Immunization & Childhood Disease Record
as of September 16, 2009

Recommended

@Age

Done

Date:Age/Location

DTP #1
Oral Polio#1
HIB #1
2 Mos DTP #1
Oral Polio #1
HIB #1
10/22/91: 2 Mos 2 Days
Mason Clinic
DTP #2
Oral Polio #2
HIB #2
4 Mos DTP #2
Oral Polio #2
HIB #2
12/16/91: 4 Mos 4 Days
Mason Clinic
DTP #3
HIB #3
6 Mos DTP #3
HIB #3
2/27/92: 6 Mos 7 Days
Mason Clinic
TB Test 12 Mos TB Test: Negative 10/92: 14 Mos
Winslow Clinic
MMR
HIB #4
15 Mos MMR
HIB #4
11/8/92: 14 Mos
Mason Clinic
DTP #4
Oral Polio #3
18 Mos DTP #4
Oral Polio #3
3/23/93: 19 Mos
Mason Clinic
Hepatitis B #1   Hepatitis B #1 6/10/94: 2 Yrs 10 Mos
Winslow Clinic
Hepatitis B #2 +1 Mo
after #1
Hepatitis B #2 7/11/94: 2 Yrs 11 Mos
Winslow Clinic
Hepatitis B #3 +6 Mo
after #2
Hepatitis B #3 12/13/94: 3 Yrs 4 Mos
Winslow Clinic
    Chicken Pox 2/12-2/19/95: 3 Yrs
DTP #5
Oral Polio #4
4-6 Yrs DTP #5
Oral Polio #4
7/19/96: 4 Yrs 11 Mos
Mason Clinic/Winslow
Optional   Hepatitis A #1 3/10/99: 7 Yrs 7 Mos
Medalia Clinic/Northgate
Optional   Hepatitis A #2 12/11/99: 8 Yrs 4 Mos
Healthsouth/Aurora
MMR #2 10-12 Yrs MMR #2 2/1/02: 10 Yrs 5 Mos
Mason Clinic
Tdap 14-16 Yrs TDAP 12/19/08: 17 Yrs 4 Mos
Mason Clinic/Winslow
MCV4 14-16 Yrs MCV4 9/16/09: 18 Yrs 1 Mo
Mason Clinic/Winslow