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Health Record · Patient: Tim

personas/two-country-family/files/health/tim-immunization-record.pdf
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                                                               22-10 Thistle Hill Road
                                                                 Fair Lawn, NJ 07410

Thistle Hill Pediatrics                                                 (201) 555-0118
                                                               thistlehillpeds.example




Immunization Record

 Patient                                               Zaretsky, Timofey ("Tim")

 Date of birth                                                       09/04/2013

 Sex                                                                             M

 Chart number                                                       THP-014482

 Printed                                 08/18/2026, for school and athletic use


Vaccines on record
 Vaccine             Dose   Date given                                    Source

 Hepatitis B         1      04/09/2013                   Foreign record (Russia)

 Hepatitis B         2      05/10/2013                   Foreign record (Russia)

 Hepatitis B         3      10/15/2013                   Foreign record (Russia)

 BCG                 1      04/12/2013                   Foreign record (Russia)

 DTP (whole cell)    1      07/11/2013                   Foreign record (Russia)

 DTP (whole cell)    2      08/29/2013                   Foreign record (Russia)

 DTP (whole cell)    3      10/15/2013                   Foreign record (Russia)

 Polio (IPV)         1      07/11/2013                   Foreign record (Russia)

 Polio (IPV)         2      08/29/2013                   Foreign record (Russia)

 Polio (OPV)         3      10/15/2013                   Foreign record (Russia)

 MMR                 1      04/16/2014                   Foreign record (Russia)

 Varicella           1      10/07/2014                                 This office

 Hepatitis A         1      10/07/2014                                 This office

 PCV13               1      10/07/2014                                 This office

 Hepatitis A         2      04/21/2015                                 This office

 DTaP                4      08/15/2017                                 This office
 Vaccine                        Dose       Date given                                  Source

 Polio (IPV)                    4          08/15/2017                                This office

 MMR                            2          08/15/2017                                This office

 Varicella                      2          08/15/2017                                This office

 COVID-19, pediatric            1          11/20/2021                       Pharmacy, reported

 COVID-19, pediatric            2          12/11/2021                       Pharmacy, reported

 Tdap                           1          08/20/2024                                This office

 MenACWY                        1          08/20/2024                                This office

 HPV                            1          08/14/2025                                This office

 HPV                            2          08/18/2026                                This office

 Influenza 2025-26              1          10/09/2025                                This office


Notes
Doses marked "Foreign record" were entered on 10/07/2014 from the patient's Russian
immunization certificate (form 156/u-93), read to the nurse by the parent. Dates on the original
are written day.month.year.

Tuberculosis: BCG given in the first week of life. Mantoux test 04/14/2014, 5 mm, consistent
with BCG.

This record meets New Jersey requirements for school attendance through grade 12,
including Tdap and meningococcal vaccine for grade 6.

Marina Vaysman, MD

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Record

Health Record · Patient: Tim Health Record · saved Aug 19, 2026

Values from records

4render unknown

The record values this file is made from: the ones its text names with {{record.field}}, and the fields its template reads. A value here is in the file's source; whether it is readable depends on the look.

ValueNow
health-tim-immunization-record.date 2026-08-18
vacc-tim-tdap.date 2024-08-20
vacc-tim-hpv-2.date 2026-08-18
vacc-tim-flu-2025.date 2025-10-09

The values at render time were not recorded: the file was rendered before files/rendered.json existed. Rendering it again records them.

Planted

mismatch The pediatrician's immunization record prints Tim's date of birth as 09/04/2013. Every other record, including the asthma plan from the same office, says 9 April 2013 (04/09/2013, 09.04.2013). April 9 is right; the printout has day and month swapped.

attachments.yaml 
record: health-tim-immunization-record
template: document
style: statement
org:
  name: Thistle Hill Pediatrics
  lines:
  - 22-10 Thistle Hill Road
  - Fair Lawn, NJ 07410
  phone: '2015550118'
  web: thistlehillpeds.example
  color: '#2f6f4f'
title: Immunization Record
body: '| | |

  |---|---|

  | Patient | Zaretsky, Timofey ("Tim") |

  | Date of birth | 09/04/2013 |

  | Sex | M |

  | Chart number | THP-014482 |

  | Printed | {{health-tim-immunization-record.date|mdy}}, for school and athletic use |


  ## Vaccines on record


  | Vaccine | Dose | Date given | Source |

  |---|---|---|---|

  | Hepatitis B | 1 | 04/09/2013 | Foreign record (Russia) |

  | Hepatitis B | 2 | 05/10/2013 | Foreign record (Russia) |

  | Hepatitis B | 3 | 10/15/2013 | Foreign record (Russia) |

  | BCG | 1 | 04/12/2013 | Foreign record (Russia) |

  | DTP (whole cell) | 1 | 07/11/2013 | Foreign record (Russia) |

  | DTP (whole cell) | 2 | 08/29/2013 | Foreign record (Russia) |

  | DTP (whole cell) | 3 | 10/15/2013 | Foreign record (Russia) |

  | Polio (IPV) | 1 | 07/11/2013 | Foreign record (Russia) |

  | Polio (IPV) | 2 | 08/29/2013 | Foreign record (Russia) |

  | Polio (OPV) | 3 | 10/15/2013 | Foreign record (Russia) |

  | MMR | 1 | 04/16/2014 | Foreign record (Russia) |

  | Varicella | 1 | 10/07/2014 | This office |

  | Hepatitis A | 1 | 10/07/2014 | This office |

  | PCV13 | 1 | 10/07/2014 | This office |

  | Hepatitis A | 2 | 04/21/2015 | This office |

  | DTaP | 4 | 08/15/2017 | This office |

  | Polio (IPV) | 4 | 08/15/2017 | This office |

  | MMR | 2 | 08/15/2017 | This office |

  | Varicella | 2 | 08/15/2017 | This office |

  | COVID-19, pediatric | 1 | 11/20/2021 | Pharmacy, reported |

  | COVID-19, pediatric | 2 | 12/11/2021 | Pharmacy, reported |

  | Tdap | 1 | {{vacc-tim-tdap.date|mdy}} | This office |

  | MenACWY | 1 | {{vacc-tim-tdap.date|mdy}} | This office |

  | HPV | 1 | 08/14/2025 | This office |

  | HPV | 2 | {{vacc-tim-hpv-2.date|mdy}} | This office |

  | Influenza 2025-26 | 1 | {{vacc-tim-flu-2025.date|mdy}} | This office |


  ## Notes


  Doses marked "Foreign record" were entered on 10/07/2014 from the patient''s Russian immunization certificate
  (form 156/u-93), read to the nurse by the parent. Dates on the original are written day.month.year.


  Tuberculosis: BCG given in the first week of life. Mantoux test 04/14/2014, 5 mm, consistent with BCG.


  This record meets New Jersey requirements for school attendance through grade 12, including Tdap and
  meningococcal vaccine for grade 6.


  Marina Vaysman, MD

  '