小学校一览表

家长姓名儿童姓名出生日期流脑A+C首针次接种日期到入学时已满3年(1=是, 0=否，从未接种过流脑A+C=9)住址年级班级11111111111111111111111111111111111111入托、入学时是否有接种证(1=是, 0=否)潘治明李英兰潘兴国金应祥杨紫琼杨政荣吴寿荣文登奎黄桥妹杨富贵龙金秀唐柄权黄大宁姚本林周当发王朝贵杨培人余金国王家平杨胜龙吴兆垒王华梅王 治杨 能罗世荣石开发杨 方杨昌警杨仕平张发文杨 华雷 文李兴伟张正强杨胜得潘建文文 奇潘兴桥潘斯勇龙美惠潘家雪金 钱王自强杨雪利吴茗娜文成毅吴登宇杨 涛舒 琳唐 宇黄 杰姚江河周永强王 府杨冬媛余 涛王 海杨 栋吴诗耘邹 谨王和平杨俊罗朝鸿石开梅杨百川杨兴江杨叶豪张衣喝杨 超雷昌万李丹丹张俊龙杨秀芝潘凯江文义川潘虹凯2006-4-122006-4-22006-5-22005-5-82005-7-132005-10-92006-2-232006-6-152006-8-232005-8-132005-4-232005-10-52004-4-92006-7-162004-11-22006-7-122005-12-82004-10-152005-11-182004-9-222006-5-12006-7-222006-11-212004-10-302005-5-142006-5-82006-8-42003-2-132005-5-52005-7-262005-5-132005-10-302006-3-252006-3-152005-12-52005-9-262006-3-282005-11-30010010000101110101101000三棵树棉席村三棵树大乌烧大风洞冠英炉山新山村老寨组凯棠六生村七组凯里市省林汽湾水桐木村屯上组高溪路18号环城西路马坡井环城路114号3-21号大十字金井路8号环城路135号锦平启蒙镇丁达村十组剑河岑松镇川洞村一组雷山西江镇乌烧村12号雷山望丰乡甘益村八组雷山郎乌肖村雷山西江镇干荣村太僵台拱镇大得村台江台盘水平村五组三穗款场款场村板桐油组岑巩大有村张溪中寨黄平重兴乡野落村三组黄平谷陇山凯乡浦江村二组 1黄平重安镇大石村十组黄平县重安马屯村崩坝组黄平谷陇山保村一组黄平野洞河乡龙南村下青杜组黄平重安干庒村龙塘组黄平重安包老村七组黄平谷陇镇滚水村一组黄平谷陇大寨村二组中坝村六组中坝村三组中坝村六组翁提村六组四联村十二组翁牙高泉11111111101110111110111110110011111111赵贵明龙胜福李精峰杨通林杨光杰张荣胜吴治进吴永军吴明琴吴星华张奇龙田应王田应刚陈 红龙政文龙润和罗才富周望明吴大根秦才生陈炳武陈锡猛廖长万王安明覃圣明杨国田龙永章赵凯旋龙兴尚李芬芬杨光华杨昌铁张妹长吴寿坤吴昌龙胡柳钰吴 昊张 菊田 娜田娟娟陈良宇龙 满龙金涛罗永红周 悦吴 帅秦元博陈凯悦陈政华廖湘雅王国权覃政宏杨 光龙春迪2005-7-292005-1-112005-4-142005-1-52005-4-102002-2-92005-10-62005-2-82006-5-252005-12-202005-10-192004-2-102005-7-32004-8-282005-2-102006-4-222005-8-32004-7-22003-9-82005-12-312004-11-272005-4-272005-12-192005-9-232005-8-242005-10-12005-6-241001111100111111舟溪枫香村舟溪舟溪舟溪舟溪湾水湾水湾水三棵树三棵树黄平谷陇大坪村二组丹寨南皋乡清江村二组丹寨南皋乡清江村三组施秉城关新红村二组施秉马号金中村巴团5组施秉城关新桥村新坝一组麻江谷硐镇湾寨村楼板组湖南新邵县潭谨栏村江西南昌市进贤县罗溪镇湖南缓宁县罗溪村江西秦和县罗溪镇木龙村广西博白洞平镇16号四川四川广西博白县旺城镇舟溪情郎村十组舟溪镇新农村二组111111111111111111111111111111110111101111111101111101注：1、每年9月新生入学时及每次补种后，查验老师须将儿童预防接种证（卡）接种记录填写到各苗的 2、百白破＋白破栏：百白破和白破的接种记录均可填写，填满3针就可，多余针次不用填写。 3、流脑A+C首针次接种日期到入学时已满3年栏：计算流脑A+C 1栏中登记的日期与入学日期

