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Get Tdap Vaccine Medication Template

Iation) Birth date: Chart number: ____________________________________ Date given Elig Code (mo/day/yr) (P, N, M, A) ____________________________________ 2 Vaccine info Statement (VIS)4 Vaccine 3 Site Lot # Mfr. Exp date Pub. date Date given Hep B (e.g., Hep B, Hib-Hep B DtaP-HepB-IPV) Diptheria, Tetanus, Pertussis (e.g., DtaP, DTaP-Hib, DTaP-Hep B-IPV, DT, DTaP-Hib-IPV, Tdap, DTaP-IPV, Td) Haemophilus influenza type b (e.g., Hib, Hib-Hep B, DTaP-Hib-IPV, DTaPHib) Polio (e.g., .

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