Get And Sign COMMONWEALTH OF KENTUCKY IMMUNIZATION CERTIFICATE Beta Calloway Kyschools 2010-2021 Form

Longer valid and a new certificate must be obtained. I CERTIFY THAT THE ABOVE NAMED CHILD HAS RECEIVED IMMUNIZATIONS AS STIPULATED ABOVE. Signature of physician APRN PA pharmacist LHD administrator or nurse designee Date Name of Office or Licensed Healthcare Facility This certificate should be presented to the school or facility in which the child intends to enroll and should be retained by the school or facility and filed with the child s health record. Hib not required at 5 years of age or...