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Staging Region   16.17.0
GRITS Online Registration - Register New Organization
GRITS is an Internet-based immunization registry operated by the Immunization Program of the Georgia Department of Public Health. Enrolled health care providers and schools can enter and/or obtain immunization information for clients, including tracking and reminder functions. Client information is confidential and only available to authorized users.
  New Organization Information
Download Registration Forms and Documents
Organization Name:
Organization Type:
Note: If your organization administers immunizations and no other category applies specifically,
please select 'Private' as Organization Type.
Org Contact Name:
County:
Street 1:
Street 2:
City:
State:
Zip: -
Email:
Area Code:
  Phone Number: -   Ext.   
Who will you designate as your GRITS Administrator for your account?:
First Name Last Name
Administrator:   
I have read, understand, and agree to abide by the GRITS User Agreement and
the GRITS Confidentiality Policy. I understand that, if I violate the GRITS
user requirements, my access to GRITS data can be terminated and I may
be subject to penalties imposed by law.
GRITS User Agreement Read  Accept  Decline
GRITS Confidentiality Policy Read  Accept  Decline
First NameLast Name
Signatory:   
Signatory's Title:
Email:
Area Code:
  Phone Number: - Ext.
Do you wish to have Data Exchange functionality?
  Yes  No
Do you wish to have GRITS Training?
  Yes  No
  Data Exchange Information
Format Type:
Vendor:
Vendor Contact:
Vendor Email:
Area Code:
Phone Number: - Ext.
  Site Information
GRITS Site Name:
County:
Receives Inventory From VFC:  Yes  No
VFC Pin:
Street Address1:
Street Address2:   P.O. Box
City:
State: Zip:  - 
  Site Contacts
First Name Middle Name Last Name     Physician?
Primary:  Yes    No
Secondary:  Yes   No
Primary Email:
Secondary Email:
Primary Telephone#: () - Ext.
Secondary Telephone#: () - Ext.
Fax#: () - Ext.
  Registration Forms and Documents
Enrollment Form (clinical setting)
Enrollment Form (non-clinical setting)
GRITS User Agreement
GRITS Confidentiality Policy
Add Site Form
Real Time Interface Client Installation Guide
newOrg.fax=GRITS Flat File Specifications
GRITS HL7 2.3.1 and 2.4 Specifications
GRITS HL7 2.5.1 Specifications
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