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M ar hialin HARVARD UNIT AMERICAN RED CROSS RECORD OF IMMUNIZATION (If your own physician does not regularly perform all of these tests, readings and immunizations, he will refer you to the proper person in your vicinity.) 1. Smallpox vaccination Date of scar 19r2 Date of revaccination since scar Thin111941 Type of reaction negative (Required at time of application) 2. Typhoid immunization (within years) Type material uned #20 triple syphoid Date bascine. of expiration - army of material m.c Dec/29/1941 Date lst dose may 15 - 1941 Mari Date 2nd dose may 22 - 1941 Date 3rd dose Today 29 1941 3. Diphtheria test and immunization. Schick test (Required at time of application on all applicants) Date of test Date of reading afril 3.1941 Negative Reading: Positive Diphtheria immunization (Necessary if Schick test is positive) Type material used Date of expiration of material Date lst dose Date 2nd dose Date 3rd dose 4. Scarlet fever test and immunization. Dick test (Required at time of application on all applicants) Date of test Capiral 1,19VI Date of reading effice 3. 1941 Negative Reading: Positive Immunization for scarlet fever (Necessary if Dick test is positive) Type material used Date of expiration of material Date of dose Date may 29,194 Signed Date May 29,1941 Signed Thouas 63479 9

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    "ocrText": "M\nar\nhialin\nHARVARD UNIT\nAMERICAN RED CROSS\nRECORD OF IMMUNIZATION\n(If your own physician does not regularly perform all of these tests, readings and\nimmunizations, he will refer you to the proper person in your vicinity.)\n1. Smallpox vaccination\nDate of scar\n19r2\nDate of revaccination since scar Thin111941 Type of reaction negative\n(Required at time of application)\n2. Typhoid immunization (within years)\nType material uned\n#20 triple syphoid Date bascine. of expiration - army of material m.c Dec/29/1941\nDate lst dose may 15 - 1941\nMari\nDate 2nd dose may 22 - 1941\nDate 3rd dose Today 29 1941\n3. Diphtheria test and immunization.\nSchick test (Required at time of application on all applicants)\nDate of test Date of reading afril 3.1941\nNegative\nReading:\nPositive\nDiphtheria immunization (Necessary if Schick test is positive)\nType material used\nDate of expiration of material\nDate lst dose\nDate 2nd dose\nDate 3rd dose\n4. Scarlet fever test and immunization.\nDick test (Required at time of application on all applicants)\nDate of test Capiral 1,19VI Date of reading effice 3. 1941\nNegative\nReading:\nPositive\nImmunization for scarlet fever (Necessary if Dick test is positive)\nType material used\nDate of expiration of material\nDate of dose\nDate may 29,194\nSigned\nDate May 29,1941\nSigned Thouas\n63479\n9"
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