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Get Nys Opwdd 2010-2024

Ving services Date of Birth Name of agency/residence Agency contact person Phone number of agency contact person MEDICAL IMMOBILIZATION/PROTECTIVE STABILIZATION APPOINTMENT TYPE Manual: Arms Legs Head Medical Dental Dx Mechanical: Arms Legs Head Torso Medical Dental Dx Papoose Board: Medical Dental Dx Special instructions (if any) regarding the above for agency staff ____________________________________ ___________________________________________________________ ___________________________.

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