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Hittites County COVID-19 Vaccine Acknowledgement Form
NAME (Last)(First)(M.I.) Date of BirthAddressCityStateZip Voicemail addressPhoneSex
Male Female Transgender
Otherwise of Primary Care Provider:Acknowledgements:
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Male, female, and transgender are terms used to describe gender identities. Male refers to someone who identifies as a man, female refers to someone who identifies as a woman, and transgender refers to someone whose gender identity does not correspond with the sex they were assigned at birth.
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