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Get TX DADS 3613 2009

Independently ambulatory: Yes No Interviewable: Yes No Capacity to make informed decisions: Yes No Combativeness ................... Yes No Similar allegations ................ Yes No Wandering ............................ Yes No Sexual misconduct .............. Yes No Verbal aggression ................ Yes No Physical aggression ............. Yes No Known history of: Diagnosis/Pertinent History Alleged Perpetrator(s) (AP) Attach documentation of any criminal histor.

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