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Complete the following: Middle Initially (Family) NameFirst Name___SMC ID___Birth Date# Program: Undergraduate English Language/Pathway Other UNDERGRADUATES ONLY Class Year Immunization Record
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How to fill out immunization record
How to fill out immunization record
01
Obtain a copy of the immunization record form from your healthcare provider or school.
02
Fill out the personal information section with your name, date of birth, address, and contact information.
03
Document the dates of each vaccination you have received, along with the type of vaccine and dosage.
04
Include the healthcare provider or clinic where each vaccination was administered.
05
Make sure to sign and date the form to certify its accuracy.
06
Keep the original copy of the completed immunization record for your records, and provide a copy to your healthcare provider or school as needed.
Who needs immunization record?
01
Anyone who has received vaccinations as part of their medical history should have an immunization record.
02
Children attending school or daycare often require an up-to-date immunization record to enroll.
03
Adults may need to provide their immunization record for certain jobs, travel, or healthcare appointments.
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What is immunization record?
An immunization record is a document that contains a detailed record of a person's vaccinations and immunizations.
Who is required to file immunization record?
All individuals, especially children, are required to have an immunization record on file with their healthcare provider or school.
How to fill out immunization record?
To fill out an immunization record, you will need to provide information about the vaccines received, the dates they were administered, and the healthcare provider who administered them.
What is the purpose of immunization record?
The purpose of an immunization record is to keep track of an individual's vaccination history to ensure they are up-to-date with recommended immunizations.
What information must be reported on immunization record?
The information reported on an immunization record typically includes the type of vaccine, date of administration, dose given, and healthcare provider information.
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