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DTaP/DTP2 A DT3 Td' Polio' MMR (Combined)' F (Separate)e G.H.I Hepatitis B9 Dose I MOMANR Dose 3 Dose 4 Dose 5 /YR% MO/DA/YR mom A/YR MARIA/YR Measles Measles (dose 2) Mwrips Rubella The state immunization ID# is an identifier supplied by the state immunization registry (optional).
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