Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with CHIRP — Children and Hoosiers Immunization Registry Program (Indiana State Department of Health) before sending sensitive documents. FaxFlow is not affiliated with this organization.
CHIRP — Children and Hoosiers Immunization Registry Program (Indiana State Department of Health) fax number
(317) 233-8827
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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No public source link was saved with this record. Confirm the number directly with the organization before using it.