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Immunization Record and Physical Examination (Please type or print.) Last Name First Name Middle Name IMMUNIZATION HISTORY PLEASE PROVIDE DATES: (See accompanying letter for requirements.) TetanusDiphtheria*
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What is immunization record and physical?
Immunization record and physical is a document that records the vaccinations and medical examination a person has received.
Who is required to file immunization record and physical?
All individuals, including students, employees, and residents, are required to file their immunization record and physical.
How to fill out immunization record and physical?
To fill out the immunization record and physical, you need to provide details about the vaccinations you have received and any medical examinations you have undergone. This information should be recorded accurately and signed by a healthcare professional.
What is the purpose of immunization record and physical?
The purpose of the immunization record and physical is to document an individual's vaccination history and medical examination results. It helps ensure that individuals are up-to-date on their vaccinations and have received necessary medical screenings.
What information must be reported on immunization record and physical?
The immunization record and physical should include information about the vaccines received, dates of administration, healthcare provider details, and the results of the medical examination, including any findings or recommendations.
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