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MMR Measles Mumps Rubella both doses must be after 1st birthday 1st immunization 2nd immunization VERIFICATION / / Office stamp RECOMMENDED BUT NOT REQUIRED 1. Meningitis Vaccine Texas State law requires this for new students under age 22 /Menveo/MCV4 within past 5 years Circle One 2. For Health Center Only Date/Initial Complete yes no CCESS Hold MCV4 MMR Dr. Bob Smith Health Center P. O. Box 750195 Dallas Texas 75275---0195 Phone 214---768---2141 Fax 214---768---2151 Email healthcenter smu....
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