Get Immunization Record And Recommendations Form - University Of ... - Uwstout

Filling out the Immunization Record and Recommendations Form is an essential step for students to ensure compliance with health requirements at the University of Wisconsin-Stout. This guide will provide clear, detailed instructions to facilitate the online completion of the form.

Follow the steps to successfully complete the form online.

1. Press the ‘Get Form’ button to access the Immunization Record and Recommendations Form and open it in your preferred application.
2. Begin by entering your full name in the designated field, followed by your student identification number. Next, input your date of birth.
3. Indicate if you are a distance learner by checking the appropriate box if this applies to you. If so, you are exempt from completing this form.
4. For the M.M.R (Measles, Mumps, Rubella) section, provide the dates of the two required doses.
5. Complete the Hepatitis B section by entering the dates of all three vaccine doses. If you were born before January 1, 1957, check the exemption box.
6. Fill in the Tetanus-Diphtheria section by providing the dates for all required doses, including booster information if applicable.
7. In the Polio section, enter the dates for the primary series doses you received as a child.
8. Proceed to complete the Varicella section, indicating whether you have a history of the disease or providing vaccination dates.
9. For the Meningococcal vaccine, enter the date of your last booster. If you are a freshman living in residence halls, ensure you have provided this information.
10. If applicable, fill out the HPV vaccine section with the dates of all doses received.
11. Sign the form, certifying that the information provided is accurate. Include the date of your signature.
12. In the Medical Exemption section, specify any relevant exemptions by checking applicable boxes and providing necessary details. Sign and date this section if you qualify.
13. For Conscientious Exemption, certify your beliefs by signing and dating that section if applicable.
14. After completing the form, ensure you save your changes and download or print a copy. You may also share the filled form as needed.

Complete your document online now to meet your immunization requirements.