ࡱ> _ 0 bjbj 4bb"||JJJ^^^^r^www$tJ7@wDDD RJDDD("Dit(Dl0D#.#D#JD(w>,D$www4www#wwwwwwwww| :  Sultan Qaboos University COLLEGE OF MEDICINE & HEALTH SCIENCES  PART I : TO BE COMPLETED BY STUDENT NAME & ID # : ... ADDRESS : . .. MALE ( FEMALE ( DATE OF BIRTH _____/_____/______ DD MM YY PART II : TO BE COMPLETED BY THE PHYSICIAN/HEALTH CARE OFFICER A] MEASLES Fully immunized: _____/_____/______ DD MM YY B] MUMPS Fully immunized: ______/_____/______ DD MM YY C] RUBELLA Fully immunized: _____/_____/______ DD MM YY D] TETANUS-DIPHTHERIA - PERTUSSIS Fully immunized: _____/_____/______ DD MM YY E] HEPATITIS B Titre : ____/____/____ DD MM YY Fully immunized: _____/_____/______ DD MM YY F] BCG Vaccine date ___/___/____ DD MM YY I certify that the immunization data given above is accurate and up-to-date. Physician's Name : ___________________________________ Signature : ______________________ Date : _________________________ Seal :  STUDENT IMMUNIZATION RECORD EGHNrs    2 ; L M   . 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