预防接种历史记录VaccineHistoryTransferredfromWrittenRecords姓名Name:/性别Sex:男/Male(或女/Female)出生日期DateofBirth:Jan.15,2010(自行修改日期)疫苗Vaccine日期Date日期Date日期Date(M-D-Y)日期Date(M-D-Y)日期Date(M-D-Y)卡介苗BCG脊髓灰质炎(口服)OPV百白破(儿童型)DTP麻疹Measles流脑Meningitis乙脑JEVaccine麻风腮MMR乙肝HepatitisB甲肝HepatitisA,HAHib水痘Varicella腮腺疫苗ParotitisVaccine(MUMPS)风疹RubellaVaccine医生签名PhysicianSignature