California Immunization Registry

AB 1797 (Akilah Weber, 2022) Immunization Registry FAQs

For Providers: General Questions

1. What is AB 1797 (Akilah Weber, 2022) and when does it go into effect?

AB 1797 (Akilah Weber, 2022), a California bill effective January 1, 2023, amends the immunization registry statute, Health and Safety Code Section 120440. With the passage of AB 1797, (Akilah Weber, 2022), California healthcare providers who administer immunizations or/and offer TB tests are required to enter:

Immunization information into the California Immunization Registry (CAIR) OR Healthy Futures/RIDE.
Race and ethnicity information for each patient in the immunization registry to support assessment of health disparities in immunization coverage.
TB test results

2. Am I required to submit all administered immunizations to the California immunization registry (CAIR or Healthy Futures/RIDE)?
Yes, under California Health and Safety Code § 120440, amended by AB 1797 (Akilah Weber, 2022), all administered immunizations are required to be submitted within a reasonable timeframe following administration including:

RSV immunizations to prevent severe RSV disease for infants and toddlers
RSV immunizations for adults and pregnant persons.
Human Papillomavirus (HPV) and Hepatitis B immunizations given to minors.
California Health and Safety Code § 120440 requires that all immunizations administered in California be submitted to a state immunization registry. Failure to report administered immunizations may be considered unprofessional conduct and may be reported to the Medical Board of California, resulting in disciplinary action under California Business and Professions Code § 2234.

3. How can a provider evaluating a baby for RSV immunization determine if the baby's birthing parent received prenatal RSV immunization?

If prenatal records are unavailable to determine if the baby's birthing parent was immunized during pregnancy, the birthing parent may request an immunization history report from their prenatal care provider or access their Digital Vaccine Record . The immunizing provider may also check the California Immunization Registry (CAIR) to confirm receipt of prenatal RSV vaccine at least 14 days before delivery or postnatal RSV immunization at the birth hospital or clinic.

4. For what ages do I have to report immunizations administered into the immunization registry (CAIR or RIDE/Healthy Futures)?

You must report immunizations administered for ALL ages.

5. Our practice does not currently participate in an immunization registry. What can we do as an immunizing provider to meet this requirement?

For more information, visit the CAIR FAQs or How to Enroll pages. Providers in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties will need to enroll in Healthy Futures/RIDE. For assistance, contact the Healthy Futures/RIDE Help Desk at (209) 468-2292 or support@myhealthyfutures.org.

6. Our practice is enrolled in an immunization registry but does not currently submit data. What can we do as an immunizing provider to meet this requirement?

The CAIR Team is here to support you along the way. Contact the CAIR Help Desk (CAIRHelpdesk@cdph.ca.gov or 800-578-7889) or your Local CAIR Representative with any questions. For more information about CAIR, visit the CAIR website.

Providers in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties will need to submit data to Healthy Futures/RIDE. For assistance, contact the Healthy Futures/RIDE Help Desk at (209) 468-2292 or support@myhealthyfutures.org.

7. I am not sure if my practice is already participating in an immunization registry. What should I do?

Contact the CAIR Help Desk (CAIRHelpdesk@cdph.ca.gov or 800-578-7889) or your Local CAIR Representative with any questions or if you want to find out whether your practice is already participating in CAIR.

Providers in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties will need to contact the Healthy Futures/RIDE Help Desk at (209) 468-2292 or support@myhealthyfutures.org.

8. How do I submit doses administered in the past (historical immunizations)?

Historical immunizations are either immunizations given by your site in the past (that have not been added to CAIR as new immunizations) or those given by another provider that were never added to CAIR (i.e., are on the patient’s Yellow Card, but are not in CAIR).

To submit historical immunizations through data exchange (DX), please work with your EHR vendor support and a CAIR Data Exchange Specialist (CAIRDataExchange@cdph.ca.gov) to discuss submission options.

To manually enter historical immunizations, consult the CAIR2 Guide to Adding Historical Immunizations (PDF) or view the Adding Historical Immunizations video.

