Fillable Form (F-42017) - Wisconsin Department of Health Services - dhs wisconsin

DEPARTMENT OF HEALTH SERVICE Division of Public Health F-42017 (Rev. 09/10) WISCONSIN INITIAL REFUGEE HEALTH ASSESSMENT Instructions: STATE OF WISCONSIN s. 252.04, Wis. Stats. (608) 267-3733 FAX: (608) 266-0049 Page 1 of 5 The refugee health assessment must be done with a trained medical interpreter or a medical provider fluent in the refugee's language. The purpose of this form is to assess the initial health...
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