The Maine Immunization Information System (ImmPact) is a repository for accurate and up to date immunization records for all persons born, residing, or receiving vaccine in Maine. It is for health care providers only, can perform a variety of functions, and contains information and resources.
Provider Forms and Updates
You can download recommended immunization forms and informational materials.
Patient Record Information
- 03/2013: Patient Eligibility Screening Record Vaccines for Children Program (PDF)
- 06/2018: Adult Eligibility Screening Record (PDF)
- 10/2011: Sharing of school health records (Word)
- 04/2024: ImmPact Patient Non-Participation Form (PDF)
This form cannot be used to remove COVID-19 administration documentation. - 6/14/2024: ImmPact Patient Re-Enrollment Form (PDF)
Provider Enrollment Agreement
- 09/2023: Individual User Agreement (PDF)
- 03/2019: Immunization Information System (IIS) Rules (PDF)
- 6/14/2024: Immpact User Confidentiality and Security Policy (PDF)
Vaccine Management
Vaccine Replacement Policy
- 5/2023: Corrective Action Plan (Excel)
- 5/2023: Statement of Replacement (Excel)
- 5/2023: Vaccine Replacement Plan (Excel)
(If you get a username/password box for any downloads, click cancel and the document will load)
- If you have feedback, questions, or want to learn more:
Call: 1-800-867-4775, 8:00am-5:00pm, Monday - Friday - Email completed forms to: immpact.support@maine.gov
Data Exchange
- Data Exchange Application (PDF)
- HL7 Specifications (PDF) Single Direction, Provider to IIS
- QBP BiDx Specifications (PDF)
- ImmPact Tradename/Vaccine/CVX/CPT list (PDF)
- Onboarding Guide (PDF)
- Testing Requirements and Expectations (PDF)
- Error Correction Guide (PDF) ImmPact Fix Tool and Detail Report