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Series received (mark one): ______ Energix-B, Recombivax, or Twinnix (3 doses required) ______ Heplisav-B (2 doses required) Primary HBV series: 1 st dose Date: _____/______/______ 2 nd dose Date: _____/______/______ (1 month after 1 st dose) 3 rd dose Date: _____/______/______ (6 months after 1 st dose) Secondary HBV series: 4 th dose Date: _____/______/______ (only if no response to primary series) 5 th dose Date: _____/______/______ 6 th dose Date: _____/______/______ AND Hepatitis B Surface Antibody (titer) Quantitative immunity demonstrated by Hepatitis B titer - attach copy of titer report.*如果负面/无反应性，请参见免疫政策日期：_____/______/______阳性/反应性负/无反应日期：_____/______/______/______阳性/反应性阴性/无反应性D.结核病D.结核病测试：最初需要两步性TB TB皮肤测试或Quantiferon TB TB TB TB Blood Bloods验证。两步结核病测试需要相距1-3周完成。*注意：如果两步进行了1-3周的测试，则在12个月内完成的任何两个已记录的结核病测试应视为两步。
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