FOR EACH VACCINE. EXEMPTION (HRS 680 - PART C) IMMUNIZATION(S) IS MEDICALLY CONTRAINDICATED. LIST VACCINE(S) AND STATE VALID HRS Farm 680. Mar 91 (DowMes Previous edtheris) Bunk Number 5740.000.0680-6) PHYSICIAN'S SIGNATURE DATE EFTA01709630 CCM III VRI00 IllTS/ ILTCNING IDC OF ILLINOIS CHIL