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Get NY TA-7 822-4 2012-2024

PART 822-4 CHEMICAL DEPENDENCE OUTPATIENT SERVICES INDIVIDUAL TREATMENT/RECOVERY PLAN Patient Name Patient ID Identified Functional Area Chemical Dependence/Abuse please indicate goal status below Address Defer give clinical reason Not applicable Areas of concern as given in Comprehensive Evaluation Goal s or Deferral Information Objectives Steps to Obtain Goal s Target Date Clinical Action/Intervention Completion TA-7 822-4 Rev. 03/12 Page 2 of.

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