Vax Verify Terms of Service and Consent

By checking the box below, I hereby consent to allowing the Illinois Department of Public Health (“IDPH”) Immunization Portal (“Portal”) to query I-CARE for my COVID-19 immunization records and for the Illinois Department of Public Health to allow such query of I-CARE to return a “yes” or “no” indicating my COVID-19 immunization status to any and all third parties.

I understand that:

• The information disclosed pursuant to this authorization may be subject to redisclosure by the recipient and may no longer be protected by applicable federal or Illinois law. IDPH cannot guarantee that the recipient will not re-disclose the immunization information provided to a third party. The third party may not be required to abide by this authorization or applicable federal or Illinois law governing the use and disclosure of health information.
• I have the right to revoke this authorization at any time through a setting in my Portal profile. The revocation will be effective immediately except to the extent that the Illinois Department of Public Health and/or this Portal acted in reliance on this authorization before it received the notice of revocation.

By unchecking the box below, I hereby revoke any and all access by third parties to my immunization records contained in I-CARE, except to the extent otherwise permitted by applicable law.

By checking this box, you understand and are certifying that you are providing “written instructions” to the State of Illinois under the Fair Credit Reporting Act, authorizing the State of Illinois to obtain information from your personal credit profile or other information from Experian. You certify that you have initiated a transaction to confirm your identity to avoid fraudulent transactions in your name with the State of Illinois and authorize the State of Illinois to perform these services solely to confirm your identity for purposes of vaccine verification. You also acknowledge that should your identity not be confirmed, or should there be suspected or actual fraudulent activity, you will not be provided vaccination status through this verification process.

This Illinois Department of Public Health (“IDPH”) Immunization Portal ("Portal") will allow you to access your, or your minor child or ward’s, immunization records contained in I-CARE and, if you consent, inform third parties of your COVID-19 vaccination status for purposes related to vaccine verification.

To facilitate this access, and for the sole purpose of confirming your identity and matching your records, the Portal will request the following essential information from you: first name, last name, date of birth, phone number(s), social security number, mother’s maiden name, and physical address, as necessary (“Personal Information”).

Based on this information, the Portal queries the I-CARE database through an interface and returns to you your, or your minor child or ward’s, immunization records. If you have consented to third party access, the application queries the I-CARE database through an interface and returns to the third party a “yes” or “no” indicating your COVID-19 vaccination status.

Providing the Personal Information to the Portal constitutes your consent to the collection and disclosure of such information by the State of Illinois for the purposes of providing your immunization records. The Portal may be hosted by third parties (“Portal Host”) working with the State of Illinois. Certain information you provide to, or that is collected by, the Portal may be shared with the Portal Host who shall limit their use of the information solely to the purposes described and as necessary to provide the services.

The Personal Information you provide will be retained by the State of Illinois and the Portal Host only for the purposes described herein and as may be required by law, administrative processes, audits, records retention policies, quality assurance or security measures.

IDPH may be required to retain the Personal Information pursuant to the State Records Act (5 ILCS 160) which prohibits the destruction and removal of records received by state agencies, including IDPH.  

The information you provide may also be subject to any applicable privacy and security laws such as Illinois’ Personal Information Protection Act (30 ILCS 530).

I hereby authorize the Illinois Department of Public Health (“IDPH”) to release my and/or or my minor child or ward’s immunization records contained in I-CARE (“Immunization Records ”), which may include, without limitation, name, address (may be removed in minor’s records), phone number(s), sex, date of birth, group number, type of vaccine, date of administration, location of vaccination, manufacturer, lot number, and expiration date.

I understand that I may not be able to view my, or my minor child or ward’s, Immunization Records using this IDPH Immunization Portal (“Portal”) if my, or my minor child or ward’s, records cannot be identified based on the information provided.

I agree that I will not impersonate any person or entity or misrepresent my identity for purposes of accessing personal and protected health information.

I agree that I will not engage in any other malicious, disruptive, or other conduct that impedes or interferes with the usage of this Portal. I truthfully represent that I am at least 18 years of age or have legal authority under Illinois law to enter into these terms and conditions to use this Portal.

If I am attempting to access my minor child or ward’s immunization records, I attest that I have the legal right to access such records and am not barred by any legal process from doing so. 

I understand that if I attempt to access a third party's personal information without legal right to do so, the State of Illinois reserves the right to seek appropriate penalties and refer to law enforcement, as applicable. 

By electronically typing my full legal name, I hereby attest that (i) I am not impersonating any person or entity or misrepresenting my identity, (ii) I authorize the release of my, and/or my minor child or ward’s, Immunization Records to the Portal, (iii) I fully understand the meaning of this authorization and agree to its terms, and (iv) I understand that I am signing this authorization electronically and agree my electronic signature is the legal equivalent of my handwritten signature.