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II
&
0
e
a
1-9
a
=
Mr.
S.
+
D.M.R. FORM No. 30
s E
DUPLICATE
13
-
-
articles
U I .
a
BUREAU OF NURSING SERVICE
CERTIFICATE OF IMMUNITY
will
Place New York City
for
ke
16
Date 5-14-19
I
I certify that I have administered anti-typhoid vaccine as a prophylactic to
a
in the following doses:
ist dose 1/2
c.c.
Date 5-14-17
2nd dose
c.c.
Date 5-71-17
C
3rd dose
c. c.
Date 5-28-17
M.D.
I certify that
miss Elizabeth Rohrbach
is satisfactorily protected by vaccination against smallpox.
Thos 1 food
M. D.
This duplicate certificate should be forwarded by nurse to the Chairman National)Committee
on Nursing Service, American Red Cross, Washington, D. c., treatment.
Req. 17-109-Feb.-5000.
Nurre,
Director No. 13 Base Hosnital
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"ocrText": "II\n&\n0\ne\na\n1-9\na\n=\nMr.\nS.\n+\nD.M.R. FORM No. 30\ns E\nDUPLICATE\n13\n-\n-\narticles\nU I .\na\nBUREAU OF NURSING SERVICE\nCERTIFICATE OF IMMUNITY\nwill\nPlace New York City\nfor\nke\n16\nDate 5-14-19\nI\nI certify that I have administered anti-typhoid vaccine as a prophylactic to\na\nin the following doses:\nist dose 1/2\nc.c.\nDate 5-14-17\n2nd dose\nc.c.\nDate 5-71-17\nC\n3rd dose\nc. c.\nDate 5-28-17\nM.D.\nI certify that\nmiss Elizabeth Rohrbach\nis satisfactorily protected by vaccination against smallpox.\nThos 1 food\nM. D.\nThis duplicate certificate should be forwarded by nurse to the Chairman National)Committee\non Nursing Service, American Red Cross, Washington, D. c., treatment.\nReq. 17-109-Feb.-5000.\nNurre,\nDirector No. 13 Base Hosnital"
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