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Get AL Public Health Pediatric Immunization Record 2009-2024

History of Chickenpox? YES or NO If yes, date if known: Vaccine (circle correct vaccine) DT DTaP Age at VIS Form Given Manuf the time Type Mo Yr Abbr* Mo Day Yr Date Admin DTP Lot Number Provider Initials*** or Dose Admin Route VFC Outside Provider Name Site a 0.5cc LT RT LA RA IM LT RT LA RA LT RT LA RA IM IM DT DTaP DTP 0.5cc DT DTaP DTP 0.5cc DT DTaP DTaP-Hib DTP Hib DTP Polio 0.5cc LT RT LA RA 0.5cc LA RA IM Td Tdap 0.5cc LA RA.

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