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D.M.R. FORM No. 30
MERICAN RED
DUPLICATE
THE NEUTRALITY GOOSE
n
HUMANITY
ASHINGTON
BUREAU OF NURSING SERVICE
CERTIFICATE OF IMMUNITY
Place
Boston, Mass.,
March 28, 1917
Date
I certify that I have administered anti-typhoid vaccine as a prophylactic to
Alyce IV. Wormwood
in the following doses:
ist dose
.5
c. c.
Date
Mar. 28, 1917.
1.
c. c.
Date
Apr. 4, 1917
2nd dose
1.
c. c.
Date
Apr. 11, 1917
3rd dose
G. P. Denny
M.D.
I certify that
Alyce N. Wormwood
is satisfactorily protected by vaccination against smallpox.
G. P. Denny
M.D.
This duplicate certificate should be forwarded by nurse to the Chairman National Committee
on Nursing Service, American Red Cross, Washington, D. C., after completion of treatment.
Req. 17-109-Feb.-5000.
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"ocrText": "D.M.R. FORM No. 30\nMERICAN RED\nDUPLICATE\nTHE NEUTRALITY GOOSE\nn\nHUMANITY\nASHINGTON\nBUREAU OF NURSING SERVICE\nCERTIFICATE OF IMMUNITY\nPlace\nBoston, Mass.,\nMarch 28, 1917\nDate\nI certify that I have administered anti-typhoid vaccine as a prophylactic to\nAlyce IV. Wormwood\nin the following doses:\nist dose\n.5\nc. c.\nDate\nMar. 28, 1917.\n1.\nc. c.\nDate\nApr. 4, 1917\n2nd dose\n1.\nc. c.\nDate\nApr. 11, 1917\n3rd dose\nG. P. Denny\nM.D.\nI certify that\nAlyce N. Wormwood\nis satisfactorily protected by vaccination against smallpox.\nG. P. Denny\nM.D.\nThis duplicate certificate should be forwarded by nurse to the Chairman National Committee\non Nursing Service, American Red Cross, Washington, D. C., after completion of treatment.\nReq. 17-109-Feb.-5000."
}