Oklahoma Patient Vaccine Record Updates

Information Change Request

Please complete this submission form for immunization record updates/requests to the Oklahoma State Department of Health. If you tried to access your (or your child’s) immunization record through the Public Portal and your record was not found, or you are requesting an update to your record, please complete the form below and click Submit. Please allow up to 10 business days for processing your submission.

Please complete the fields below with your (or your child’s) information, exactly how you reported it to your provider/clinic, as an exact match in the Oklahoma Immunization Information System (OSIIS) is required.
* Note: A parent can only access an immunization record for their child under age 18.
If you have questions on how to complete this form, contact (405) 426-8580 during business hours Monday-Friday 8:30am-4:30pm.
If you have other questions NOT related to immunization record updates/requests, please call (405) 426-8580.

All fields marked with * are required.

Is the request for you or on behalf of your child (under age 18)?

Me Dependent

Patient First Name

Patient Last Name

Patient Date of Birth (MM/DD/YYYY)

Patient Gender (as shown on your immunization/medical records)

Current Street Address

City

State

ZIP Code

Patient Current Email Address

Patient Mobile Phone Number

Please specify which update(s) you need to submit (select all that apply)

New email or mobile phone

Name is misspelled or needs to be updated, date of birth is incorrect, or gender is incorrect

Immunization record is missing vaccination(s)

I am a parent/guardian but am not listed on my child's record

I am attaching a Release of Information, Proof of Guardianship or Power of Attorney and proof of identification to request an immunization record be mailed or faxed

Other

Comments

Please provide details of your corrections/updates in the box below.

Proof of identification

Please provide one of the following documents to validate your request:

Government issued identification (Driver's liscense/State ID)
Passport

Should a photographic identification be unavailable, any two of the following documents below may be substituted for it:

Birth certificate
Employee ID w/picture
Current automobile registration
Current copy of utility bill showing name and address
Student ID
Current voter registration card

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