Immunization Registry Information System (IRIS)
Adult Record Request
IRIS - Immunization Program
Lucas State Office Bldg, 5
th
Floor
321 E 12
th
Street
Des Moines, IA 50319-0075
Phone: (800)374-3958
Fax: (800)831-6292
http://idph.iowa.gov/immtb/immunization/iris
Email: irisenrollment@idph.iowa.gov
Iowa’s Immunization Registry Information System (IRIS) is a statewide database of immunizations
administered in Iowa from either public or private providers. IRIS helps parents, health care providers, schools
and other authorized users to know an individual’s immunization and health screening status.
Iowa state law [Iowa Code § 22.7(2) and 641IAC Chapter 7] specifies immunization and health screening
information is confidential, which can only be shared with enrolled users, including an individual’s health care
provider, school, child care facility, local health department, the individuals themselves.
Once an individual attains 18 years of age, that person’s parents can no longer request a record, but the legal
adult may request the information directly. To obtain a copy of your immunization or health screening record,
please complete the following information and fax to the IRIS Help Desk at 800-831-6292.
First Name: Middle: Last:
Address: City, State, Zip:
Previous/Maiden Name: Date of Birth: Gender: Female Male
Please send the record to one of the following:
Health Care Provider School Myself Other:
Recipient/to the attention of:
Name of Organization:
Fax Number: Phone Number:
OR
Mailing Address: City, State, Zip:
OR
Email:
By signing this agreement, I verify the information listed above is true and accurate:
Print Name of Parent/Guardian: Telephone Number:
Signature: Date:
Office Use Only
Date Received: Record Found, Date Sent: Initials:
Record Not Sent Reason: Initials:
Adult Record Request - August 2019
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