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  • Influenza: Vaccine Type & Batch No. Date Given Administered by (Clinic, Doctor, Etc) Next Dose Date

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    Adit Yanuardi
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    Vaccine revisi

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    3 views2 pages

    Influenza: Vaccine Type & Batch No. Date Given Administered by (Clinic, Doctor, Etc) Next Dose Date

    Uploaded by

    Adit Yanuardi

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    Date Administered By Next Dose

    Vaccine Type & Batch No.


    Given (clinic, doctor, etc) Date

    Influenza

    Diphteria, Tetanus,
    Pertussis

    Varicella (chickenpox)

    Human Papillomavirus

    Zoster

    Measles, Mumps,
    Rubella (MMR)

    Hepatitis A

    Hepatitis B

    Vaccine Type & Batch No. Date Administered By Next Dose


    Given (clinic, doctor, etc) Date

    Hepatitis A

    Pneumococcal

    Meningococcal

    Japanese Enchephalitis
    (JE)

    Other

    INSTRUCTIONS
    Record the type of vaccine and the Date for each vaccination given. Take a copy of your
    immunization record with you when you visit a healthcare professional. Have them assist
    you in completing the form. For information about the vaccines and recommended
    immunization schedules, pleas ask your healthcare professional.

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