General Information |
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| Visit Date: | ID Number: 153104 |
| Provider Community: African-American | Community Health Worker: |
| Primary language: English | Do you read write in this language: Yes |
| Other languages: | Do you read write in this language: English |
| Children in Care are: Family | Provider Relationship: |
| Number of Children: 2 | Ages are: 2yrs, 9yrs |
| Location where care takes place: | |
