As required under the National Childhood Vaccine Injury Act, all health care providers in the United States who administer vaccines listed under the act, are required to provide vaccine informational materials (VIS) to the parent or legal guardian of the recipient of the immunization, or to any adult to whom the provider is providing such vaccine.  In Michigan, these VIS also include a statement explaining the Michigan Childhood Immunization Registry (MCIR).  Michigan requires that this statement be included on all VIS distributed within the State.

The Health Department can now make these forms, with the MCIR statement included, available via this website.  You may print these Adobe files (.pdf) directly from our web site or you may download them for use in your practice at your convenience.  You may also access forms directly from the MDCH website.

•     Chickenpox

•     Diphtheria/Tetanus/Pertussis (DTaP)

•     Haemophilus Influenzae type b (Hib)

•     Hepatitis A

•     Hepatitis B

•     Measles/Mumps/Rubella (MMR)

•     Meningococcal

•     Pneumococcal Polysaccharide (PPV23)

•     Pneumococcal Conjugate (PCV7)

•     Polio

•     Rotavirus

•     Tetanus/Diphtheria (Td)

•     Multiple Vaccines

Page Last Updated:  07/15/2009

Questions or Comments?  Please e-mail to Webmaster
Website Maintained by:  Carol A. Stephens, MIS Manager
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