Epstein Secrets

LY PHYSICIAN (413) PHYSICIAN PHONE µe7 Does your child currenV have health insurance? BYES 0 NO If YES, indicate: (07) HOSPITAL PREFERENCE . 0 Medicaid airivate 0 Healthy Kids/Kid Cam 0 Interested in receiving information eittiS •i p ER, tpl.PeEtliii,„_, ,,,,,_ cfrk oil _ ,§q. ,pp 73, (49) NA

my knowledge. (66)DATA /GUARDIA DATE REV:10636 (REV 416,2001) page 2 of 2 EFTA01709726 12t r emae (Form: 23(3 SSN: NA 2004 Ain No 0017 ASVAB RV RESULTS ASVAB Results 12th Credo Standard Scores 12th Grade Standard Score Bands Percentile Scores 12th 12th 12th Gtaile Grad. Grade

0 Yes (Permission is void through grade 5.) 0 No 6. Does your child currently have health Insurance? ;Yes Q No p If YES, check insurance plan: 0 Medicaid 0 Healthy Kids/Kid Care IXPrivate K Interested in receiving information 7. All new students to Palm Beach County are required to answer the followin

) Test Date: Nov 22, 2004 Royal Palm Beach I-Is Royal Palm B FL Pam 19.0003 ASVAB SUM ARMED SERVICES VOCATIONAL. APTITUDE BATTERY ARY RESULTS ASVAB Results — 11th Standard Scores 11th Grade Standard Score Bands Percentile llth Made Females Scores ITO Gads Mat 11th Grade Students

0 Yes (Permission is void through grade 5.) 0 No 6. Does your child currently have health Insurance? ;Yes Q No p If YES, check insurance plan: 0 Medicaid 0 Healthy Kids/Kid Care IXPrivate K Interested in receiving information 7. All new students to Palm Beach County are required to answer the followin

) Test Date: Nov 22, 2004 Royal Palm Beach I-Is Royal Palm B FL Pam 19.0003 ASVAB SUM ARMED SERVICES VOCATIONAL. APTITUDE BATTERY ARY RESULTS ASVAB Results — 11th Standard Scores 11th Grade Standard Score Bands Percentile llth Made Females Scores ITO Gads Mat 11th Grade Students