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Get CT ED191 2004-2024

D PRESSURE2 %ILE / Immunization Record Screening/Test Results Screening Test Date of History/Physical Exam (mm/dd/yy) Abnormal/Comments Vaccine (Month/Day/Year) Vision2 Test type: Dose 1 Hearing3 Dose 2 Dose 3 Dose 4 Dose 5 Dose 6 DTP Test type: DTP/Hib Lead4 Risk: Yes/No DTaP DT/Td TB4 Risk: Yes/No OPV IPV Urinalysis (UA)4 MMR Anemia5 (HGB/HCT) Risk: Yes/No Measles Mumps Rubella Developmental Assessment6 HIB Test type: Hep B Has this child received dental care in .

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