t SENATuTTE JUL 2 '6 1498 ONE DOE AUTOMATED STUDENT DATA BASE CODES: • IMMUNIZATION STATUS CURE / • VACCINATION COOS EFTA01710203 DATE OF RRTH DELOS NAME iHNOEU SS* m0 DA YR PARENT OR GUARDIAN DOCTOR. THE CHILD HAS NOT RECEIVED THE REQUIRED DOSES LISTED IN PART A PLEASE COMPLETE PART B OR P