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Get OK Determination of ASAM Service Level ODASL 2018-2023

S experienced a prior miscarriage Live birth with complications There have been multiple live births with complications and/or miscarriages ________________________________________________________________ ________________________________________________________________ 0 1 2 3 4 _____ 0 1 2 3 4 _____ 4 6) HAS THE CONSUMER BEEN PRESCRIBED ANY KIND OF MEDICATIONS? List all prescribed medications reported There is no medication need indicated 0 The consumer is taking meds as prescribed 1 .

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