Directory information, not recipient confirmation. Fax numbers can change and differ by department, location, form, or plan. Confirm this destination directly with Montana Department of Public Health and Human Services – Immunization Program before sending sensitive documents. FaxFlow is not affiliated with this organization.

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Montana Department of Public Health and Human Services – Immunization Program fax number

(406) 444-2920

Montana DPHHS Immunization Program (imMTrax)

Used for: Submitting immunization record requests and releasing records through Montana's Immunization Information System (imMTrax).

Fax destination details

Department
Montana DPHHS Immunization Program (imMTrax)
Purpose
Submitting immunization record requests and releasing records through Montana's Immunization Information System (imMTrax).
Form
Montana Immunization Information System Authorization to Release Immunization Records (imMTrax) — Montana Immunization Information System Authorization to Release Immunization Records
Address
Montana Department of Public Health and Human Services – Immunization Program, P.O. Box 202951, Helena, MT 59620-2951
Voice phone
406-444-5580

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Complete patient information and receiving organization details; specify the official recipient and reason for request; fax to (406) 444-2920; allow 3 business days for processing; must be signed and dated.

Official form instructions are published as a downloadable file on the organization's website.

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