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Get Immunization Form - Clover

Skztlls or. fiie at the s h o o ipreschool , or a chiici care facility tnet they attend. A chart showing which vacclnes shouid be given and when is printed on the other side of this form. Diphthei s.Tcianus, OP?/ by mouth. lnfiilenzae B Date Doti 348-013(X) Revised February 2004 Immunization Entry Requirements for Schools, Preschools and Child Care Facilities Vaccines are listed under the routinely recommended ages. Shaded bars indicate range of acceptable ages for vaccination. Age.

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