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MONTHLY IMMUNIZATION REPORT

Brgy. Calaocan District, Rizal, Nueva Ecija


Date: _______________________________

Vaccine Taken
Name of Mother/Guardian Name of Child Birthdate Age Height Weight BCG DPT OPV Hepatitis B M Nut. Other Vaccines/
Stat Remarks
6 10 14 6 10 14 6 14 9
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Prepared By: Checked By: Approved By:

Barangay Nutrition Scholar Midwife Barangay Chairman

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