WebRemove User form. Fax this form to the CHIRP program at 317-233-8827 within one week of the User’s last day of employment. User: CHIRP was implemented by the Indiana State Department of Health under the authority of Indiana Code §16-38-5. It allows for the sharing of immunization information among authorized health care providers, schools,

CHIRP, Inc. - CHIRP, Inc.

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INDIVIDUAL USER AGREEMENT - Chirp

[email protected]. Part A – To be completed by Primary and Backup coordinators . Full Name (First and Last): VFC PIN Number: Job Title: E-mail Address: Medical Director’s Name: Facility Phone Number : Part B - Check the appropriate box . New CHIRP User User is new to CHIRP with NO previous access. WebIndiana State Department of Health -Immunization Division . Page 1 of 4 Childhood Vaccine Eligibility Statement 2 7/17/2012 . ... by documenting all vaccination information in CHIRP as an administered dose. Definitions of Eligibility Categories. Medicaid . A child who has any form of Medicaid insurance. • CHIRP: Medicaid WebMyVaxIndiana – Activating Patients from CHIRP This guide is for existing CHIRP users that have a user account. If you need any assistance with this or other processes concerning CHIRP or MyVaxIndiana please call 1-888-227-4439 or email [email protected]. MyVaxIndiana PINs can be activated by a medical provider or the County Health … fishing in aylett va