Epstein Secrets

inical reasoning or evidence for exemption: DOE Code 3 I cestift that the physical condition of this child Lt nth that immenitatiomNat indicated in Pan C above is medically caltraindicated. Physician or Clinic Name: (flint or stamp) Address: D44 610, 1196. dada= la (4Omo (SIM Maher 574.11O:MX1106)

. DTaP is an acceptable a0ernative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Perrussis vaccine is medically contraindicated. (Complete Part C for Pcnussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polo 4 doses required if the third d

cal reasoning or evidence for exemption: DOE Code 3 I certify that he physical condition of this child is such that immunization(s) as indicated in Pan C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Address. Physician Signature. DN 680, &NS repbces earlier ed

d. Mal is an acceptable alternative for one or moredoses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) Td (Adult) Vaccine is recommended for children 7 years of age orolder. $ Polio 4 doses required. If the third do

nical reasoning or evidence for exemption. DOE Code 3 1 cent that the physical condition of this child is such that immunization(s) as indicated in Pan C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: DH 680, 8/2000, obsoktm tallitt

DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third d