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DEPARTMENT OF HEALTH SERVICES Division of Public Health DPH F00103STATE OF WISCONSIN Bureau of Environmental and Occupational HealthWISCONSIN BLOOD LEAD REGISTRY USER SECURITY AND CONFIDENTIALITY
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To fill out DPH-F-00103, follow these steps:
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Begin by entering the current date in the 'Date' field.
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Fill in the 'Name' field with your full legal name.
04
Provide your date of birth in the 'Date of Birth' field.
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Enter your address in the 'Address' field.
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In the 'Phone Number' field, enter your contact number.
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If applicable, enter your email address in the 'Email' field.
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Specify your gender by selecting the appropriate option.
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Answer the questions related to your medical history, if any.
10
Read and acknowledge the statements at the bottom of the form.
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Sign and date the form to complete the process.

Who needs dph f-00103?

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DPH F-00103 is needed by individuals who are required to provide their personal and medical information for a specific purpose. This form may be required for various purposes such as healthcare registration, employment, or participation in certain programs.
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dph f-00103 is a tax form used for reporting state sales and use tax.
Businesses that sell goods or services subject to state sales tax are required to file dph f-00103.
To fill out dph f-00103, you need to provide information about your sales and use tax collections, exemptions, and any credits you may have.
The purpose of dph f-00103 is to report and remit state sales and use tax collected by businesses.
Information such as total sales, taxable sales, exemptions, and credits must be reported on dph f-00103.
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