imMTrax Forms

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Please call 1 (406) 444-5580 or (833) 254-3876
Monday - Friday, 8am-5pm (MST)




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imMTrax Consent Forms

imMTrax New User Access Form

To apply for imMTrax access, a completed Non-DPHHS Employee System/File Access Request form and Single User Memorandum of Agreement (imMTrax Access Request form below) is required for each individual user and must be approved by IIS staff before a new user will be granted an imMTrax user login. The role descriptions below can assist you in determining what access role best fits your system workflow needs. For questions regarding appropriate access levels for individual imMTrax users, contact the Montana Immunization Program at (406) 444-5580.

imMTrax Access Request Form (updated January 2021)


Access Levels

  1. Read Only with Consent - Search, View, Print, and Update imMTrax Consent Status
  2. Record Maintenance - Search, View, Print, Update and Add Patient Information and Add Immunizations
  3. Vaccine Mgmt - Search, View, Print, Update/Add Client Information, Add Immunizations, and vaccine lot management (VOMS 2.0)


imMTrax Access Change Request Form

imMTrax Access Deletion Form