5) Please check the table below. The following criteria must be met to be considered to have immunity from these diseases. Disease Inspection Method Criterion Measles EIA 4.0 HI NT, CF 1:8 PA Rubella EIA 4.0 HI Mumps EIA 4.0 HI NT, CF 1:8 Varicella EIA 4.0 FA CF 1:8 IAHA 1:8 Intradermal Skin Test Positive I certify that the immunization data given above are accurate and that this immunization status is thus up-to-date. Physician’s name (in block capitals) Physician’s signature CONSULTANT MEDICAL GASTROENTEROLOGIST Name of clinic Date Address 2/2 University of Tsukuba Hospital
5) Please check the table below. The following criteria must be met to be considered to have immunity from these diseases. Disease Inspection Method Criterion Measles EIA HI NT, CF PA 4.0 1:8 Rubella EIA HI 4.0 Mumps EIA HI NT, CF 4.0 1:8 Varicella EIA FA CF IAHA Intradermal Skin Test 4.0 1:8 1:8 Positive I certify that the immunization data given above are accurate and that this immunization status is thus up-to-date. Physician’s name (in block capitals) Physician’s signature CONSULTANT MEDICAL GASTROENTEROLOGIST Name of clinic Date Address 2/2 University of Tsukuba Hospital
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