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Erformed (e.g., vision, hearing, speech, physical). a. Public/Community Health Department Yes No b. Child Welfare/Social Services Agency Yes No c. Developmental Evaluation Center Yes No d. Mental Health/Intellectual Disability Yes No e. Special Needs/Crippled Children Agency Yes No f. Speech and Hearing Center Yes No g. Women, Infants and Children (WIC) Program Yes No Use the letter designation (5a, 5b, etc.) to identify the agency. __________________________________________.

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