入学、入托儿童免疫状况登记

儿童家长是否同意补种(1=是,0=否,不祥=9脊灰百白破+白破111111111112005-9-182005-10-182005-11-182009-6-52005-9-182005-10-1812006-6-32006-7-222006-9-92010-10-142006-6-172006-7-2212005-8-282005-9-302005-10-302009-6-152005-8-222005-10-30112004-1-52006-11-262007-1-82004-12-62004-1-52006-11-2212006-9-232006-12-22007-2-32012-4-132006-12-22007-2-312006-3-282006-5-172006-7-202009-12-202006-3-282006-5-1712008-12-132009-6-92011-9-162011-10-262009-6-92011-9-1612006-2-102006-5-32006-6-32009-12-82006-5-32006-6-3112006-4-112006-7-242006-12-62006-7-242006-12-612007-3-232007-4-232007-5-23 2007-3-23 2007-4-2312009-1-172009-2-172009-3-1712010-9-112010-10-112010-11-82010-12-62010-9-112010-10-1112005-12-52006-1-92006-3-62005-12-52006-3-612007-2-112007-3-112007-4-112010-8-42007-2-112007-3-1112005-1-82005-3-82005-4-82008-10-302005-3-82005-4-81112007-12-262008-12-82011-9-192011-10-232011-9-192006-3-72006-5-92006-7-112011-10-272006-5-72006-7-1112011-4-172011-5-182011-7-182012-3-282011-4-172011-5-182006-5-212006-7-82006-7-292010-9-282006-7-82006-7-2512006-2-182006-4-182006-5-182010-7-162006-4-182006-5-1812005-12-182006-1-182006-2-182010-10-142006-1-182006-2-1812012-3-2812006-1-182006-2-182006-3-182010-7-202006-2-182006-3-181232006-12-102007-1-102007-2-102010-2-182010-3-182010-4-282006-8-12008-12-102009-1-132006-10-102006-11-102010-9-112005-10-132005-11-162005-12-242005-12-242006-2-112006-3-252008-8-212008-4-182008-6-262007-4-192007-5-192007-6-192006-12-182007-1-182007-5-2042010-9-182011-7-82010-9-242011-5-132009-9-4122006-12-182007-1-182010-4-282010-6-32008-12-132009-1-132006-10-102011-5-132005-10-132005-11-162006-2-112006-3-252008-7-202008-4-212008-7-262009-4-252007-4-92007-5-192010-7-192006-12-182007-5-2612005-11-272005-12-272006-1-262009-11-242005-11-2712005-4-192005-5-252005-8-112010-3-22005-5-112005-8-292006-1-22006-2-252009-5-222005-8-2912008-6-1912005-7-122005-8-122005-9-162005-7-18112006-9-202008-11-212009-1-192009-11-32006-9-212006-12-82007-1-102008-12-52009-8-292006-12-812006-7-252006-8-252006-9-252012-4-12006-5-2512006-3-242006-4-242006-5-292007-1-172006-3-24012010-9-212010-10-262010-11-252010-9-2112005-9-32005-10-32005-11-32011-6-112005-10-312005-8-72005-10-82006-3-102009-9-252005-8-712010-4-242010-6-282010-7-282010-10-282010-4-2412006-7-82006-9-82006-10-132010-6-202006-4-812005-11-92006-1-142006-3-152009-8-92005-11-912006-10-252006-12-112007-5-252006-12-412003-12-102004-1-202004-2-202007-12-252004-1-20112005-1-302005-3-32005-4-42006-5-302005-3-312005-7-102005-8-32005-9-102009-4-272005-8-1012006-2-192006-3-102006-4-172008-6-142006-3-812007-9-62007-10-112007-11-152007-9-612006-3-112006-4-112006-5-112009-10-22006-3-11112005-8-232005-10-102005-12-152009-7-152005-10-102005-12-272005-5-312006-1-22005-8-72008-11-202007-1-102006-9-252006-4-292010-10-262005-11-32005-10-82010-6-282006-10-132006-1-142007-1-42004-2-202005-4-42005-9-102006-4-172007-10-112006-4-112005-12-15接种记录填写到各苗的相应栏内；要填写年、月、日，如脊灰疫苗接种证记录为：2007年1月12日，填写本表为07（余针次不用填写。

