Transcription of PM-298F2-IMM-75LK(1-07).ai 4/12/07 9:20:23 AM …
1 RETAIN THIS DOCUMENT CONSERVE ESTE DOCUMENTOTB SKIN TESTS* Pruebas de la TuberculosisType**Date givenGiven byDate readRead bymm/indurImpression* A chest x-ray may be indicated if skin test is positive.**If required for school entry, must be Mantoux unless exception granted by local health X-RAYFilm date: ____/____/____ Interpretation:normalabnormal[Radiografi ]Person is free of communicable tuberculosis yes no(Necessary if skin test positive.)Signature/Agency: _____NamenombreBirthdatefecha de nacimientoSexsexoAllergiesalergiasIMMUNI ZATION RECORDC omprobante de Inmunizaci nVaccine Reactionsreacciones a la vacunaVACCINE vacunaDATEGIVEN fecha devacunaci nDOCTOR OFFICE OR CLINICm dico o cl nicaNEXTDOSE DUEpr xima vacunaVACCINE vacunaDATEGIVEN fecha devacunaci nDOCTOR OFFICE OR CLINICm dico o cl nicaNEXTDOSE DUEpr xima vacunaParents: Your child must meet California s immunization requirements to be enrolled in school and child care.
2 Keep this Record as proof of : Su ni o debe cumplir con los requisitos de vacunas para asistir a la escuela y a la guarder a. Mantenga este Comprobante: lo necesitar .DT/Td = Diphtheria, tetanus [difteria, t tano]DTaP/Tdap = Diphtheria, tetanus, and pertussis (whooping cough) [difteria, t tano, y tos ferina]DTP = Diphtheria, tetanus, pertussis (whooping cough) [difteria, t tano, y tos ferina]HEP A = Hepatitis AHEP B = Hepatitis BHIB = Hib meningitis (Haemophilus influenzae type b) [meningitis Hib]HPV = Human papillomavirus [virus del papiloma humano]INFV = Influenza [la gripe]MCV = Meningococcal conjugate vaccine [vacuna meningoc cia conjugada]MMR = Measles, mumps, rubella [sarampi n, paperas y rub ola (sarampi n alem n)]MPV = Meningococcal polysaccharide vaccine [vacuna meningoc cia polisac rida]PNEUMO = Pneumococcal vaccine [neumoc cica]POLIO = Poliomyelitis [poliomielitis]RV = Rotavirus [rotavirus]VZV = Varicella (chickenpox)
3 [varicela] PM 298 F2 (8/08) IMM-75 LKCMYCMMYCYCMYKPM-298F2-IMM-75LK(1-07).a i 4/12/07 9:20:23 AMRegistry ID Number
