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WELL CHILD VISIT 1517 Year Name Age in Years Date of Visit Concerns/Discussion (from parent and adolescent) Family concerns Parent/Adolescent relationship Behavior/Discipline School issues Other concerns
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This form is used to report income and expenses for individuals aged 15-17 years old receiving care services from wyequalitycareacs inccom.
Parents or legal guardians of individuals aged 15-17 years old receiving care services from wyequalitycareacs inccom are required to file this form.
The form can be filled out online or by mail, providing information on income, expenses, and care services received by individuals aged 15-17 years old.
The purpose of this form is to accurately report income and expenses related to care services for individuals aged 15-17 years old.
Information on income, expenses, and care services provided to individuals aged 15-17 years old must be reported on this form.
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