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CERTIFICATE OF IMMUNIZATION FOR 20192020 Name: Vaccine Circle one vaccine: Tap DTP DT Date (MM/DD/BY)Tap DTP DT TD Tap DTP DT TD Tap DTP DT TD Tap DTP DT TD Trap TD Combination Vaccines: may use codes
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To fill out the vaccine information statement for diphtheria-tetanus-pertussis, follow these steps:
02
Gather all the necessary information about the patient, such as their name, date of birth, and contact information.
03
Identify the healthcare provider who will administer the vaccine and note their details.
04
Obtain the appropriate vaccine information statement form for diphtheria-tetanus-pertussis.
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Read the form carefully and fill in all the required fields.
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Make sure to include accurate and up-to-date information.
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Provide any additional information or comments, if necessary.
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Review the completed form for any errors or missing information.
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Sign and date the form as the healthcare provider or authorized representative.
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Distribute the filled out form to the patient or their legal guardian.
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Retain a copy of the form for your records.

Who needs vaccine information statementdiphformria-tetanus-pertussis?

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The vaccine information statement for diphtheria-tetanus-pertussis is needed by individuals who are receiving the vaccine or their legal guardians. This includes:
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- Infants and children who are due for the vaccination according to the recommended immunization schedule.
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- Adolescents and adults who require a booster dose or have not received the vaccine previously.
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- Healthcare providers who administer the vaccine and need to provide accurate information to their patients.
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