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Addendum to Tdap (Tetanus, Diphtheria, Pertussis) Vaccine
I am an adult who can legally consent for the person named below to get the vaccine. I freely and voluntarily give my signed permission for this vaccine.
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Immunization Encounter Form
Aug 27, 2020 I agree that the immunizations may be shared with schools, day care centers, health care providers, and others to verify immunization status,
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Consent for Tetanus, Diphtheria, and Pertussis (TDap)
Vaccination Information Record: (One booster with in last 10 years. A single dose of. TDap recommended for all students.) TYPE Manufacturer and Lot # Expiration.
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