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Get LIC 613B (1/03) - Personal Rights - Children's Residential - Dss Cahwnet

This form is to be reviewed completed and signed by each child and/or each authorized representative upon admission to the home/facility. The child and/or authorized representative also has the right to receive a completed copy of the originally signed form. The original signed copy shall be retained in the child s file which is maintained by the TO CHILD OR AUTHORIZED REPRESENTATIVE Upon satisfactory and full disclosure of the personal rights as....

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