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DEPARTMENT OF HEALTH SERVICES Division of Public Health F04020L (Rev. 02/08) STATE OF WISCONSIN 252.04 and 120.12 (16) Wis. Stats. STUDENT IMMUNIZATION RECORD INSTRUCTIONS TO PARENT: COMPLETE AND

How to fill out student immunization record

How to fill out a student immunization record:

1. Gather all relevant immunization information: Before filling out the student immunization record, gather all the necessary immunization information such as the dates and types of vaccines received. This information can usually be obtained from the student's doctor or healthcare provider.
2. Fill in the student's personal information: Start by filling in the student's personal information on the record. This typically includes their full name, date of birth, gender, and contact information.
3. Enter the dates and types of vaccines: In the designated sections of the record, enter the dates and types of vaccines the student has received. It is important to accurately enter this information to ensure the record is comprehensive and up to date.
4. Include information about vaccine boosters: Some vaccines require booster shots at specific intervals. Make sure to include this information on the record if applicable, noting down the date of the booster shot.
5. Document any vaccine exemptions: If the student has received exemptions for any vaccines due to medical or religious reasons, make sure to indicate this on the record. In most cases, additional documentation may be required to support the exemption.
6. Review and double-check the information: After completing the record, review all the information entered and double-check for accuracy. It is essential to maintain accurate and up-to-date immunization records for students.
7. Sign and submit the record: Once the record is complete and accurate, sign and submit it to the relevant parties. This can include the student's school, healthcare provider, or other authorized entities that require the immunization information.

Who needs a student immunization record:

1. Schools and educational institutions: Student immunization records are typically required by schools and educational institutions to ensure compliance with vaccination requirements. These records help create a safe and healthy environment for all students.
2. Health departments: Local or state health departments may require student immunization records to track vaccination rates and monitor disease outbreaks. These records are important for public health purposes.
3. Healthcare providers: Student immunization records are essential for healthcare providers to keep track of a patient's immunization history. This information helps in providing appropriate care and ensuring that all required vaccinations are up to date.

In conclusion, filling out a student immunization record involves gathering immunization information, entering personal details, documenting vaccine dates and types, noting any exemptions, reviewing and double-checking the information, and finally signing and submitting the record. These records are needed by schools, health departments, and healthcare providers to ensure compliance with vaccination requirements and monitor public health.

For pdfFiller’s FAQs

What is student immunization record?

Student immunization record is a document that contains information about the vaccines a student has received, including dates and types of vaccines.

Who is required to file student immunization record?

Parents or guardians are typically required to file student immunization records for their children before they can attend school.

How to fill out student immunization record?

Student immunization records can be filled out by healthcare providers or parents/guardians, and should include information such as vaccine names, dates of administration, and healthcare provider signatures.

What is the purpose of student immunization record?

The purpose of student immunization record is to ensure that students are up-to-date on their vaccines, which helps protect them and others from vaccine-preventable diseases.

What information must be reported on student immunization record?

Student immunization records typically include the student's name, date of birth, vaccine names, dates of administration, and healthcare provider information.

How do I edit student immunization record online?

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