学日期的时间间隔，已满3年填“1”，不满3年填“0”。

儿童免疫状况登记一览表（小学校用）_2012_年

破儿童入学、入托时及补种后免疫状况登记结果麻疹乙肝312007-2-182007-2-182010-7-72010-2-202009-2-132008-12-102011-8-142006-11-102005-12-242006-3-162006-4-292006-6-242008-8-202008-4-272007-6-192007-6-192007-6-282007-6-22005-11-182006-9-92005-12-182007-1-82007-3-32006-7-202008-8-52006-6-172006-1-2621232008-7-222006-12-182007-1-182007-9-102010-2-202010-3-252011-7-82010-2-202006-8-12008-12-132010-2-202008-7-282006-10-102006-11-102011-5-132007-5-92005-7-132005-8-152006-3-162006-7-72005-10-192005-11-192006-4-172009-7-192008-6-262008-8-202009-5-162008-6-92006-6-152006-7-152007-12-182008-6-202006-8-232006-9-232007-2-202009-9-52005-10-182005-11-182008-5-102006-6-32006-7-222006-1-242005-8-222005-9-302007-1-82006-12-22006-1-172006-2-102006-4-182008-5-102006-4-162007-9-152007-4-282006-7-92006-7-42006-8-42007-9-152006-11-222007-3-242008-12-102006-9-232006-8-92007-9-92005-12-82008-12-132011-9-162011-10-262006-7-32006-7-182007-8-182006-1-42007-1-222007-1-222008-7-282005-12-312006-4-112006-12-6 2007-5-23 2007-5-23 2008-6-24 2007-3-23 2007-4-23 2007-9-252009-1-172009-4-72010-11-82010-9-112010-12-62010-10-112010-11-82011-3-112007-3-72006-1-92007-3-72005-12-52006-1-92006-6-92008-3-272005-5-82007-5-112005-7-82008-4-302006-12-112006-7-302005-1-82007-1-112005-2-262007-6-112005-7-202007-8-262011-7-182007-10-272006-6-182006-3-182006-4-182008-7-262008-12-82011-9-192011-10-232007-7-112007-98-262006-12-302006-3-72006-8-132008-7-272010-9-142006-3-252007-10-272008-9-152006-3-152006-5-92007-10-272006-8-182007-7-62005-12-52006-1-52006-6-182006-2-232007-4-182005-9-262005-10-262006-3-262008-7-262010-9-162006-6-2320076-7-232006-9-182007-7-182005-11-32005-12-32006-5-182006-1-262005-8-112006-2-252006-4-262005-9-162006-1-22008-6-192005-9-112005-12-152009-1-192009-8-272006-11-102006-5-292006-9-22008-7-192007-2-102006-8-202007-3-102007-4-212006-10-42007-8-132005-7-302005-11-272006-1-262005-1-122005-2-122005-10-272005-4-142005-8-292006-1-22005-4-112005-5-112005-12-152009-5-162006-7-232006-6-22008-7-272006-9-22008-11-202009-8-292010-9-112006-6-232006-7-232007-7-82005-12-202006-1-202005-12-32006-3-102010-7-282006-11-132006-3-152004-3-3-202010-9-212010-10-262006-3-32007-2-262005-8-282005-9-282006-2-282005-8-72005-10-82006-3-102006-8-102010-4-242011-5-132010-10-182010-12-61011-2-82007-1-102007-11-232006-4-232006-5-222006-10-232006-5-142007-7-202005-9-192005-10-192006-3-192007-8-312006-8-252006-9-252007-2-252004-6-212005-6-242003-1-62003-11-62004-4-202005-5-52005-7-312006-6-212005-1-302005-3-32005-7-42005-10-102006-1-102006-2-202005-4-282005-5-252005-10-282006-5-172006-10-132008-12-142005-12-102006-1-202006-6-202007-11-152007-10-42008-7-62007-9-42007-10-42008-3-42006-5-112006-6-112007-8-102005-9-272005-10-272006-4-112006-1-202006-2-252007-4-212005-8-202005-9-142006-2-25月12日，填写本表为07（12/1）

乙脑流脑A+C甲肝辍学和转转入日期出日期12007-5-82011-8-112010-2-242011-6-252006-3-162007-3-292009-6-152008-4-102007-7-202008-8-52008-4-102007-5-112007-5-142007-6-162007-5-1312010-4-212011-9-162011-4-192009-6-52010-12-262007-8-152008-8-202008-4-92008-9-212012-6-162008-4-92007-11-202009-9-52008-10-122008-7-72009-11-112011-1-272009-5-122011-10-2622008-4-9212011-7-82011-6-122011-6-152011-12-42007-9-222009-8-182006-8-102007-12-202007-5-182008-4-292007-6-52008-4-112009-6-172011-7-72007-6-12008-2007-7-122008-4-72008-5-302008-12-52009-10-32010-12-62009-9-92008-9-62008-8-182008-8-42006-7-42006-4-112007-2-42011-4-172011-5-182007-12-232008-11-232008-1-132008-4-92010-7-162007-5-102010-10-142010-7-202011-12-82008-4-132012-1-132008-6-232007-5-212009-11-142007-5-272008-3-112007-12-232006-4-262007-6-82008-12-172008-12-112008-4-82008-4-102007-1072008-4-72009-11-32008-4-72008-12-12009-7-72008-12-12009-3-232007-6-232012-3-282008-8-262010-5-282007-1-102007-5-92008-3-22005-4-202011-8-302006-5-82011-6-142011-5-172010-10-182008-4-252010-6-102009-3-92008-8-72009-3-82008-11-122010-12-292006-4-132006-12-232009-12-282004-10-202006-4-202006-4-42007-4-122006-11-52007-242008-5-12007-3-262008-4-82006-5-202007-5-142008-8-162008-9-282009-7-162006-1-102011-8-162009-11-162006-12-212008-7-102012-3-29 入托、入学查验人员 _____________ 登记者 _____________