Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by CHIRP — Children and Hoosiers Immunization Registry Program (Indiana State Department of Health). Before sending anything sensitive, confirm the number and receiving department directly with CHIRP — Children and Hoosiers Immunization Registry Program (Indiana State Department of Health), and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
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CHIRP — Children and Hoosiers Immunization Registry Program (Indiana State Department of Health) fax number
(317) 233-8827
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Indiana State Department of Health, Immunization Program (CHIRP)
Used for: Provider enrollment and management of CHIRP access, including submitting enrollment paperwork and managing user accounts.
Fax destination details
- Department
- Indiana State Department of Health, Immunization Program (CHIRP)
- Purpose
- Provider enrollment and management of CHIRP access, including submitting enrollment paperwork and managing user accounts.
- Form
- Individual User Agreement (State Form 52303) — INDIVIDUAL USER AGREEMENT
- Address
- 2 North Meridian Street, Indianapolis, IN 46204, USA (Immunization Program, CHIRP) – Section 6A-22
- Voice phone
- CHIRP Support Center: 1-888-227-4439
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
After completing the Individual User Agreement, return page one via fax to 317-233-8827; for user removals, fax the User Removal Form as directed. CHIRP enrollment paperwork should be faxed to the CHIRP Support Center.
Official form instructions are published as a downloadable file on the organization's website.
Sources and verification
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