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Get TX DSHS C-93 2018-2024

Vaccine checked below. I received or was offered a copy of the Vaccine Information Statement (VIS) for the vaccine listed above. I know the risks of the disease this vaccine prevents. I know the benefits and risks of the vaccine. I have had a chance to ask questions about the disease the vaccine prevents, the vaccine, and how the vaccine is given. I know that the person named below will have the vaccine put in his/her body to prevent the disease this vaccine prevents. I am an adult who can legal.

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