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Regist ID Numb <br /> IMMUNIZATION 9 <br /> ;�-:, DATE NEXT <br /> Comprobante de Inmunfzacion GIVEN DOSE DUE <br /> VACCINE fecha de DOCTOR OFFICE OR CLINIC proxima <br /> j' vacuna vacunacion medico o clinica vacuna <br /> ^ <br /> KAISER MR` # ®006971458 <br /> Name <br /> nombre RATTANASACK SOUKPRASEUTH r HepB 08/11 KAISER HOSPITALS <br /> Birthdate Sex HEPB 3996 <br /> fecha de nacfmiento 02/09/1979 sexo M HepB 10/31 KAISER HOSPITALS <br /> Allergies HEPB <br /> alergios HepB 09/11 KAISER HOSPITALS <br /> Vaccine Reactions HEPB 1996 <br /> reacciones a la vacuna <br /> RETAIN THIS DOCUMENT — CONSERVE ESTE DOCUMENTO <br /> DATE NEXT <br /> GIVEN DOSE DUE <br /> VACCINE fecha de DOCTOR OFFICE OR CLINIC Proxima <br /> vacuna vacunacion medico o clinica vacuna <br /> Parents: Your child must meet California's immunization requirements to be enrolled in TB SKIN TESTS* Pruebas de la Tuberculosis <br /> school and child care.Keep this Record as proof of immunization. <br /> Padres: Su nino debe cumplir con los requisitos de vocunas para asistir a to escuela y a la Type** Date given Given by Date read Read by mm/indur Impression <br /> guarderia.Montenga este Comprobante: (o necesitar6. <br /> DT/Td-Diphtheria,tetanus [diheria,tetano] <br /> DTaP/Tdap-Diphtheria,tetanus,and pertussis(whooping cough) [diheria,tetano,y tos ferina] <br /> DTP=Diphtheria,tetanus,pertussis(whooping cough) [diheria,tetano,y tos ferina] <br /> HEP A=Hepatitis A <br /> HEP B=Hepatitis B <br /> HIB=Hib meningitis( Haemophilus influenzae type b) [meningitis Hib] <br /> HPV= Human popillomovirus [virus del popiloma humano] <br /> INFV=Influenza (la gripe] A chest x-ray may be indicated if skin test is positive. <br /> MCV=Meningococcal conjugate vaccine [vacuna meningoc6c(a conjugoda] **If required for school entry,must be Mantoux unless exception granted by local health department. <br /> MMR=Measles,mumps,rubella [sarompi6n,paperas y rubeola Isorompi6n alem6ni] CHEST X-RAY Film date:_/_/_ Interpretation: ❑normal [Dabnormal <br /> MPV=Meningococcal polysaccharide vaccine [vacuna meningococia poli5ac6rida] <br /> PNEUMO.Pneumococcal vaccine [neumoc6cica] [Radiogrofi6l Person is free of communicable tuberculosis ❑yes ❑no <br /> POLIO-Poliomyelitis [poliomielitis] (Necessary if <br /> RV= Rotavirus [rotavirus] skin test positive.) <br /> VZV=Varicella(chickenpox) [varicela] Signature/Agency: <br /> PM 298 F2(8/08)IMM-75LK <br />