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  • Wi Dhs F-04020l 2020

Get Wi Dhs F-04020l 2020-2025

DEPARTMENT OF HEALTH SERVICES Division of Public Health F04020L (Rev. 6/2020)STATE OF WISCONSIN Wis. Stat. 252.04 and 120.12 (16)STUDENT IMMUNIZATION RECORD INSTRUCTIONS TO PARENT: COMPLETE AND RETURN.

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Wisconsin Immunization Registry (WIR) is an online database that tracks vaccine records for Wisconsin children and adults. WIR is an important tool that: Helps ensure children and adults receive vaccines on time.

WIR must receive a completed Opt-out request before the record is locked in the WIR. Print name of person whose record will be locked. By signing this Opt-out Request, I confirm that I am the individual, or parent/legal guardian of the child named above.

(3) “DTP/DTaP/DT/Td/Tdap” means any combination of diphtheria, tetanus, and pertussis vaccine; diphtheria, tetanus and acellular pertussis vaccine; pediatric type diphtheria and tetanus vaccine; adult type tetanus and diphtheria vaccine; or tetanus, reduced diphtheria and acellular pertussis vaccine.

To protect students and children from diseases that are preventable by immunization, Wisconsin law requires all students to show that they have received the required immunizations or have a signed waiver.

Registries consolidate an individual's immunizations from all doctors and clinics into one record so the person has a reliable immunization history available even when they move or switch health care.

Waivers: The Wisconsin student immunization requirements can be waived for personal conviction, religious, or medical/health reasons.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
Content Takedown Policy
Bug Bounty Program
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
+1 833 426 79 33
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232