Immunization / Health History Form
Wisconsin law [SS 36.25 (46)] requires students who live in a University Residence Hall to affirm whether they have received vaccination against meningococcal disease and hepatitis B, and to provide the dates of vaccination if any. The University Health Services has a health record form for students to complete which is confidential and will be retained by University Health Services. This form is available from the University Health Services web site at: www.uhs.wisc.edu
Students are required to affirm this information before they move into the University Residence Halls.
