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School Immunization Annual Reports And Surveys 2007-2008
K12 Attachment: ARS DH684
Handle: Document-4625
Owner: Site Administrator (User-2, admin:DocuShare)DS
Thursday, September 27, 2007 09:26:54 AM EDT
Thursday, September 27, 2007 09:26:54 AM EDT
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  • DH Form 684, 06/2007 (Obsoletes all previous versions) IMMUNIZATION ANNUAL REPORT OF COMPLIANCE FOR KINDERGARTEN AND SEVENTH GRADE COMPULSORY IMMUNIZATION - FLORIDA STATUTES 1003.22 School Information Date Name of School: School Type: Public Nonpublic Information on the person completing this form: Address: Name: City County Zip Position/Agency: Name of Principal: Phone Number: Student Information List students not fully immunized – indicate type of exemption or out of compliance. Medical Exemptions Name Grade Temporary DH-680 (Part B)* List Expiration Date Permanent DH-680 (Part C) Religious Exemption DH-681 30-Day Transfer Exemptions List Enrollment Date Out of Compliance K or 7 th K or...
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K12-DH684-ARS.pdf
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Appears In: Health Services MIS School Choice Student Services
Preferred Version: School Immunization Annual Reports And Surveys 2007-2008