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Get Ca Ads014 - County Of San Bernardino 2007-2025

Client Name: Client Identification # Based on my review of the client s medical history, substance abuse history, and/or most recent physical examination documentation, I am waiving the admission physical examination. Physician s Name (printed) Physician s Signature ADS014 (10/07) Date Signed Alcohol and Drug Services Page 1 of 1.

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  • physicians
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