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Get the free CHILD INFORMATION RECORD State of Michigan - Department of ...

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Examinations and/or Inspections Essential Findings Deviating from Normal Exam Date Page 1 of 2 Rev. July 2015 SECTION III - IMMUNIZATIONS Statements such as UP-TO-DATE or COMPLETE will not be accepted. Admission to school may be denied on the basis of this information. DATE ADMINISTERED VACCINES Circle Type Hepatitis B HepB DTaP/DTP/DT/Td MM/DD/YYYY Hepatitis A HepA Influenza IIV/LAIV Meningococcal MCV4 / MPSV4 Human Papillomavirus HPV9/HPV4/HPV2 Tdap Haemophilus Influenzae type b HIB...
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