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Get and Sign Dhcs 1802 2014-2022 Form
Be given specific information orally and in writing,
and in a language or modality accessible to the person and a record of the advisement be kept in the
person’s medical record.
My name is
My position here is
You are being placed in this psychiatric facility because it is our professional opinion, that as a result of a
mental health disorder, you are likely to: (check applicable)
Harm yourself
Harm someone else
Be unable to take care of
your own food clothing or shelter
(List specific...
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