CA CDPH 8342 2014-2024 free printable template
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State of California-Health and Human Services Agency California Department of Public Health Worksheet for the Annual Immunization Report On Children Enrolled in Child Care Centers Side 1 Only list ALL children ages 2 through 4 years 11 months Check the box indicating the total number of doses received for each vaccine Page of VACCINE DOSE SUMMARY POLIO DOSES NAME OR I. D. OF CHILD Example Sierra DOB FollowUp Needed 4/14/2012 MMR1 DTP/Td DOSES HEP B HIB VARICELLA EXEMPT 1 med3 pers4 Type of...
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