Get the free Student Immunization Record - wsalem.k12.wi.us
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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 RECORD INSTRUCTIONS TO PARENT: COMPLETE AND RETURN
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How to fill out student immunization record
How to fill out student immunization record
01
Step 1: Gather all necessary information, including the student's personal details, vaccination information, and any relevant medical history.
02
Step 2: Obtain the official student immunization record form from the school or healthcare provider. Make sure to use the correct form that meets the requirements of the educational institution or jurisdiction.
03
Step 3: Fill in the student's personal information, such as name, date of birth, and contact details.
04
Step 4: Provide accurate details about the vaccinations the student has received. Include the vaccine type, date of administration, lot number, and the healthcare provider or clinic where it was given.
05
Step 5: If the student has any medical exemptions or allergies, ensure to mention them on the form. If applicable, provide supporting documentation from a healthcare professional.
06
Step 6: Review the completed form for accuracy and completeness. Ensure that all required fields are filled out and all information is legible.
07
Step 7: Sign and date the form as the responsible person filling out the record.
08
Step 8: Submit the completed student immunization record to the designated school or educational institution as per their requirements.
09
Step 9: Keep a copy of the completed form for your records and future reference.
Who needs student immunization record?
01
Student immunization records are necessary for all students attending educational institutions, such as schools, colleges, universities, and childcare centers.
02
Parents or guardians of students are responsible for providing and maintaining accurate immunization records for their children.
03
School administrators, healthcare professionals, and public health officials may also require access to student immunization records for various purposes, including tracking and ensuring compliance with vaccination requirements, disease surveillance, and public health planning.
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What is student immunization record?
Student immunization record is a document that contains a student's vaccination history, showing which vaccines they have received.
Who is required to file student immunization record?
Parents or legal guardians are typically required to file the student immunization record for their child.
How to fill out student immunization record?
The student immunization record can be filled out by providing information on the vaccines the student has received, including the dates and types of vaccines.
What is the purpose of student immunization record?
The purpose of student immunization record is to ensure that students are properly vaccinated to protect their health and prevent the spread of communicable diseases.
What information must be reported on student immunization record?
The student immunization record must include information on the vaccines received, dates of vaccination, and any exemptions or waivers granted.
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