Section 144-274-6 - Individual's Right To Opt Out Of The Immunization Information SystemA. Any individual may choose to be excluded from the IIS, thereby limiting future access to his or her Immunization Records and Demographic Information from the IIS, by submitting a signed and witnessed document to his or her Immunization Provider on a form prescribed by the Department. The Department's form shall contain, at a minimum, the following information: (2) the Patient's address;(3) the Patient's date of birth;(4) the Patient's signature;(5) the Witness's signature(6) the Patient's reason for the requested exclusion; and(7) the Department address.B. The Patient is responsible for notifying any Immunization Provider at each encounter of the decision to be excluded from the IIS. No Immunization Provider or health plan shall be liable for entering a previously excluded Patient into the Registry if that Patient did not provide that Immunization Provider or health plan with written notice of the exclusion. This rule does not relieve the excluded Patient from the obligation to comply with current immunization requirements set forth in State Law.C. Upon being notified that a Patient wants to be excluded from the IIS, the Immunization Provider is responsible for opting out that Patient from the IIS, and continues to be responsible for the maintenance of appropriate immunization record keeping for the Patient.D. In the event that an individual does not have an Immunization Provider, that Patient shall notify the Department directly in writing on the prescribed form of his or her decision to be excluded from the IIS.10- 144 C.M.R. ch. 274, § 6