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Get TX Form 3643 1996

Ges recommended to the Goals? Yes No Are changes recommended to the Approaches? A. Yes No Yes No Is the Plan of Care appropriate? B. Are changes to the Restorative Program recommended? If YES to any items in B, update next month’s SECTION I–PLAN OF CARE with the changes. Comments: C. Continue Program? Yes No D. Discharge to basic nursing? Signature–Licensed Staff Date .

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