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DEPARTMENT OF HEALTH & FAMILY SERVICES Division of Public Health DPH 4020L (Rev. 02/08) STATE OF WISCONSIN 252.04 and 120.12 (16) Wis. Stats. STUDENT IMMUNIZATION RECORD INSTRUCTIONS TO PARENT: COMPLETE
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How to fill out student immunization recordstudent services
How to fill out student immunization record student services:
01
Make sure you have the required immunization records handy.
02
Start by filling out the personal information section of the form, including the student's name, date of birth, and contact information.
03
Provide the name and contact information of the student's healthcare provider or clinic.
04
Indicate the current academic year and school that the student is attending.
05
Enter the dates and details of each immunization received, including the vaccine name, date administered, and healthcare provider or clinic that administered it.
06
If the student has any medical exemptions or contraindications to certain vaccines, make sure to document them properly on the form.
07
Double-check all the information entered to ensure accuracy and completeness.
08
Sign and date the form, certifying that the information provided is true and correct.
09
Submit the completed immunization record to the appropriate student services department or school administration.
Who needs student immunization record student services:
01
All students, regardless of grade level or age, may need student immunization record student services.
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Schools and educational institutions require students to provide proof of immunization to ensure the safety and well-being of the entire school community.
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Student immunization records help healthcare providers and schools track and manage immunization compliance and prevent the spread of vaccine-preventable diseases.
04
In some cases, certain students may be exempt from specific vaccines due to medical or religious reasons, and the immunization record helps document these exemptions.
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What is student immunization recordstudent services?
Student immunization recordstudent services is a document that records a student's immunizations and vaccinations.
Who is required to file student immunization recordstudent services?
All students are required to file student immunization recordstudent services.
How to fill out student immunization recordstudent services?
To fill out student immunization recordstudent services, students need to provide documentation of their vaccinations and immunizations.
What is the purpose of student immunization recordstudent services?
The purpose of student immunization recordstudent services is to ensure that all students are properly vaccinated to prevent the spread of diseases.
What information must be reported on student immunization recordstudent services?
Student immunization recordstudent services must include the student's name, date of birth, and a record of all vaccinations received.
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