| Immunization | |
| Influenza | □ |
| Pneumococcal | □ |
| Tdap (adolescent/adult tetanus, diphtheria & pertussis) | □ |
| Td (tetanus, diphtheria) | □ |
| Hepatitis A | □ |
| Hepatitis B | □ |
| HPV (Human Papillomavirus) | □ |
| MCV4 (meningococcal) | □ |
| Zoster (shingles) | □ |
| Travel vaccines (Yellow fever, Japanese Encephalitis, polio, typhoid, and rabies) | □ |
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