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Northeast Texas Treatment Center Nttcrusk Org Form

Northeast Texas Treatment Center Nttcrusk Org Form

Name: Nttcrusk Org Form - Fill Out and Sign Printable PDF Template | signNow
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Rating: 4.8 (113 reviews)

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Has not been taken C. Crack 2. Cocaine 3. Alcohol 4. THC 5. Heroin 6. 12. Please list type of Hashish Opium Other Narcotics 15. Physical Evaluation Pg. 2 TUBERCULOSIS SCREENING QUESTIONNAIRE Name TB Skin test PPD Date Last Chest X-Ray Date longer. Hx of Hepatitis Yes No Type Hepatitis Immunization 12. Current Medications Dosage Frequency Last Dosage Taken on Date time 13. I further understand that withholding or giving false information could result in being discharged from Northeast Texas...

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