Wisconsin Immunization Program
Childhood Vaccine Information and Schedules
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for the benefit of the general public. The Department of Health
Services does not testify to, sponsor, or endorse the accuracy of the
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Department of Health Services Resources
- Day Care Immunization Assessment Booklet 2011-12 (PDF, 1 MB)
- Day Care
Immunization Record (PDF, 83 KB)
- Day Care
Immunization Record in Spanish (PDF, 14.1
KB)
- Student
Immunization Record (English) (PDF, 46 KB)
- Student
Immunization Record (Spanish) (PDF, 52.0 KB)
- Student
Immunization Record (Hmong) (PDF, 52 KB)
- School Report
to Local Health Department (PDF, 21 KB)
- School Report
to the District Attorney (PDF, 10 KB)
- Vaccine
Administration Record (PDF, 14 KB)
- Vaccine
Administration Record in Spanish (PDF, 15
KB)
- Required Immunizations for School Admission - Legal Notice (English) (PDF,
60.2 KB)
- Required Immunizations for School Admission - Legal Notice (Spanish) (PDF,
66.9 KB)
- Required Immunizations for School Admission - Legal Notice (Hmong) (PDF,
37 KB)
- Varicella, Tdap, and PCV (Pneumococcal) School Requirements
- School Based Clinic Consent-Tdap/Varicella (English) (PDF, 55 KB)
- School Based Clinic Consent-Tdap/Varicella (Spanish) (PDF, 29 KB)
- School Based Clinic Consent-Tdap/Varicella (Hmong) (PDF, 29 KB)
- School Based Clinic Consent-Tdap only (English) (PDF,
27 KB)
- School Based Clinic Consent-Tdap only (Spanish) (PDF,
27 KB)
- School Based Clinic Consent-Tdap only (Hmong) (PDF,
27 KB)
Centers for Disease Control and Prevention (CDC)
American Medical Association (AMA) Link
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Last Revised: January 27, 2012
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