Form F-05102 Wisconsin Immunization Registry Opt-Out Request - Wisconsin

Form F-05102 Wisconsin Immunization Registry Opt-Out Request - Wisconsin

What Is Form F-05102?

This is a legal form that was released by the Wisconsin Department of Health Services - a government authority operating within Wisconsin. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form F-05102?
A: Form F-05102 is a Wisconsin Immunization Registry Opt-Out Request.

Q: What is the purpose of Form F-05102?
A: The purpose of Form F-05102 is to request to opt-out of the Wisconsin Immunization Registry.

Q: Who needs to fill out Form F-05102?
A: Anyone who wishes to opt-out of the Wisconsin Immunization Registry needs to fill out Form F-05102.

Q: What information is required on Form F-05102?
A: Form F-05102 requires the individual's name, date of birth, address, and signature.

Q: How do I submit Form F-05102?
A: Form F-05102 can be submitted by mail or fax to the contact information provided on the form.

Q: What happens after submitting Form F-05102?
A: After submitting Form F-05102, the individual's information will be removed from the Wisconsin Immunization Registry.

Q: Is there a deadline to submit Form F-05102?
A: There is no specific deadline to submit Form F-05102, but it is recommended to submit it as soon as possible.

Q: Can I opt back in to the Wisconsin Immunization Registry after submitting Form F-05102?
A: Yes, individuals can choose to opt back in to the Wisconsin Immunization Registry at any time by completing a new consent form.

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Form Details:

  • Released on July 1, 2019;
  • The latest edition provided by the Wisconsin Department of Health Services;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form F-05102 by clicking the link below or browse more documents and templates provided by the Wisconsin Department of Health Services.

Download Form F-05102 Wisconsin Immunization Registry Opt-Out Request - Wisconsin

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