There are important benefits to submitting historical doses for your patients to CAIR. Having complete patient records in CAIR is essential to ensuring future immunization recommendations are accurate. As more immunization data is submitted to CAIR and patient records become more complete, more people will access their immunization records through the Digital Vaccine Record (DVR) portal. This will help reduce requests from your patients for their immunization records.

Providers in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties will need to report historical immunizations to Healthy Futures/RIDE. For assistance, contact the Healthy Futures/RIDE Help Desk at (209) 468-2292 or support@myhealthyfutures.org.

9. When I enroll in CAIR or Healthy Futures/RIDE , it may take time to obtain user accounts, have my staff trained, and/or get my EHR connected to a registry. Will there be a grace period for entering doses and/or TB test results into a registry?

CDPH expects providers to start reporting to CAIR or Healthy Futures/RIDE as soon as all the necessary steps are completed. Please refer to FAQ #7 as to how to submit historical data. CAIR and Healthy Futures/RIDE staff will work with providers to help them start reporting doses and TB tests as quickly as possible.

10. If I am a VFC provider, what will happen if I do not enter doses into CAIR or Healthy Futures/RIDE?

California Health and Safety Code § 120440 requires that all immunizations administered in California be submitted to a state immunization registry. Failure to report administered immunizations may be considered unprofessional conduct and may be reported to the Medical Board of California, resulting in disciplinary action under California Business and Professions Code § 2234.

In addition, providers participating in the VFC Program are required to ensure doses reported to CAIR or Healthy Futures/RIDE are reported according to funding source and VFC eligibility. These dosess administered in CAIR and Healthy Futures/RIDE should match the doses administered that are manually entered into the VFC order form.

11. My organization uses data exchange (DX) to submit doses administered to CAIR. How do I make sure doses are being submitted correctly?

If your organization uses data exchange (DX), CAIR requires that you set up at least one staf memberf with a Data Exchange Quality Assurance (DX QA) user role in CAIR. The DX QA user role allows access to the CAIR ‘Check Status’ page for monitoring data submissions and data quality (PDF). Providers can also run a Doses Administered Report (PDF) to verify that doses administered are being accurately recorded in the registry. For more information, visit the Data Exchange Monitoring Resources section on the CAIR2 User Guides webpage.

12. How do I address patient concerns regarding privacy?

Explain to them that CAIR is safe and private. By law, it can be used only by authorized medical providers or health plans. In addition, schools, childcare centers, WIC programs, foster care agencies, and other programs can be authorized to look up immunization records—but only for the children they serve. The registry can only be used to check immunization records, see what immunizations are due, and see how many children need immunizations.

Per California Immunization Registry law, all patients/parents must be disclosed that California medical providers are required to submit patient immunization records and tuberculosis (TB) test results to CAIR (Health and Safety Code, Section 120440). Before adding patient information to CAIR, provide patients with a copy of the Immunization Registry Notice to Patients and Parents (this is the “Disclosure Form” – they do not have to sign it) for them to read.

If patients would prefer to prevent their immunization record from being shared with non-clinical CAIR users, medical providers can lock their record or the patient can complete the “Request to Lock My CAIR Record” form. Forms in English and Spanish can be submitted directly on the website. Forms in all other languages must be downloaded and faxed to the CAIR Help Desk at 1-888-436 -8320. See CAIR FAQs for more information.

13. Will my site have access to ALL patient records in CAIR?

Not necessarily. There are two situations in which a patient record may not be immediately accessible:

I. “Non-Disclosed” records: Basic birth certificate information for all births in California are automatically uploaded into CAIR weekly. Only clinical CAIR providers (i.e., Regular and Power users) are allowed to access these “Non-Disclosed” records once they have properly disclosed the parent/guardian following the CAIR Disclosure/Sharing Policy. Providers will receive a pop-up message when attempting to open the record. Once they have properly disclosed the parent/guardian, they can click the “OK” button on the pop-up to open the record. If they are unable to disclose the parent/guardian, they must click the “Cancel” button and not access the record.

