Find detailed directions on where to return forms and contact information for assistance at the bottom of this page.

MCIR Provider Site Usage Agreement (PSUA)

Establish a new MCIR site, renew a site agreement, change Site Administrators, update the supervising medical provider, modify information such as address, phone number, or site name, or discontinue a MCIR site.

Site Administrators – How to Add a New or Existing User to a MCIR Site

MCIR Online Site Renewal Tip Sheet

MCIR Site Agreements must be renewed every 3 years. Site Administrators should renew electronically in MCIR. Use the Provider Site Usage Agreement form if other site changes are needed, such as changing administrators.

Petition for Modification Form – Change Person Information (P4M)

Request modifications to a person’s MCIR record information including spelling or DOB corrections, legal name changes, adoptions, or to merge duplicate records.

B&W Version for printed, scanned, or faxed copies.

P4M Adoption Tip Sheet

Petition for Modification Form – Immunization Correction (P4M)

Request modification or deletion of immunizations entered into a MCIR record by another provider.

How to Edit an Immunization Entered by Your Site

Dispensing Pharmacist Site Usage Agreement

Request MCIR access as Universal Hospital Hep B, All-Hazard, non-administering pharmacies.

Medical Exemption Form

Physicians should complete this form to report a child with a medical exemption to a particular vaccine. Completed forms should be returned to the child’s school or childcare.

Read-Only Access Site Usage Agreement

Request read-only access to MCIR – for Health Care Organizations or Health Plans only.

QUERY-Only Site Usage Agreement

Request QUERY-only access to MCIR.

Return Completed Forms (please allow up to 3 business days for processing):
Email: MDHHS-MCIRHelp@michigan.gov
Fax: 517-763-0370
Please provide contact information on the form so the Help Desk can contact you with any questions. Forms will be returned for missing or incorrect information.

Note: Some forms may still refer to MCIR Regional Offices. As of October 2023, the Help Desk has centralized and the regional contact information is no longer valid. Thank you for your patience as we update our materials.

For technical assistance with MCIR or form questions, contact the MCIR Help Desk:
Phone: 888-243-6652
Email: MDHHS-MCIRHelp@michigan.gov
MILogin: 877-932-6424, option 5 for password reset

MCIR Help Desk Hours of Operation:
Phone: Monday-Thursday 10AM-12PM and 1PM-4PM, Friday 10AM-12PM and 1PM-3PM
Email: Monday – Friday 8AM – 4:30PM