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HEALTH RECORD IMMUNIZATIONSNAME (print)LastFirstMiddleHOME ADDRESS Street HOME PHONECityStateZip DOB(include are code)Country /Month/ Daycare×Maine State Law (22MRSA 6359) requires ALL full time

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How to fill out title 20-a 6359 immunization

01

Obtain a copy of the title 20-a 6359 immunization form.

02

Fill in the required personal information such as name, date of birth, and address.

03

Provide information about the type of immunizations received, including dates and names of vaccines.

04

Make sure the form is signed and dated by a healthcare provider.

05

Submit the completed form to the relevant institution or organization.

Who needs title 20-a 6359 immunization?

01

Individuals who are required to provide proof of immunization status for school enrollment or employment purposes may need title 20-a 6359 immunization.

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What is title 20-a 6359 immunization?

Title 20-a 6359 immunization refers to the specific section of law that requires individuals to provide proof of immunization for certain diseases.

Who is required to file title 20-a 6359 immunization?

Students attending school or child care facilities are typically required to file title 20-a 6359 immunization.

How to fill out title 20-a 6359 immunization?

Title 20-a 6359 immunization forms can usually be filled out by providing documentation from a healthcare provider showing the individual's immunization history.

What is the purpose of title 20-a 6359 immunization?

The purpose of title 20-a 6359 immunization is to protect public health by preventing the spread of communicable diseases.

What information must be reported on title 20-a 6359 immunization?

Title 20-a 6359 immunization typically requires information on the individual's vaccination history, including dates and types of vaccines received.

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