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  • Wi Dhs F-04002 2021

Get Wi Dhs F-04002 2021-2025

DEPARTMENT OF HEALTH SERVICES Division of Public Health F04002 (Rev. 07/2021)STATE OF WISCONSIN Wis. Stat. 252.04 Page 1 of 5SCHOOL REPORT TO LOCAL HEALTH DEPARTMENT, 20212022 Wisconsin Stat. 252.04.

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How to fill out the WI DHS F-04002 online

The WI DHS F-04002 form is essential for schools in Wisconsin to report student immunization compliance to local health departments. This guide will provide clear and supportive instructions on how to complete the form online.

Follow the steps to accurately fill out the form.

  1. Click the ‘Get Form’ button to obtain the form and open it for completion.
  2. In Section A, fill out the school’s information, including the Local Education Agency (LEA) code and the DPI School Code. Ensure you accurately report the grades enrolled at the school.
  3. In Section B, categorize the number of students based on immunization compliance for each vaccine. Use the specific categories (e.g., meets minimum requirements, in process) for accurate reporting. Remember to enter zeros where applicable.
  4. Section C requires you to report the total number of students meeting specific criteria such as those with waivers or those with no immunizations. Ensure that the sums are accurate and align with your data.
  5. In Section D, list the number of students who have specific types of waivers, ensuring that each metric is clear and accurate.
  6. After completing all sections, review the form for accuracy. Make any necessary corrections and ensure all data is complete before submitting.
  7. Finally, you can save changes, download, print, or share the form as needed.

Complete your forms online today to ensure timely compliance with health reporting requirements.

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Click on the 'Public Immunization Record Access' hyperlink from the login screen for the Wisconsin Immunization Registry web site. The Public Access Search screen displays. Enter the first name, last name, and date of birth for the person whose record you are searching for. These are required fields.

Choosing to opt-out of participation in the WIR, for yourself, or your child, means that the demographic and immunization information is locked so it is not available to any WIR users or to the individual themselves.

Waiver: Waivers are available for medical/health, religious, or personal conviction reasons. Children for whom waivers are filed are compliant.

Students should receive the Tdap (tetanus, diphtheria and acellular pertussis) vaccine before the start of 7th grade rather than 6th grade. Students who received one dose of Tdap prior to the start of 6th grade under the previous requirement are compliant and do not need to receive an additional dose of Tdap.

Parents who choose to waive an immunization are required to sign a waiver on the Student Immunization Record form, F-04020L, and list the dates (month, day, year) of all of the vaccines the child has already received.

Failure to meet Wisconsin's immunization requirements is AGAINST THE LAW. If you fail to comply with the law, you may be fined up to $25 per day, and your child may be excluded from child care or school.

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.

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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
Privacy Notice
Legal Hub
Content Takedown Policy
Bug Bounty Program
About Us
Help Portal
Legal Resources
Blog
Affiliates
Contact Us
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 WorkFlow
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