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VACCINE
vacuna
KAISER MR#
000019814972
PRINTED: 02/04/2015
DATE
GIVEN
fecha de
vacunación
DATE NEXT
DOSE DUE
próxima
vacuna
DOCTOR OFFICE OR CLINIC
médico o clinica
Name
YOUNG,BRIDGETTE J
nombre
Birthdate
Sex
sexo F
03/28/1991
fecha de nacimiento
Allergies
alergias
Vaccine Reactions
reacciones a la vacuna
RETAIN THIS DOCUMENT
VACCINE
vacuna
___
CONSERVE ESTE DOCUMENTO
DATE
GIVEN
DOCTOR OFFICE OR CLINIC
DATE NEXT
DOSE DUE
fecha de
médico o clinica
próxima
vacunación
vacuna
08/07/2012 TDAP (ADACEL)
TDAP
Kaiser Permanente
TDAP
POL-IPV
06/28/2011 POL-IPV
Kaiser Permanente
HPV4 HUMAN
08/07/2012 HPV4 HUMAN PAPILLOMA
Kaiser Permanente
POLIO
HPV
MENINGOCOCCAL 06/28/2011 MENCN, GRPS A,C,Y & W-135
MENCN GRPS
Kaiser Permanente
INFLUENZA
INFS 4YRS
11/08/2013 INFS 4YRS+ (FLUVIRIN)
Kaiser Permanente
06/28/2011 TYDVI
TYPHOID
Kaiser Permanente
TYDVI
YELLOW FEVER
YF
06/28/2011 YF
Kaiser Permanente
Chickenpox
Parents:
Padres:
DT/Td
DTaP/Tdap
DTP
HEPA
HEPB
HIB
HPV
INFV
MENINGOCOCCAL
MMR
PNEUMO
POLIO
RV
VZV
Your child must meet California's immunization requirements to be enrolled in
school and child care.Keep this Record as proof of immunization.
Su niño debe cumpar con los requisitos de vacunas par asistar a la escuela y a la
guarderia. Marienga esta Comprobanta lo necesitana.
= Diphteria,tetanus [difteria,tetano]
= Diphteria,tetanus,pertussis(whooping cough)[difteria,tetano,y los forino]
= Diphteria,tetanus,pertussis(whooping cough)[difteria,tetano,y los forino]
= Hepatitis A
= Hepatitis B
= HIB Meningitis (Haemophilius influenzae type B) [meningitis Hib]
= Human papilloma virus [viris del papiloma humana]
= Influenza [la gripa]
= Meningococcal vaccine [vacuna meningococia]
= Measles, mumps, rubella [sarampion, papras rubeola]
= Pneumococcae vaccine [pneumococica]
= Poliomielitis [poliomielitis]
= Rotavirus [rotavirus]
= Varicella (chickenpox) [varicela]
TB SKIN TESTS¹ Pruebas de la Tuberculosis
Type²
Date given
Given by
Date read
PPD
__/__/____
07/15/2013
PPD
__/__/____
__/__/____
PPD
__/__/____
__/__/____
Read by
mm/indur
Impression
0
NEG
¹ A chest x-ray may be indicated if skin test is positive.
² If required for school entry, must be Mantoux unless exception granted by local health department.
CHEST X-RAY Film date: ____/____/____ Interpretation: [ ]normal [ ]abnormal
[Radiografia] Person is free of communicable tuberculosis [ ]yes [ ]no
(Necessary if skin test positive.)
Signature/Agency ________________________________
Kaiser Permanente, SCPMG: Young, Bridgette J (000019814972)
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