| Medical Information for Maksim . |
Health care institution
Issued on 20.04.2011
Medical report to be issued to child protection offices
Name (given name and surname) MAKSIM
Age: 13 years
Has suffered from the following contagious diseases: VERICELLA 07.01.2008
Vaccinations:
DTL Copy added
Tbc Copy added
MMR Copy added
IPV Copy added
Hepatitis B Copy added
Results of the medical examination: The last visit to the doctor was on 04.08.2010 – DS. HEALTHY
Peculiarities of the health condition (including chronic health problems and allergy) that need medical
observation, help or counseling: HEALTHY
Recommendations for physical activities, nutrition etc: normal nutrition regime
Doctor’s seal: Svetlana Sinkina/Family Doctor/D03064 Signature:
Health card
Name: MAKSIM
Date of birth: 15.12.97
ID: 49903112245
Vaccinations: Chronic illnesses
Vaccine: Date: Dosage: Series: Contr. Diagnosis: Registered Deleted:
BCG 18.12.97 0,05 9627 ? ? IX-2005?
DTL 05.11.98 0,5 6257 F80
18.03.99 0,5 5484 F83
01.06.99 0,5 5484 ?
31.01.01 0,5 5301
dT 20.02.06 0,5 Y6510 ?
OPV: 05.11.98 ? 5668 -4
18.03.99 ? 5286 - 2
08.06.99 ? 2602A4
07.11.00 ? 2842A4A
10.11.05 ? 75922
Measles: 23.03.99 0, 5 01510301 Riskfactors: Hepatitis B
Rev: 14.01.11 0,5 A69CC009A K01-11 I 18.12.09 0,5 ………..unreadable
Mumps: 23.09.99 0,5 01510901 II 22.01.2010 0,5 ………- “ -
Rev: 14.01.11 0,5 A69CC009AK 07-11 III 24.04.2010 0,5 ………- “ -
Rubella: 23.09.00 0,5 01510301
Rev: 14.01.11 0,5 A69CC009AK 07-11
Issued on 20.04.2011
Medical report to be issued to child protection offices
Name (given name and surname) MAKSIM
Age: 13 years
Has suffered from the following contagious diseases: VERICELLA 07.01.2008
Vaccinations:
DTL Copy added
Tbc Copy added
MMR Copy added
IPV Copy added
Hepatitis B Copy added
Results of the medical examination: The last visit to the doctor was on 04.08.2010 – DS. HEALTHY
Peculiarities of the health condition (including chronic health problems and allergy) that need medical
observation, help or counseling: HEALTHY
Recommendations for physical activities, nutrition etc: normal nutrition regime
Doctor’s seal: Svetlana Sinkina/Family Doctor/D03064 Signature:
Health card
Name: MAKSIM
Date of birth: 15.12.97
ID: 49903112245
Vaccinations: Chronic illnesses
Vaccine: Date: Dosage: Series: Contr. Diagnosis: Registered Deleted:
BCG 18.12.97 0,05 9627 ? ? IX-2005?
DTL 05.11.98 0,5 6257 F80
18.03.99 0,5 5484 F83
01.06.99 0,5 5484 ?
31.01.01 0,5 5301
dT 20.02.06 0,5 Y6510 ?
OPV: 05.11.98 ? 5668 -4
18.03.99 ? 5286 - 2
08.06.99 ? 2602A4
07.11.00 ? 2842A4A
10.11.05 ? 75922
Measles: 23.03.99 0, 5 01510301 Riskfactors: Hepatitis B
Rev: 14.01.11 0,5 A69CC009A K01-11 I 18.12.09 0,5 ………..unreadable
Mumps: 23.09.99 0,5 01510901 II 22.01.2010 0,5 ………- “ -
Rev: 14.01.11 0,5 A69CC009AK 07-11 III 24.04.2010 0,5 ………- “ -
Rubella: 23.09.00 0,5 01510301
Rev: 14.01.11 0,5 A69CC009AK 07-11