This document is an immunization record for Kristina Hockett showing that she received doses of the HepAlHepB vaccine on December 16, 2015, December 23, 2015, and February 5, 2016 at the Victoria City-County Health Department. It lists her birthdate as September 2, 1972 and provides her identification number and the health department contact information.
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HepA B
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Personal Immunization Record Page 1 of 1
Victoria City-County HD
Friday, February 05, 2016
Personal Immunization Record
POBOX 363
SEADRIFT, TX 77983
Birthdate: 09/02/1972
IMMTRAC Consent: Unknown
Chart No:
Client ID: 12124299
Patient's Name:
Parent/Guardian:
Address:
HOCKETT, KRISTINA
Vaccine
HepAlHepB, adult
Dose 1 Dose 2 Dose 3 Dose 4 Dose 5 Dose 6
12/16/2015 12/23/2015 02/05/2016
MEDICAL EXEMPTIONS: _
Victoria City-County HD
Private Pay - Victoria
2805 N. Navarro
Victoria, TX 77901
361-578-6281
Date ~ - S- -r ~ Phone
-------
Certified By _
Older revisions of this form already on file for students in school should not be replaced.
VIctoria County Public Health Department
Official Document
DOf~T DISCARD
Replacement charge $5.00
https://www.twices.dshs.state.tx.us/twices/ImmunlImrnPersonalImrnPorm.asp?Language=E... 2/512016