EFTA Document EFTA01316596

CONFIDENTIAL hJ Case o5-31.08 itrbptrflj QC' I Ote'tL\ TO - DISTRICT: 0000050 PALM BEACH GRADE LEVEL: 12 PREPARED DATE: 01/ FL STUDENT ID: 591660245X SSN: 59: LEGAL NAME: MAILING PARENT/GUARDIAN (NAME/CODE): TERESE HALL-GOLICK PARENT IMMUNIZATION STATUS: PERMANENT INNUNI:ATI2N VACCINE STATUS, DATE - TYPE DOSE DATE DOSE DATE DTP 1 03/04/1987 2 05/1 4'1". POLIO 1 03/04/1987 2 05/1 1 ' 4'' HIE 1 04/02/1990 Nom, 1 07 b,:,:,,; • 10' RO ALIAS: 591‘6024SX RACIAL/ET B