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Get and Sign Behavioral Health Services Telephone 1 800 454 3730fax 1 800 505 1193 2017 Form

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Retesting is requested DSM-5/ICD-10 diagnosis Rationale for testing Please describe the rationale for testing. Clinical information Indicate the presenting problems symptoms and need for testing. Inattention Irritability Disorganization Depression Labile mood Lethargy Low motivation Distractibility Poor attention Acting out Attention seeking Hallucinations span behavior Low frustration Suicidal/ Violence/physical Speech and tolerance homicidal aggression language delays ideation Other Duration...
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