Get the free STUDENT IMMUNIZATION RECORD

DEPARTMENT OF HEALTH SERVICES Division of Public Health F-04020L (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 the student immunization record:

1. Obtain the student immunization record form from your school or healthcare provider. This form is usually required by schools and colleges to ensure that students are up-to-date with their vaccinations.
2. Fill in the student's personal information such as full name, date of birth, address, and contact information. It's important to provide accurate details to avoid any confusion.
3. Provide the student's medical history, including any known allergies or medical conditions that may affect their immunization.
4. Record the specific vaccinations received by the student. Include the name of the vaccine, the date it was administered, and the healthcare provider who administered it. If there are multiple doses required for a specific vaccine, make sure to indicate each dose separately.
5. If the student has not received all the required vaccinations, leave those sections blank or indicate "Not Yet Received." Make a note to follow up with the healthcare provider to complete the necessary vaccinations.
6. If the student has received any exemptions or waivers from vaccinations, clearly document those exemptions and the reasons for them, as required by your school or local health department.
7. Before submitting the form, review it thoroughly for accuracy and completeness. Ensure that all information is legible and there are no missing or inconsistent entries.

Who needs the student immunization record?

1. Schools and colleges require the student immunization record to ensure that students are protected from preventable diseases and to create a safe and healthy learning environment.
2. Healthcare professionals may also request the student immunization record to assess the student's vaccination status and provide appropriate healthcare services.
3. Parents or guardians of the student may need the immunization record for various purposes, including enrolling the student in a new school, participating in certain activities, or ensuring the student's health and well-being.

It's important to check with your school or local health department for specific requirements regarding the student immunization record and who needs access to it.

For pdfFiller’s FAQs

What is student immunization record?

Student immunization record is a documented record of the vaccinations or immunizations received by a student.

Who is required to file student immunization record?

Parents or guardians of students are typically required to file the student immunization record with the school or relevant authorities.

How to fill out student immunization record?

The student immunization record can be filled out by providing details of the vaccinations received including the type of vaccine, date administered, and healthcare provider.

What is the purpose of student immunization record?

The purpose of student immunization record is to ensure that students are protected against preventable diseases and to comply with school or government regulations.

What information must be reported on student immunization record?

The student immunization record must include details such as the student's name, date of birth, vaccine types received, dates administered, and healthcare provider information.

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