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Get Ccc Follow Up

R: Specify _________________ Scheduled Walk in Warm hand-off o Reason for follow up/Chief complaint: o Anxiety/PTSD o Bereavement/grief o Chronic illness management o Adjustment to medical condition: Specify__ o Diabetes o Pain o Other: Specify______________________ o Depression o Positive depression screen o Positive PTSD screen o Positive AUDIT C screen o Relapse prevention o Relationship/marital concern o Sleep concerns: Specify_____________ o Stress: Specify___________________________ ____ .

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