REVIEWED THE RECORDS AVAILABLE AND TO THE BEST OF MY KNOWLEDGE T DIPHTHERIA, TETANUS, PER RUBELLA AS REQUI PHYSICIAN OR CONIC NAME (PLEASE PRINT) JATELY IMMUNIZED AGAINST 'DANCE. -//,1/2,73 DATE EFTA01710101 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, a 10D-