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Get HI Form 272927

ERMANENT ADDRESS AND PHONE NO. BIRTHDATE OR AGE SEX MARITAL STATUS FEMALE MALE RESPONDENT-SUBJECT If a subject is a minor, parent s or guardian s or custodian s : Name, Address, Phone No.: Subject s spouse, relative or friend, other than applicant: Name, Address, Phone No., and Relationship: Pursuant to HRS Chapter 334, the undersigned applies for emergency examination and treatment of the subject identified above and alleges as follows: (1) That he/she is a licensed.

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