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Get CA Standardized HMIS Intake Form 2015

Se from the Middle East should mark White.] o o o o o American Indian/Alaskan Native Asian Native Hawaiian / Pacific Islander o o Black/African-American White Client Doesn’t Know Client Refused *16. Household Configuration: o Single o Couple Without Children * = HUD Required Fields o Female Single Parent o Male Single Parent Questions in bold = Continuum Required o Two Parent Family Modified 12/31/2015 o Other ______________ Page 1 of 5 17. Sexual Orientation: Heterosexual __.

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