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Provide the appropriate data in the field F, PERSON, TO, CONTACT, If, institution G, TELEPHONE, NOInclude, Area, Code HE, VALUATION, CRITERIA I, EVALUATION, PROCEDURE J, EVALUATION, SCHEDULE K, PROGRESS, NOTES A, OBJECTIVE, TWO, Description B, ANTICIPATED, COMPLETION, DATE C, SERVICES, PROVIDED D, DURATION, OF, SERVICES, TOMo, Yr FROM, MoY, r and F, PERSON, TO, CONTACT, If, institution

Put together the crucial information in the G, TELEPHONE, NOInclude, Area, Code HE, VALUATION, CRITERIA VA, FORM, JUL and Continued, on, Reverse segment.

You will have to describe the rights and obligations of both sides in paragraph ITEM, CONTINUED I, EVALUATION, PROCEDURE J, EVALUATION, SCHEDULE K, PROGRESS, NOTES A, OBJECTIVE, THREE, Description B, ANTICIPATED, COMPLETION, DATE C, SERVICES, PROVIDED D, DURATION, OF, SERVICES, FROM, MoY, r, TOMo, Yr F, PERSON, TO, CONTACT, If, institution G, TELEPHONE, NOInclude, Area, Code HE, VALUATION, CRITERIA and I, EVALUATION, PROCEDURE

Look at the fields J, EVALUATION, SCHEDULE K, PROGRESS, NOTES CLOSURE, STATEMENT SIGNATURE, OF, COUNSELING, PSYCHOLOGIST and ANNUAL, REVIEW, DATE and thereafter fill them in.

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