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Get NY LDSS-4526 2010-2024

D Understands and remembers instructions Standing Moderately Limited Other: Seeing, Hearing, Speaking Using Hands V. TREATMENT HISTORY (list for medical, psychiatric, alcoholism and drug treatment for the past Two Years) Name of Program/Provider Type of Program/Provider i.e. Outpatient, Residential, (for addiction specify modality) Length of Treatment (# of Months) ___________________________________________ ___________________________________________ ______________________.

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