Immunization/Vaccination Records/COVID-19 Documentation

• Complete the pdf Immunization Vaccine Record Release Request Form (226 KB) .
  • You must include a copy of all necessary supporting documentation with your request or it cannot be processed. See list below for acceptable forms of documentation.
  • To obtain a record for yourself, one of the following must be provided: Current Driver’s License, State Identification Card, U.S. Passport
  • To obtain a record for a minor you must provide proof of your status as a parent or guardian with one of the following: Birth Certificate, Legal Guardian Paperwork, Custody Paperwork or most recent Tax Return showing the child listed as a dependent. You must also provide identification for yourself, by providing a copy of one of the following: Driver’s License, State Identification Card, U.S. Passport.
  • To obtain a record for someone you are a guardian of, either child or adult, you must provide a copy of: Custody paperwork, legal guardian paperwork or healthcare power of attorney.
• There MUST be a valid phone number on the request form or it cannot be processed.
• You may return the form by mail, email, or fax. Please note that the form MUST have a signature from a parent, guardian or patient 18 years of age or older.
  • By Mail
    Public Health – Dayton & Montgomery County
    Medical Records Department
    
    117 South Main Street
    Dayton, OH 45422-1280
  • By Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
  • By Fax: 937-496-7613
    
    
• There is no charge for patients or parents to receive copies of their medical records.
• Please allow a minimum of 7-10 business days for copies to be prepared. No same day requests will be accepted.
• If you choose to pick the records up in person. They must be picked up by the record requestor with proof of ID. You will be called when it is ready to be picked up.
• Copies of immunization/vaccine records/COVID-19 documentation may also be received by email or fax. A COVID-19 Replacement Card cannot be emailed or faxed.
• If you want to obtain COVID-19 documentation only or a COVID-19 Replacement Card, specify this request on the Immunization/Vaccine Record Release Request Form. You must include a copy of all necessary supporting documentation with your request or it cannot be processed. See the list above for acceptable forms of documentation.

It is possible that if Public Health- Dayton & Montgomery County did not administer all of the vaccines you have received, your record may not be complete. Medical providers in Ohio are not required to report immunizations to the State Immunization Registry. Please contact your healthcare provider who provided your vaccination.