II. “Locked” Records: At any time, a patient/parent/guardian may request that CAIR2 staff or their CAIR provider lock their/their child’s CAIR record. These records will not be immediately accessible to CAIR providers who have never recorded an administered and/or historical dose in the patient’s CAIR record.

Only clinical CAIR providers are allowed to open a “Locked” record and only if their site is providing immunizations to the patient and/or need to know the patient’s immunization history in order to provide medical care. These providers will receive a pop-up when attempting to open the record. If the requirements in the pop-up are not met, the user must click the ‘Cancel’ button and not access the record.

For questions and additional information, contact your Local CAIR Representative.

14. How soon after immunization administration should I enter doses into CAIR or Healthy Futures/RIDE?

Entering doses into a registry on the same day is beneficial for providers, staff, and patients. If doses are entered on the same day as administration, it makes entry of doses and inventory management easier. Same day entry of doses into CAIR or Healthy Futures/RIDE also helps patients quickly show proof of coverage to meet school or work requirements.

15. If I am already enrolled in Healthy Futures/RIDE, do I also need to enroll in CAIR?

If you are a provider in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties, being enrolled and reporting doses administered to Healthy Futures/RIDE will meet this requirement. You do NOT also have to enroll in CAIR.

16. What do I do if our clinical team forgot to capture a patient’s race and/or ethnicity during an immunization visit?

Remind clinical staff that providers are now required to report race/ethnicity data - make sure to ask at the next patient visit. Ensure that your practice has clear protocols to incorporate this step into your workflow.

17. What if a patient declines to tell me their race and/or ethnicity? How do I report that declination if I am using: CAIR Data Exchange (DX), Manual entry into CAIR, MyTurn, or CAIR Mass Vax Module?

Please explain that this information is requested to help improve immunization access for all children. Please select “Prefer not to say” if the race/ethnicity question was asked and not answered. If you submit doses via data exchange, please share the HL7 code (PDF) for “Prefer not to say” with your EHR vendors to update.

18. Is my organization required to report immunization doses administered to employees on-site?

Yes. All immunizations administered by your organization to employees must be entered into CAIR2.

19. Are we allowed to look up employees’ records in CAIR for reporting purposes if we did NOT immunize them onsite?

No. Employers cannot access the local Immunization Information System (California Immunization Registry [CAIR2], Healthy Futures [RIDE]) to check the vaccination status of their staff. CDPH would urge you to consult with your Counsel and to review HSC 120440, in particular subdivision (d).

Individuals can obtain their immunization records by providing:

An immunization history report from their medical provider
Their Digital Vaccine Record

20. Must providers report administration of immune globulins (e.g., HBIG) or BCG vaccine as an immunotherapy agent?

No, administration of immune globulins and BCG vaccine as an immunotherapy agent are not required to be reported to a California immunization registry (CAIR or Healthy Futures/RIDE).

21. Where can I get more information?

Find more information about CAIR by clicking on topics in the left navigation.

For Providers: Tuberculosis (TB) Test Results Questions

22. When I enroll in CAIR or Healthy Futures/RIDE, it may take time to obtain user accounts, have my staff trained, and/or get my EHR connected to a registry. Will there be a grace period for entering TB test results into a registry?

CDPH expects providers to start reporting to CAIR or Healthy Futures/RIDE as soon as all the necessary steps are completed. Please refer to FAQ #8 as to how to submit historical data. CAIR and Healthy Futures/RIDE staff will work with providers to help them start reporting doses and/or TB test results as quickly as possible.

23. My site only provides TB tests, not immunizations. Am I still required to enroll in a California immunization registry solely to report the TB tests I give?
Yes, all providers giving TB tests are required by AB 1797 (Akilah Weber, 2022) to report TB test results to a California immunization registry (CAIR or Healthy Futures/RIDE).

