Michigan Care Improvement Registry (MCIR)
“Read Only” Access Application
In accordance with Public Act 540 of the Public Acts of 1996, Amended 2006 as Act 91, and codified as MCL 333.9201 et seq. of the
Michigan Public Health Code, the Department of Health and Human Services (MDHHS) has established the Michigan Care Improvement
Registry (MCIR) to record and to access information regarding administered immunizations and other health related data by health care
providers. Users of the system must refrain from employing the MCIR and data on the MCIR for any other use. Access to the MCIR
database is permitted only under part 92 of the public health code. Access to MCIR data is under the terms and conditions prescribed by
the MDHHS. Improper use of the MCIR will result in revocation of the user’s access privileges and potential liability under MCIR, Vital
Records, and Michigan Computer Crime Laws. The MDHHS reserves the right to revoke a user’s access privileges at any time, without
Please read the following statements. If you agree to abide by these statements, please complete the information requested below and fax
this agreement to : the appropriate Regional MCIR Office (visit https://www.mcir.org/providers/regional-coordinators/contact-regions/
contact information).
As a user of the Michigan Care Improvement Registry, I accept and agree to the following:
I will handle information or documents obtained through the MCIR in a confidential manner.
I will restrict my use of the MCIR to accessing information and generating documentation only as necessary to properly conduct
the administration and management of my duties as they relate to immunizations.
I understand that my transactions on the MCIR are logged and are subject to being audited.
I will not furnish information or documentation obtained through the MCIR to individuals for personal use nor to any individuals
not directly involved with the conduct of my duties as they relate to immunizations.
I will not falsify any document or data obtained through the MCIR.
I will not attempt to copy all or part of the database or the software used to access the MCIR database in any unauthorized
fashion, nor attempt to falsify or otherwise alter data in the MCIR database or otherwise violate the Michigan Computer Crime
Law (MCL 752.794 - 752.797) or the Vital Records Law (MCL 333.2894) summarized on the reverse side of this form.
I will carefully safeguard my access privileges and password for the MCIR and I will not permit the use of my access privileges or
password by any other person.
I will report any threat to or violation of the MCIR security.
MCIR data may not be used for research purposes without approval by the MDHHS Institutional Review Board
(www.michigan.gov/irb). Refer to Admin Rule R 325.9055
MCIR User Information:
I am registering as a member of (Check One Only): Health Care Organization WIC Clinic
Health Department Administrative Staff
I have read the above security agreement and the prohibited acts provided on the reverse side of this form.
I understand this information and I agree to comply with the above provisions. Further, I understand any
violation of these provisions may result in termination of access privileges and/or recommendation for
Phone: ( )
Fax: ( )
Other License #: (specify)
(REQUIRED) E-mail Address:
User’s Signature
Date Signed:
This document is subject to revision or withdrawal at any time at the discretion of the Michigan Department of Health and Human Services- 5-2015
Instructions for Completing the MCIR “Read Only” Access Application
You must complete this agreement and submit it to your Regional Coordinator for approval before
gaining access to the Michigan Care Improvement Registry (MCIR). Follow the instructions below to
complete the MCIR “Read Only” Access Application
Step One: Read the Agreement
Carefully read the entire application, including the bulleted list of statements, so that you completely
understand the confidentiality regulations, restrictions, and requirements for using the MCIR.
Step Two: Register as a Health Care Organization
Under the Provider Information heading, specify whether you are registering as a member of a Health
Care Organization, WIC Clinic or Health Department Administrative Staff:
You may check only one option.
Step Three: Entering Site Demographic Data
User’s Name: Person accessing MCIR data
Facility: Name of Facility or Organization
Enter Facility/Organization/ Name as well as the full name and title of the designated User on the lines
Step Four: Sign and Deliver the Agreement:
The User specified in Step 3 should sign and date this agreement and send it to the address identified
in paragraph two of the MCIR “Read Only” Access Application. Any issues or questions regarding
confidentiality or the appropriate use of the MCIR by the members or staff of the registered
organization are the responsibility of the User specified in Step 3.
This document is subject to revision or withdrawal at any time at the discretion of the Michigan Department of Health and Human Services 5- 2015