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MARYLAND DEPARTMENT OF HEALTH AND MENTAL HYGIENE IMMUNIZATION CERTIFICATE CHILD'S NAME LAST SEX: MALE G FEMALE G FIRST MI BIRTHDATE / / COUNTY SCHOOL GRADE PARENT OR GUARDIAN NAME PHONE NO. ADDRESS
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What is immunization form?
The immunization form is a document used to report and record information about a person's vaccination history.
Who is required to file immunization form?
Generally, anyone who has received vaccinations is required to file an immunization form.
How to fill out immunization form?
To fill out the immunization form, you need to provide details about the vaccines you have received, including the names of the vaccines, dates of administration, and the healthcare provider who administered the vaccines.
What is the purpose of immunization form?
The purpose of the immunization form is to maintain a record of an individual's vaccination history for various purposes such as school enrollment, healthcare services, and public health monitoring.
What information must be reported on immunization form?
The information that must be reported on the immunization form includes the name of the vaccine, date of administration, lot number of the vaccine, and the healthcare provider who administered the vaccine.
How can I send immunization form to be eSigned by others?
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