预防接种证明书出国填写,英文

预防接种证明书CERTIFICATE OF VACCINATION 姓 名 ？ ？性 别 男出生日期2005年1月12日国籍中国Name Gender Male Date of Birth ,2005 Nationality已接种下列疫苗The following vaccine had been immunized: 疫苗Vaccine 接种日期Date of given 剂量Dose 接种单位Hospital 卡介苗Bacillus Calmette Guerin Vaccine Maternity and Child Health Center Of Song Jiang District 松江区妇婴保健所乙型肝炎疫苗Hepatitis B Vaccine Song Jiang Center Hospital 松江区中心医院Yue Yang community health care 岳阳社区卫生服务中心Yue Yang community health care 脊髓灰质炎疫苗Oral Poliomyelitis Vaccine 1 dosage 1 dosage 1 dosage 1 dosage 1 dosage Yue Yang community health care Yue Yang community health care Yue Yang community health care Yue Yang community health care 白喉百日咳破伤风联合疫苗Diphtheria Pertussis Tetanus Vaccine Yue Yang community health care Yue Yang community health care Yue Yang community health care Yue Yang community health care 麻疹疫苗Measles Vaccine Yue Yang community health care Yue Yang community health care 乙型脑炎疫苗Encephalitis B Vaccine Yue Yang community health care Yue Yang community health care 麻疹腮腺炎风疹联合疫苗Measles Mumps Rubella Vaccine Yue Yang community health care Yue Yang community health care A 群流行性脑膜炎疫苗Meningococcus A Vaccine Yue Yang community health care Yue Yang community health care Yue Yang community health care 水痘疫苗Varicella Zoster Vaccine Yue Yang community health care 甲型肝炎疫苗Hepatitis A Vaccine Yue Yang community health care Yue Yang community health care 精制白喉破伤风两联疫苗Purified Diphtheria Tetanus Vaccine Yue Yang community health care 肺炎球菌结合疫苗Conjugate Pneumococcal Vaccination 流感疫苗Influenza Vaccine 日期2016 年 3 月 21 日医生签名 Signature ：__________中国 上海市松江区 疾病预防控制中心Date ,2016 Centers for Disease Control and Prevention Songjiang District , Shanghai , P. R. China