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Xavier University First day of class Documents: Immunization Certificate Immunization Dates: Men A/C/W/Y (1 dose @ age 16 or older) Hepatitis B (3 doses OR Pos. Quant. Titer) MMR (2 doses OR Pos. Titer) Immunization Dates: Meningococcal B Two-Step Tb Results Varicella Polio Hepatitis A TDaP Booster HPV COVID-19 Immunization Dates: JE - Japanese Encephalitis Typhoid Yellow Fever Rabies Copyright © 2021 by MedProctor, LLC.

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Page 1: Xavier University First day of class Documents

Xavier University

First day of class

Documents:Immunization Certificate

Immunization Dates:Men A/C/W/Y (1 dose @ age 16 or older)Hepatitis B (3 doses OR Pos. Quant. Titer)MMR (2 doses OR Pos. Titer)

Immunization Dates:Meningococcal BTwo-Step Tb ResultsVaricellaPolioHepatitis ATDaP BoosterHPVCOVID-19

Immunization Dates:JE - Japanese EncephalitisTyphoidYellow FeverRabies

Copyright © 2021 by MedProctor, LLC.

Page 2: Xavier University First day of class Documents

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Xavier University

PRINT CLEARLY WITH DARK BLACK INK.This form will be read by a computer.

Copyright © 2021 by MedProctor, LLC.


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