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Get GA Form 1013 2012

E facility has a bed available for this individual. This certificate authorizes the peace officer or other person to deliver the individual named on this 1013 to the named facility for examination to determine whether admission is necessary. ____________________________________________________________________________________________ SIGNATURE AND PRINTED NAME of staff at Referring Facility Date_______ 20____ Time ________m For Receiving Facility Staff Use Only – A copy of form 1013 is placed i.

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