ON 0 YES El Ng 0 1 2 3 4 t) 6 (70) VERIFICATION W BIRTH 1 I 3 4 5 6 7 8 9 T On RAS z 4 B t MI DOCUMENTATION (*CRUST CHECK AND DATE WHEN O CA EC IMMLNIZATIONS 0 OAT( EaDED) VERIFICATION Ol OP Kles RECORDS Doan SODIAk, SECURITY n NO DPT OTIAL g..4 OAT{ PHPSOCAL IIXMAS (73) DATA ENTRY