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Title:	Medical_Exemption_Form_B
Summary:	pdf version
Description:
Keywords:	Medical Exemption Form B
Handle:	Document-4686
Owner:	Site Administrator (User-2, admin:DocuShare)^DS
Create Date:	Wednesday, June 9, 2010 09:43:39 AM CDT
Modified Date:	Wednesday, September 25, 2019 08:16:58 AM CDT
Modified By:	Site Administrator (User-2, admin:DocuShare)^DS
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Abstract:	KANSAS CERTIFICATE OF IMMUNIZATIONS - FORM B MEDICAL EXEMPTION Student Name:_______________________________________________________ Birthdate:____________ City:___________________________________________ State:_______ Zip Code:________________ Parent/Guardian:_______________________________________________________________________________ Telephone:______________________________ Medical exemption due to for the following vaccine(s): ( ) DTaP/DT ( ) Hepatitis A ( ) Tdap/Td ( ) Hepatitis B ( ) Pertussis ... Signature:_______________________________________________________ Date:___________________ PLEASE PRINT Name:...
Add Versions:	Allowed
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Content Type:	Adobe Portable Document Format (.pdf) - application/pdf
File name:	KCI_formB (1).pdf
Is Placeholder:	No
Max Versions:	4
Size:	84533
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Ready for Declare:	No
Appears In:	Health Services
Preferred Version:	Medical_Exemption_Form_B