The code block below illustrates how one might use # and // as comments in your logic and calculations.

This value you provided is not a number. Please try again.

This value you provided is not an integer. Please try again.

The value entered is not a valid Vanderbilt Medical Record Number (i.e. 4- to 9-digit number, excluding leading zeros). Please try again.

The value you provided must be within the suggested range

The value you provided is outside the suggested range

This value is admissible, but you may wish to double check it.

The value entered must be a time value in the following format HH:MM within the range 00:00-23:59 (e.g., 04:32 or 23:19).

This field must be a 5 or 9 digit U.S. ZIP Code (like 94043). Please re-enter it now.

This field must be a 10 digit U.S. phone number (like 415 555 1212). Please re-enter it now.

This field must be a valid email address (like joe@user.com). Please re-enter it now.

The value you provided could not be validated because it does not follow the expected format. Please try again.

Required format:

9k7UqHk7ynQc8EI3Gkm5tBDdgDCTZwpg8MmEuWD7aWuFj8KjGqm5P5

Non-MIIC Provider Record Requests

The Minnesota Immunization Information Connection (MIIC) is a statewide immunization information system that stores electronic immunization records. MIIC combines the vaccines a person has received into a single record, even if they were given by different health care providers in the state. MIIC helps Minnesotans get the right vaccines at the right time.

The information in MIIC is classified as private and only those authorized by law (Minnesota Statutes, Section 144.3351) can access it. Please answer the questions below to determine if your organization is authorized to request client records from MIIC. If authorized, complete the survey to submit an official request.

If at any point you have questions or need assistance completing this form, please contact the MIIC Help Desk at health.miichelp@state.mn.us.

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To save your responses and end the survey, click the 'End Survey' button below. If you have selected the wrong option by accident and/or wish to return to the survey, click the 'Return and Edit Response' button.