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Get KS Certificate of Immunization (KCI) 2019-2024

L Immunization Law (amended 1994.) Student Name: County : Ethnicity: Race: SEX: [ ] MALE [ ] FEMALE Birthdate (MM/DD/YYYY): RECORD THE MONTH, DAY, AND YEAR THAT EACH DOSE OF VACCINE WAS RECEIVED = Dose determined invalid by provider VACCINE 1st 2nd = Invalid Dose. KSWebIZ minimum age/interval not met 3rd 4th 5th 6th 7th DTaP/DT/Td/Tdap (Diphtheria, Tetanus, Pertussis) Required for school entry. Single Tdap required for entry to 7th grade. Polio State Type If additional doses.

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