Application For Electronic Reporting to CT WiZ (HL7/UI)

Please read the requirements before completing the Application

All vaccinating health care providers are required to report electronically to CT WiZ. Please complete this application to submit your intention to start the CT WiZ electronic reporting process. Below are your options for reporting:
  • Bi-directional (VXU and Query & Response): connect your EHR to CT WiZ to automatically submit immunizations you entered in EHR, and your staff can electronically query CT WiZ for your patients' immunization records and forecasting
  • Uni-directional reporting (VXU-only): connect your EHR to CT WiZ to automatically submit immunizations you entered in your EHR
  • User Interface (Direct Data Entry in CT WiZ): your staff can login to CT WiZ and manually enter vaccines administered (this option is used when a clinic does not have an Electronic Health Record (EHR) that can connect to to CT WiZ)
  • Both (User Interface/Bi-directional): start this option in parallel when your EHR vendor requires additional time to setup your interface. Your staff can start with the user interface and once the EHR interface is ready, DPH will support you to transition to just EHR reporting
  • Query and Response (Query-only): from your EHR your staff can electronically query CT WiZ for your patients' immunization records and forecasting
  •  The application process takes approximately 10-15 minutes to complete.
  •  If the organization has more than five locations, click on "More Than Five Locations" and complete the spreadsheet.
  •  Complete the required fields * on the form.
  •  At the bottom of the form, click on "Upload More Than Five Locations" and upload the "ClinicLocations" spreadsheet.
* - Required Field
 Bi-directional
 Uni-directional reporting (VXU-only)
 User Interface (Direct Data Entry in CT WiZ)
 Both (User Interface/Bi-directional)
 Query and Response (Query-only)

Provider Organization Information

National Provider Identifier
 Yes  No

Organization Point of Contact



 Yes  No
 Yes  No

List of Locations that Give Immunizations

 Yes  No
  •  If the organization has more than five locations, click on More Than Five Locations and completed the spreadsheet.

 Yes  No

 Yes  No

 Yes  No

 Yes  No

Vendor/HL7 and Software Information (Contact your EHR Vendor/IT Contact/Hub)


Vendor/EHR Primary Point of Contact

 Program Manager  Developer
 Yes  No
 Yes  No
 Yes  No

Upload the "more than five locations spreadsheet"

 Yes  No
How to attach file(s)

Click on "Select files....", select your document(s), click on "OPEN" and click "UPLOAD" to attach document(s) or "CLEAR" to remove document(s). You can only upload XLS, XLSX, XLSM files.