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Get CA MH 224A - Los Angeles County 2009-2024

Ee Client Face Sheet Codes Table for a listing of codes/definitions for the field. ** Field is NOT entered into the IS; information gathering only. CLIENT I.D.# CLIENT DATA Last Name: First Name: Middle Name: AKA/Maiden Last Name: AKA First Name: Middle Name: SSN: Mother’s Maiden Name: Gender: Male Female Other Unknown DOB: Age: *Primary Lang: *Preferred Lang: *Ethnicity: English Speaking: Yes No *If Hispanic, Indicate Origin: *If American Indian/Alaska Native, Indicate Tribe: *Education Leve.

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