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 Immunization Record and History 2007

Immunization Record and History 2007

Use a Immunization Record And History 2007 template to make your document workflow more streamlined.

Administered the vaccine. State of California Health and Human Services Agency Department of Health Services Immunization Record and History PATIENT NAME Last Name First Name Middle Initial BIRTHDATE Male NUMBER KNOWN REACTIONS TO VACCINES/ALLERGIES PRACTICE NAME/ADDRESS Female VACCINES FOR CHILDREN VFC ELIGIBILITY check one No health insurance CHDP/Medi-Cal eligible American Indian/ Alaskan Native Only federally qualified and rural health centers Health insurance does not cover IZs If a...
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