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DMR Form No. 30
THE MERICAN NEUTRALITY SCOOSE
RED
DUPLICATE
GSS43
W HUMANITY
ASHINGTON %
13111
NURSING SERVICE
CERTIFICATE OF IMMUNITY
Place
Don Date
I certify that have administered vaccine as a prophylactic to
in the following doses:
Ist dose c. each
2nd dose.
-
2/3 c. c.
.
Date Date Jack
a
3rd dose
c. c.
Chamber The M.D.
Date Jan 1018
I certify that
is satisfactorily protected by vaccination against smallpox.
M. : D.
Fill in location of base hospital, unit or detachment with which service is desired:
Army base hospital at
Naval base hospital at
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
This duplicate certificate should be forwarded by nurse to Chief Nurse of Unit or to Committee
Organizing Detachment.
Req. 17-478-April-3000.
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"ocrText": "DMR Form No. 30\nTHE MERICAN NEUTRALITY SCOOSE\nRED\nDUPLICATE\nGSS43\nW HUMANITY\nASHINGTON %\n13111\nNURSING SERVICE\nCERTIFICATE OF IMMUNITY\nPlace\nDon Date\nI certify that have administered vaccine as a prophylactic to\nin the following doses:\nIst dose c. each\n2nd dose.\n-\n2/3 c. c.\n.\nDate Date Jack\na\n3rd dose\nc. c.\nChamber The M.D.\nDate Jan 1018\nI certify that\nis satisfactorily protected by vaccination against smallpox.\nM. : D.\nFill in location of base hospital, unit or detachment with which service is desired:\nArmy base hospital at\nNaval base hospital at\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nThis duplicate certificate should be forwarded by nurse to Chief Nurse of Unit or to Committee\nOrganizing Detachment.\nReq. 17-478-April-3000."
}