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P×PORTSMOUTH Health Department
1701 High Street, Suite 1O2
Portsmouth, VA 23704
(7s7) 393858s
FAX: (757) 3938027Health Department WIC PROGRAM
17O1 High Street, Cfrdrthrg aQotrtefir goodtteaftt. Suite
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The document is the TDAP form.
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Parents or guardians of students.
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The form requires information on the student's name, date of birth, and vaccination records.
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