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New CAIR Organization/Site Enrollment

Fields with an * are required.

Organization Name *

Organization Type *

Childcare Facility License Number *
School District
Public Organization (eg. Community Clinic) *
County Organization (eg. Local Health Department) *

Provider of Record *

First Name as it appears on your medical/pharmacist license * CA Medical/Pharmacist License *
Last Name as it appears on your medical/pharmacist license * License Type *

Physical Address *

Address 1 * Address 2 PO Box
City * State ZIP Code *

Mailing Address

Address 1 Address 2 PO Box
City State ZIP Code

State Supplied Vaccine Profile

Do you receive State-supplied Vaccine (VFC, 317, SGF)? *
VFC PIN

Vaccine Delivery

Address 1 Address 2 PO Box
City State ZIP Code

Primary CAIR Contact *

First Name * Address 1
Last Name * Address 2
Middle Name PO Box
Email * City
Telephone * () - Ext State
Facsimile () - Ext Zip Code

Other Contact

First Name Address 1
Last Name Address 2
Middle Name PO Box
Email City
Telephone () - Ext State
Facsimile () - Ext Zip Code

CAIR Technical Contact

First Name Address 1
Last Name Address 2
Middle Name PO Box
Email City
Telephone () - Ext State
Facsimile () - Ext Zip Code

Vaccine Coordinator (*Required for VFC Providers)

First Name Address 1
Last Name Address 2
Middle Name PO Box
Email City
Telephone () - Ext State
Facsimile () - Ext Zip Code

Primary VFC/AFIX Contact

First Name Address 1
Last Name Address 2
Middle Name PO Box
Email City
Telephone () - Ext State
Facsimile () - Ext Zip Code


New CAIR Organization & Individual User Access Agreement



CAIR Providers/Organization Terms & Conditions

The California Immunization Registry (CAIR) is a secure, computerized online information system developed to assist medical providers and other approved agencies to track and review immunization information and TB test results for individuals, assess immunization needs and remind/recall patients, avoid unnecessary or redundant immunizations, and control disease outbreaks. Information in CAIR is only available to authorized users. Based on the access level approved, this Agreement will allow the Organization to access, view, add, or modify immunization information/TB test results in CAIR either via the web interface or through electronic data exchange under the conditions listed below. As conditions for participating in CAIR, the above Organization agrees to:

  • Comply with California Health and Safety Code Section 120440 regarding immunization registry use, as well as State and Federal laws and HIPAA regulations regarding maintaining the confidentiality of patient information.
  • Ensure your Organization staff receive appropriate CAIR training prior to accessing information in CAIR.
  • Access information in CAIR only as needed to perform immunization/TB-related activities for individuals presenting to your Provider/Organization for services.
  • Safeguard and ensure no sharing of assigned passwords.
  • Ensure no misuse or wrongful disclosure of information in CAIR by your Organization staff.
  • Disclose to patients or their parents/guardians that state law requires patient immunization information and TB test results to be shared with CAIR and that patients have the option to share their immunization records/TB test results with all CAIR providers or only providers that require vaccination history to provide care. Written disclosure is highly recommended.
  • Report any activity that may compromise the protection and privacy of the information in CAIR.

CAIR Individual User Terms & Conditions

California Health and Safety Code Section 120440 limits access to the California Immunization Registry (CAIR) to authorized users who require the information for the purpose of providing immunization services as specified.

As a condition of authorized access to the California Immunization Registry, I agree:

  • To only access and use the registry system in the course of my assigned duties for the purpose stated above.
  • To keep my user password confidential.
  • To only use my own password to access to the registry.
  • To maintain the privacy and confidentiality of information in the registry.
  • To not communicate, publish and/or otherwise provide or make public any information regarding persons enrolled in the registry and their immunization status, except:
    1. To patients who request their own immunization records,
    2. To individuals authorized by law to access immunization registry information, or
    3. When records are presented in aggregate reports and have no associated identifying information.

To assure appropriate usage of CAIR, a permanent electronic record will be created that will log each User’s access into any registry client record. Any unauthorized release of confidential information by a User may revoke my or my Organization's access to the California Immunization Registry (CAIR). User accounts will be inactivated if a User fails to login to CAIR for a period of 90 days.


By checking this box and entering your name below, you as the Organization Representative agrees that the Organization and all listed Users associated with the Organization have read and will abide by the CAIR rules set forth in this Agreement. If the Organization/Site closes or is bought by another Organization, the Organization/Site must inform CAIR staff within 14 days so that the existing Organization/Site and user accounts can be terminated or reassigned. CAIR reserves the right to terminate this Agreement if the Organization or it's Users violate this Agreement or use the system in an unauthorized manner. This Agreement will remain in effect until terminated by either party.
Full Name *:
Title *:
Email Address *:
Contact Number *:
 

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