Get Division Of Public Health F-04020l Rev 0712 67817 - Fvlhs

This guide provides clear, step-by-step instructions for completing the Division Of Public Health F-04020L Rev 0712 67817 - Fvlhs form online. Whether you are a parent or guardian, this resource will assist you in ensuring that your child's immunization records are accurately reported.

Follow the steps to complete your form accurately.

1. Select the ‘Get Form’ button to access the form and open it in your editor.
2. Begin by entering the student’s name and birthdate in the specified fields. This information is crucial for identifying the records associated with your child.
3. Next, fill in the name of the parent or guardian along with their contact details. This establishes the responsible party for the immunization records.
4. Provide the student's school, grade, and address. Ensure that all information is accurate to avoid any complications with the school’s record-keeping.
5. For immunization records, list each required vaccine received by your child. Use the appropriate format for the dates, and ensure you include all doses received.
6. Indicate if your child has had chickenpox disease by checking the appropriate box and providing the year if known. This may affect vaccine requirements.
7. Review any additional notes regarding immunization requirements, and make sure to sign the form in the designated area. Your signature confirms the accuracy of the information provided.
8. Finally, complete the submission by saving changes, downloading, printing, or sharing the completed form as required by your school.

Complete your immunization documentation online today to ensure compliance with school requirements.