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DEPARTMENT OF HEALTH SERVICES Division of Public Health F04020L (Rev. 6/2018)STATE OF WISCONSIN Wis. Stat. 252.04 and 120.12 (16)STUDENT IMMUNIZATION RECONSTRUCTIONS TO PARENT: COMPLETE AND RETURN
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How to fill out student immunization record
How to fill out student immunization record
01
To fill out a student immunization record, follow these steps:
02
Obtain a copy of the immunization record form from your school or healthcare provider.
03
Gather the necessary information, including the student's personal details such as name, date of birth, and contact information.
04
Provide information about the student's immunization history, including the dates and types of vaccines received.
05
Make sure to accurately record the vaccine manufacturer, lot number, and the healthcare provider who administered each vaccine.
06
If any vaccines are missing, talk to your healthcare provider about the necessary immunizations and get them administered to the student.
07
Sign and date the form, certifying that the information provided is accurate and complete.
08
Submit the completed immunization record to your school or healthcare provider as per their instructions.
Who needs student immunization record?
01
Student immunization records are needed by:
02
Schools and educational institutions to ensure compliance with state and local regulations regarding immunization requirements.
03
Healthcare providers to maintain a comprehensive record of a student's immunization history and to track any necessary vaccinations.
04
Parents or guardians who may need the records for enrollment in school or participation in extracurricular activities.
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What is student immunization record?
Student immunization record is a document that shows a student's vaccination history.
Who is required to file student immunization record?
Schools and parents are typically required to file student immunization records.
How to fill out student immunization record?
Student immunization records are usually filled out by healthcare providers or school nurses.
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 vaccinations.
What information must be reported on student immunization record?
Student immunization records typically include the type of vaccine, date administered, and healthcare provider information.
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