For more information, visit the CAIR FAQs or How to Enroll pages

Providers in Alpine, Amador, Calaveras, Mariposa, Merced, San Joaquin, Stanislaus, or Tuolumne counties will need to enroll in Healthy Futures/RIDE. For assistance, contact the Healthy Futures/RIDE Help Desk at (209) 468-2292 or support@myhealthyfutures.org.

24. The type of TB test I give is not one of the TB tests currently listed in the TB module. Will those tests be added to CAIR?

If the TB test you administer is not currently listed in the CAIR TB module, please send a note describing the test you use to CAIRHelpDesk@cdph.ca.gov and check back soon, as CDPH is adding more tests to the CAIR TB module. Once your test is included, you are required to report results into CAIR.

25. My site uses CAIR Data Exchange. How do I submit TB tests results via my data exchange file?

All TB test results reported to CDPH are being received and stored by CAIR, thus meeting the TB reporting requirements of AB 1797.

As some TB skin test results may not be reportable to CDPH, CAIR is working on a method to accept these results electronically and will notify providers once the process is in place.

For the General Public

26. How does AB 1797 (Akilah Weber, 2022) affect me?

To better address health equity, AB 1797 (Akilah Weber, 2022) passed to require immunizing providers to collect all patients’ race and ethnicity. When you or your children get an immunization, the doctor, pharmacist, or nurse is required to ask about your race and ethnicity. This information will be entered into the California Immunization Registry (CAIR) or Healthy Futures/RIDE and will help public health officials better understand immunization coverage across all races and ethnicities. If you prefer not to share this information, however, you have the option of asking the provider to select the “prefer not to say” field.

27. May I get a copy of my immunization records from the Digital Vaccine Record portal (DVR)?

Yes, you can access your COVID-19 Vaccine Record (with QR code) or your California Immunization Record from the DVR portal. For more information, please visit the DVR FAQs.

28. What if my digital vaccine records are incomplete or incorrect?

It is possible that vaccine doses you received prior to 2023 have not yet been reported to the California Immunization Registry (CAIR), resulting in your current Digital Vaccine Record being incomplete. This new reporting requirement will improve the completeness of CAIR over the future.

If the personal or contact information on your Digital Vaccine Record (DVR) is incorrect, you may need to request review of your immunization record by submitting a request to the Virtual Assistant. You will be notified of our findings and follow-up actions, generally within a week.

If doses on your record are missing or incorrect, we recommend contacting your healthcare provider to have them update your record by submitting the missing doses to a California Immunization Registry (CAIR). If you were immunized outside of California, you may request that your California healthcare provider submit your doses to CAIR.

If you believe there is an error or need further assistance, please email CAIRHelpDesk@cdph.ca.gov and include your Virtual Assistant Ticket Number along with a description of the issue in your message. Please note that the CAIR Help Desk cannot assist with correcting or adding missing doses to your record.

For Schools

29. How does this requirement impact our school/childcare?

This requirement will ultimately have a positive impact on schools and childcare settings because it will mean that immunization records will become increasingly complete in CAIR or Healthy Futures/RIDE. This will make it easier for schools to obtain complete immunization records of students and determine their school/childcare enrollment eligibility. This also includes schools using the School and Child Care Roster Lookup (SCRL) tool from the CAIR Hub site.

30. How do I address parents’ concerns about privacy?

Explain to them that CAIR or Healthy Futures/RIDE is safe and private. By law, it can be used only by authorized people in their medical office or health plan. In addition, schools, childcare centers, WIC programs, foster care agencies, and other programs can be authorized to look up immunization records—but only for the children they serve. The registry can only be used to check shot records, see what doses are due, and see how many children need immunizations.

Let them know that by law, parents must be informed before their children’s information is added to CAIR or Healthy Futures/RIDE. They must be provided with a copy of the Immunization Registry Notice to Patients and Parents (the ‘Disclosure Form’ – they do not have to sign it) to read.

If parents would prefer to prevent their child’s immunization record from being shared with other CAIR or Healthy Futures/RIDE providers, they must complete the Decline to Share or Start Sharing Immunization Information Request (Lock/Unlock) forms. See CAIR FAQs for more information.