预防接种申请单.pdf

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预防接种 申请单 BJZ-048 预防接种 预防接种

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预防接种记录单 BJZ-048 预防接种申请单 未成年人(<18岁) BJZ-048 A pplicat ion Form and Screening Quest ionnaire for Children and Adolescents Immunizat ion ( < 18years) Is your child sick today ? Has your child ever had a seriou s reaction after receiving a vaccination ? Does the child have allergies to medication s, food (eggs ect .),or any vaccine? Has your child received any vaccination s in the past four week s? Does your child,or any per son who lives with or takes care of him/her, have cancer,leukemia,AID S,or any other immune sy stem problem ? Is your child ,or any per son who lives with or takes care of him/her,taking cortisone,prednisone,other steroids,antican

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