General Information |
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| Visit Date: | ID Number: 153120 |
| Provider Community: Somali1 | Community Health Worker: |
| Primary language: Somali | Do you read write in this language: |
| Other languages: Somali | Do you read write in this language: Somali |
| Children in Care are: Family | Provider Relationship: |
| Number of Children: 5 | Ages are: 2yrs, 4yrs, 5yrs, 7yrs, 9yrs |
| Location where care takes place: | |
