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T Name: ___________________________________ Date ________________________ From Overview of PAC Forms completed by the patient: Presenting Problems (brief notes): 1. ______________________________________ ______ 2. ______________________________________ ______ 3. ______________________________________ ______ Axis III Medical Conditions: No Yes _________________________________________ Current Medications: No Yes _________________________________________ Axis IV Current Severe Stressors: No Ye.

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