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Inquiries may be directed to Dr. Dara Ware Allen Title IX Coordinator or the Section 504/ADA Title II Coordinator at 341 S. Bellefield Avenue Pittsburgh PA 15213 or 412. VISION subjective until age 3 HEARING subjective until age 4 LEAD RECORD DATES OF IMMUNIZATIONS BELOW OR ATTACH A PHOTOCOPY OF THE CHILD S IMMUNIZATION RECORD IMMUNIZATIONS COMMENTS HEP-B ROTAVIRUS DTAP/DTP/TD HIB PNEUMOCOCCAL POLIO INFLUENZA MMR VARICELLA HEP-A MENINGOCOCCAL OTHER MEDICAL CARE PROVIDER SIGNATURE OF PHYSICIAN...
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