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Get Michigan Accident Death 2015-2024

INCIDENT, ACCIDENT, ILLNESS, DEATH OR FIRE REPORT Michigan Department of Health and Human Services Division of Child Welfare Licensing INSTRUCTIONS The completion of this form may optionally be used to document the requirements of the following licensing rules: Child Caring Institutions R 400.4167(1)(2) Court Operated Facilities R 400.10159(2) Child Placing Agencies R 400.12415 (2) The completion and submission of this form to the department is required by the following licensing rul.

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