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Get Tx Vs-109.1 2011

RN MR# ________________________________ MEDICAID # _______________________________ DELIVERING DR ________________________________ RM # ____________ The information you provide on this worksheet is used to create your child’s birth certificate. The birth certificate is a legal document used to prove your child’s age, citizenship and parentage. Your child will use the birth certificate throughout his/her life. The State of Texas safeguards against the unauthorized release of identifying in.

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