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Get Az Adhs Immunization Record Request Form 2016

Are: a stateissued photo driver's license with address, a state-issued photo identification card with address or a U.S. passport or passport card with photo. Please lighten the copy of the identification cards. If the record requested is for a minor under 18 years of age, please state your relationship to the minor in the "Requestor's Relationship" field. Immunization record requests will be processed within 5-7 business days. IMMUNIZATION RECORD REQUESTED FOR: First Name: Middle Name: / Dat.

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