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1 I
&
0
e
a
|
9
a
III
=
N
taken
Mr
15
UR
+
DMR 30
13
5
E
DUPLICATE
-
TE
U 2
-
8
NURSING SERVICE
CERTIFICATE OF IMMUNITY
Rather
be
Place Putuam Connecticut
eth
parage
Date September 12,1917.
5
I certify that I have administered anti-typhoid vaccine as a prophylactic to
T
Elizabette Robeback
in the following doses:
5
1st dose 500, 000, 000be I....c.
c.
Date august 2711917
I
2nd dose/ 1000,000,0esbe /c. c..
Date sept 3, 1917
a
3rd dose 1,000,000,000.be /c. c.
Date sept 12,1917
C
m. gubland
5
C
M. D.
I certify that
C
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. 17-919-May-25M
Drama
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