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Get AL ADPH-IMM-66 2003-2024

Or offered a copy of the Alabama Department of Public Health Notice of Privacy Practices. Signature: OFFICE USE ONLY Date of Vaccine and VIS Given Vaccine Given Type and Date of VIS Manufacturer and Lot Number Influenza Clinic Site Site of Injection LA RA Route LT RT IM SQ Signature of Nurse Income Assessment: Medicaid Y N American Indian/Alaskan Native Y N Ins.

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