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Get Item By Item Instructions For Adult Interview - New Dhh Louisiana

Ed for further services after the 3rd session of individual crisis counseling. . If crisis counseling continues (CCS OR SCCS), the Assessment Questions (Page 2) should be re-administered after the next three visits. PAGE 1 PROVIDER NUMBER PROVIDER NAME EMPLOYEE NUMBER EMPLOYEE NAME RECIPIENT NUMBER NAME OF HURRICANE(s) DATE ADMINISTERED LOCATION OF SERVICES: (Check one) SERVICE TYPE VISIT NUMBER ZIP CODE OR SERVICE RISK CATEGORIES DEMOGRAPHIC INFORMATION AGE SEX ETHNICITY RACE PREFERRED LANGUA.

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