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D. Include all supporting documentation such as Court Orders Birth Certificates Guardianship/Custody etc. as applicable. Option 2 Fax to 404-657-7496 Option 3 Email to dph-immreg dph. ga.gov 3. Please allow 3-5 business days for processing. REQUESTED IMMUNIZATION RECORD INFORMATION Last Name Suffix if applicable Jr Sr III etc First Name Date Of Birth Month/Day/Year Full Middle Name Last Name If applicable Gender Please Circle One Male Mother s First Name Maiden Name Female Counties in Georgia...

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