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Get CA care-015 2006-2021

Being assessed: Date of assessment: Who was present during assessment? Location of assessment: 1. Presenting Problem(s) and Requested Service(s): A. What is the client's presenting problem / why are they here? (in client's own words when possible) B. Describe precipitating events: C. 2. If minor, attach “Authorization to Treat Minor.” What service(s) is the client asking for? Lifespan / Developmental History: A. Health at birth: B. Developmental milestones: C. Special services .

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