Professional Documents
Culture Documents
D-19Vac
cinat
ionRec
ordCar
d
Pl
ea ekeepthi
srec
ordcard,
whichincludesmedi
cali
nfor
mat
ion
aboutthevacci
nesyouhavere
ceived.
Porfavor
,guar
dee s
tata
rtej
aderegisto,quei
ncl
uyei
nfor
macion
me dic
aobrelasva
cunaqueharecibido.
L
ast
Name F
ir
stNa
me MI
Da
teof
bir
th P
ati
ent
numbe
r(me
dic
alr
eco
rdo
rII
Sre
cor
dnumbe
r)
1s
t
Dos
e . .
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
.._
. __
_/_
___
/__
__
COVI
D-19 mm dd yy
2r
d
Dos
e . .
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
..
..
.
.._
. __
_/_
___
/__
__
COVID-19 mm dd yy
_
___
/__
__/
____
Ot
her
mm dd y y
_
___
/__
__/
____
Ot
her
mm dd y y