Completed Forms

Can be returned to:

Detailed information on where to return specific forms can be found at the bottom of each page and on the form itself.

Forms Assistance 
Email: MDHHS-MCIRHelp@michigan.gov

Contact MDHHS-HL7@michigan.gov for HL7/data transfer questions
MILogin: 877-932-6424, option 5 for password reset

MCIR Help Desk Hours of Operation:
Phone: Monday – Thursday 10AM – 12PM and 1PM – 4PM
Email: Monday – Friday 8AM – 4:30PM

Public Forms

Forms for public use including requests for immunization records, requests to change information in your MCIR record, and participation in MCIR reporting/opt-out. 

Provider Forms

Forms for provider use including site usage agreements and petition for modification forms.

School and Childcare Forms

Forms for school and childcare use including requests to new school or childcare site agreements, request to change site administrator, petition to modify MCIR data, aggregate reporting forms, and more.