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Get TX DADS 3613-A 2012-2023

Other: Y N Y N Y Independently ambulatory Interviewable Capacity to make informed decisions History of Combativeness Verbal aggression Physical aggression Sexual misconduct Y N Wandering Wearing wander guard at time of incident Similar allegations Other pertinent history: Name Female Male Social Security No. N Date of Birth Functional Ability: Level of Supervision: Total assistance Extensive Minimal No assistance No special supervision Within eyesight Within hearing Within arm’s length .

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