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Get Sma 162 Form

FORM SMA-162 revised 2010 FRONT Submit in triplicate Department of Veterans Affairs County Government Other Specify A. DEPARTMENT OF HEALTH AND HUMAN SERVICES SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION CENTER FOR SUBSTANCE ABUSE TREATMENT Form Approved OMB Number 0930-0206 Expiration Date 06/30/2016 See OMB Statement on Reverse Application for Certification to Use Opioid Drugs in a Treatment Program Under 42 CFR 8. Gov or sent by.

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