edically contraindicated. Physician or Clinic Name: (Print or stamp) Address: Physician Sign re: Date: C41 680, II/96. obsolete* eel echunra (Sack Nernter 5740-000-0660.6) EFTA01709620 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: sections 232.032, 402.305, 402.313, Florida Statutes; rules