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Colorado Immunization
Information System (CIIS)

LOGIN REQUEST FORM
  

*Attention NEW CIIS Users: Before completing a Login request form, you must complete the CIIS user training.

Click to view training directions.

Instructions: Complete this online form to create a new CIIS account, change your existing CIIS account, or inactivate a CIIS account.  *You can only complete this form if your site has a signed Letter of Agreement with CIIS.*  NOTE: All fields marked with * are required.  Have questions about how to complete this form?  Call us toll-free at 1.888.611.9918 or 303.692.2437 or email us at CDPHE.CIIS@state.co.us.



 





 

 








 

 

 



 
*Privacy and Confidentiality Agreement:
By typing my initials in the box below, I acknowledge that I have read and that I understand the terms of the CIIS Privacy and Confidentiality Policy (available upon request and posted at
www.ColoradoIIS.com).  I agree to comply with all applicable laws, regulations and CIIS policies.  I will only access immunization information for clinical, quality assurance, public health, authorized research or school entry law purposes.  I will treat all information in CIIS as confidential.  I will not release or re-disclose any information in CIIS to any unauthorized person.  I will neither disclose my CIIS account information nor allow another person to use my account information to access CIIS.  I will notify CIIS when I no longer need a CIIS account or when I no longer work for this site.