines and dates given |
| | Any serious reactions to shots |
| | As the parent/guardian of your child you have the right: |
| | To look at your child's record and have corrections made. |
| | To refuse to get reminder notices when vaccines are due. |
| | To refuse to allow any of this information to be shared with authorized members now or at any time. |
| | To obtain the names and addresses of anyone with whom this information is shared. |
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