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Get Mass Dds Healthcare Practitioner Encounter Form Pdf

Massachusetts Department of Developmental Services HEALTH CARE PRACTITIONER HCP ENCOUNTER FORM To be completed by DDS provider Name Date and Time of Appointment Name of Health Care Practitioner Allergies Reason for Visit/Symptoms The following section to be completed by health care practitioner. Health Care Practitioner signature Print name Staff Follow-up Yes No N/A Posted Date Provider Staff Signature Transcribed orders to med log Time Verified.

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