VaxRef Form

Asterisk (*) Indicates required field

This application will help you translate your vaccine records to English. Select the language of your document and complete all the information below.

The Minnesota Department of Health and Minnesota IT Services developed this application (VaxRef) to translate immunization records. You should always give the original immunization records with the translated materials to your doctor or other health care professionals.

The application is intended for use by people who want to translate their immunization records, health care professionals needing help with translating immunization records, or community organizations translating immunization records.

This application and its translated materials do not give medical advice or immunization guidance. Talk to your doctor or other health care professional for advice or information about immunizations.

Information you enter in this application, including the patient or user’s name, date of birth and other personal information, will be deleted immediately. The Minnesota Department of Health will not have access to or store the information you provide when using this application, except for two items: (1) the US state where the user accessed or used the application and (2) the original language of the translated materials. The Minnesota Department of Health will use the state and language information to understand how and where the application is used.

If you do not wish to enter the requested information, you cannot use the application to translate immunization records.

Please provide the information of the person whose vaccines are being translated.

First Name:

First name must be written in English/Latin characters

Last Name:

Last name must be written in English

Date of Birth

Enter the date of birth in month (MM), day (DD), year (YYYY) of the person whose vaccines are being translated

State

Select your state of residence (in English)

Please provide a valid email (English). We will send a copy of the translated immunization history to this email. The user would need to print or save a copy to share with the health care provider.

Please confirm your email address

Vaccine List

Select the Vaccine Type and Enter the vaccine date. Click on the "Add Another Vaccine" to add more vaccines for translation.
Vaccine Name Vaccine Name Enter other… Vaccine Date

Review your records before submitting.

VaxRef is provided by the Minnesota Department of Health and the Minnesota Center for Excellence in Newcomer Health which is supported by NU50CK000563 from the U.S. Centers for Disease Control and Prevention (CDC).