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Description of certificate of child health examination
FOR USE IN DCFS LICENSED CHILD CARE FACILITIES CFS 600 Rev 2/2013 State of Illinois Certificate of Child Health Examination Student s Name Birth Date Last First Address Middle Street City Sex Race/Ethnicity School /Grade Level/ID Month/Day/Year Parent/Guardian Zip Code Telephone Home Work IMMUNIZATIONS To be completed by health care provider. Note the mo/da/yr for every dose administered* The day and month is...
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