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Get Fiu Immunization Form

(Month) (Day) (Year) Email: Day-time phone or cell: Vaccine and Immunity Verification (to be completed by health care provider): For Hepatitis B & Varicella: Copies of actual lab test results indicating positive serum antibody titers are required as proof of immunity. When vaccine series is incomplete, dates of vaccination should be provided on this form until the time when serum antibody titers are don.

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