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G
D M R Form No. 30
DUPLICATE
E AV GOSS
NURSING SERVICE
CERTIFICATE OF IMMUNITY
Place Keny County Hospital
Date
I certify that I have administered anti-typhoid vaccine as a prophylactic to
Juni 5/9/7
Jossie 9. Pattenson
in the following doses:
ist dose
A.c.c.
2nd dose
Date. may and 1917
c.c.
3rd dose
Date mA ay 29th 1917
c. c.
Date
Iunt 3 - -1917
Hubbut K Justry
M. D.
I certify that JESSIE 9. Patter son
is satisfactorily protected by vaccination against smallpox.
Hubert
M. D.
Fill in location of base hospital, unit or detachment with, which service is desired:
Army base base hospital hospital at at Kmug County Hospitas Brooklyn
Naval
Emergency detachment at
Navy detachment at
Hospital unit at
Surgical section at
Organizing Detachment.
This duplicate certificate should be forwarded by nurse to Chief Nurse of Unit or to Committee
Req. 17-478-April-3000.
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"ocrText": "G\nD M R Form No. 30\nDUPLICATE\nE AV GOSS\nNURSING SERVICE\nCERTIFICATE OF IMMUNITY\nPlace Keny County Hospital\nDate\nI certify that I have administered anti-typhoid vaccine as a prophylactic to\nJuni 5/9/7\nJossie 9. Pattenson\nin the following doses:\nist dose\nA.c.c.\n2nd dose\nDate. may and 1917\nc.c.\n3rd dose\nDate mA ay 29th 1917\nc. c.\nDate\nIunt 3 - -1917\nHubbut K Justry\nM. D.\nI certify that JESSIE 9. Patter son\nis satisfactorily protected by vaccination against smallpox.\nHubert\nM. D.\nFill in location of base hospital, unit or detachment with, which service is desired:\nArmy base base hospital hospital at at Kmug County Hospitas Brooklyn\nNaval\nEmergency detachment at\nNavy detachment at\nHospital unit at\nSurgical section at\nOrganizing Detachment.\nThis duplicate certificate should be forwarded by nurse to Chief Nurse of Unit or to Committee\nReq. 17-478-April-3000."
}