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B M R Form No. 30
DUPLICATE
ASHINGTON
NURSING SERVICE
CERTIFICATE OF IMMUNITY
Date aug. 20-17
Place Dept of Health h. ag
Jana
I certify that I have administered anti-typhoid vaccine as a prophylactic to
Katharine macklin
in the following doses:
ist dose
1/2
c.c.
Date 8-3-17
2nd dose.
/
c.c.
Date 8-10-17
3rd dose
I
c. c.
Date 8-20-17
Adreph Jacoby
M.D.
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.
5
2
J
x
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"ocrText": "Zm\ne\n-\n-\nit\nK\nK\n?\n+\n5\nB M R Form No. 30\nDUPLICATE\nASHINGTON\nNURSING SERVICE\nCERTIFICATE OF IMMUNITY\nDate aug. 20-17\nPlace Dept of Health h. ag\nJana\nI certify that I have administered anti-typhoid vaccine as a prophylactic to\nKatharine macklin\nin the following doses:\nist dose\n1/2\nc.c.\nDate 8-3-17\n2nd dose.\n/\nc.c.\nDate 8-10-17\n3rd dose\nI\nc. c.\nDate 8-20-17\nAdreph Jacoby\nM.D.\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.\n5\n2\nJ\nx"
}