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, DATETYPE DOSE DATE DOSE DATE POLIO DTP 1 03/04/1987 2 05/1 4'1". HIE 1 1 03/04/1987 2 05/1 1 ' 4'' 04/02/1990 Nom, 1 07 b,:,:,,; • 10' RO ALIAS: 591‘6024SX RACIAL/ET BIRTH DAT BI RTHPLAC CERTIFICATE VACCINE CERTIFICATE $ DOSE DATE COSE D$ 08/01/1987 4 01 08/01/1987 4 SDNY_GM_00344732 EFTA 0(1217425 EFTA01316596