12/1/2022 3:27 PM COURT-ORDERED CASE NO, 22CCJPO3833ABC NO RMO FA Maintenance APPLIES YE Liberty-Rose Rader (Mother) SRA Natasha Rader Parents ] YE ailab thos Name Address Slano t with: al Rights Ro oerior ty BIRTH HISTORY: (Optional) To the Physician: Please complete both sides and return to the Pre-natal Complications Birth Weight Neo-natal Complications DEVELOPMENTAL MILESTONES: Crawl mo. mo. Sentences Sat. Words. Toilet Trained MEDICAL HISTORY: Surgery Allergic Reactions Serious Ilnesses or injuries DPT Or TD Polio Measles Mumps LOS ANGELES UNIFIED SCHOOL DIST Rubella IMMUNIZATIONS OF (NUMBER DOSES AND DATES):