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DEPARTMENT OF HEALTH & FAMILY SERVICES Division of Public Health DPH 4020L (Rev. 12/05) STATE OF WISCONSIN 252.04 and 120.12 (16) Wis. Stats. STUDENT IMMUNIZATION RECORD INSTRUCTIONS TO PARENT: COMPLETE

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dph4020l1205doc is a specific document required to be filed with the Department of Public Health.

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Healthcare facilities and providers are required to file dph4020l1205doc.

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The dph4020l1205doc form can be filled out online or submitted via mail with the required information.

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The purpose of dph4020l1205doc is to ensure that healthcare facilities and providers are compliant with public health regulations.

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