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  • Wi Dhs F-04002 2015

Get Wi Dhs F-04002 2015-2026

DEPARTMENT OF HEALTH SERVICES Division of Public Health F-04002 (Rev. 08/08) STATE OF WISCONSIN s. 252.04, Wis. Stats. SCHOOL REPORT TO LOCAL HEALTH DEPARTMENT Wisconsin State Statute 252.04 requires.

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How to fill out the WI DHS F-04002 online

Filling out the WI DHS F-04002 form is essential for schools to report the vaccination status of their students to local health departments. This guide will provide you with clear, step-by-step instructions to complete the form correctly and efficiently.

Follow the steps to successfully fill out the WI DHS F-04002 online.

  1. Click ‘Get Form’ button to access the document and open it in the online editor.
  2. Begin by entering the telephone number, ID number from the address label, the school district, and the school year in the appropriate fields.
  3. Next, provide the name of the principal and the person completing the form in the designated sections.
  4. Fill in the name of the school as listed on the label and complete the school's address, including city/town, zip code, and county.
  5. Indicate the number of students in each category from prekindergarten to grades 1-12. Refer to the specified categories: those meeting all minimum requirements, those in process with vaccination, those behind schedule, those with no record on file, and those with various waivers.
  6. Ensure that the total of all categories equals the enrollment for the grades included in the column to maintain accurate records.
  7. Once all fields are accurately filled out, you can save changes, download the form, print it for your records, or share it with relevant parties as needed.

Start filling out the WI DHS F-04002 online to ensure compliance and keep your school's vaccination records up to date.

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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.

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.

This may have happened for a number of reasons: The person's vaccine record may not have been recorded in WIR by a doctor's office. The person's vaccine record is in WIR, but the searchable information (for example, the social security number, date of birth, or chart number) may be missing or wrong.

Wisconsin's statewide, population-based IIS, the Wisconsin Immunization Registry (WIR), was established in 2000 by the Wisconsin Divisions of Public Health (WDPH) and Health Care Access and Accountability.

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. Reduces the time and money it takes you to get old vaccine records.

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.

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.

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