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Screening Checklist for Contraindications to Vaccines for Adults patient name Last: date of birthmonthFirst: /day/DOD ID #: careful SSN: (SEPARATE SCREENING SHEET FOR Anthrax, Smallpox, Typhoid)For
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How to fill out patient name last

How to fill out patient name last
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To fill out the patient name last, follow these steps:
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Start by writing the patient's last name in the designated box or space.
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If the patient has a suffix, such as Jr. or Sr., include it after the last name.
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