Get Wi Dhs F-04020l 2020-2026

Filling out the WI DHS F-04020L form, also known as the student immunization record, is an essential step for parents and guardians to ensure compliance with Wisconsin state law. This guide will walk you through the process of completing the form online, providing clear instructions for each section.

Follow the steps to accurately complete the student immunization record online.

1. Press the ‘Get Form’ button to access the form and open it in your chosen editor.
2. Provide the personal data required, including the student's name, the name of the parent, guardian, or legal custodian, and the student's birthdate in MM/DD/YYYY format. Indicate the gender, school, grade, address (including street, city, state, and zip code), school year, and the telephone number.
3. In the immunization history section, list the month, day, and year your child received each vaccination. Do not use a check mark or 'X', except when indicating your child's history with chickenpox. If you are unsure about the immunization dates, reach out to your healthcare provider or local health department for assistance.
4. For the compliance data section, check whether the student meets all immunization requirements, and sign where indicated. If the student does not meet the requirements, check the appropriate box to acknowledge their current status and your responsibility for timely updates.
5. If applicable, indicate any health, religious, or personal convictions waivers for vaccinations as per the provided instructions. Ensure that relevant immunizations are cited in this section.
6. Complete the signature field by signing your name as the parent, guardian, legal custodian, or adult student, and date the form. Review all information for accuracy before submission.
7. Once you have reviewed the entire form and confirmed its completeness, save your changes. You can then download, print, or share the document as required.

Complete your forms online quickly and easily today.