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Get Disability Placement Program In Cdcr Form

SICAL DISABILITIES LISTED IN SECTION B HOUSING ASSIGNMENT: CDC NUMBER: INSTITUTION: DATE FORM INITIATED: INMATE NAME: Sections A - B to be completed by licensed medical staff. SECTION B: DISABILITY BEING EVALUATED SECTION A: REASON FOR INITIATION OF FORM Inmate self-identifies to staff Third party evaluation request Blind/Vision Impaired Speech Impaired Observation by staff Medical documentation or Central File information Deaf/Hearing Impaired Mobility Impaired Sections C - G to be c.

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