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EFTA01709600
F IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C. LAST NAME PARENT OR GUARDIAN FIRST MI DOB MCYDAAR Child's SS# (optional) STATE IMMUNIZATION Mal Directions: • Enter all appropriate doses and dates below. • Sign and date appropriate certificat
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