HomeMy WebLinkAboutSmallpox Immunization CardMAY ~ t? 1~r.: 19
THIS CII~TIFIES THAT
(Name)
has been given the recommended dosage, or dosage;... for
immunization against:
1. Diphtheria Date
2. Smallpox Date ?.r` ~ ~ r'
3. Whooping Cough Date
~+. Typhoid Date
5. Others Date
(Signed) ~~ ~ ~~ ~~'
852+ Director of Public Health