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Effective 4/2016 3 Pond Road (978) 2823027 Phone Gloucester, MA 01930 (978) 2823035 Fax COMMUNITY DEVELOPMENT DEPARTMENT GRANTS DIVISION LEAD HAZARD CONTROL PROGRAM The Lead Hazard Control Program

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01

Start by gathering all the necessary information and documents. Make sure you have all the required details, such as personal information, medical history, and any previous rehab treatments.

02

Begin by filling out the personal information section. This includes your full name, date of birth, address, contact information, and social security number.

03

Move on to the medical history section. Provide detailed information about any medical conditions, medications you are currently taking, and any allergies or sensitivities.

04

Fill out the section on substance abuse history. Provide accurate and honest information about your previous or current substance abuse issues, including the type of substances used, frequency, and duration of use.

05

If you have any legal issues related to substance abuse, disclose them in the legal history section. This may include any previous convictions, court-mandated treatments, or probationary periods.

06

Complete the section on mental health history. Be transparent about any mental health conditions or diagnoses you have received in the past, as well as any current or previous mental health treatments.

07

Provide emergency contact information. This should include the names, phone numbers, and relationships of at least two individuals who can be contacted in case of an emergency.

08

Review the completed application carefully. Make sure all the information is accurate and up-to-date. Any inconsistencies or missing details could impact the effectiveness of your rehabilitation treatment.

Who needs rehab - 01 applicationdoc?

The rehab - 01 applicationdoc is typically required by individuals seeking admission to a rehabilitation center or program. It is used to gather important information about the individual's personal, medical, and substance abuse history. This application helps the rehab facility assess the individual's needs and determine the most appropriate treatment plan. It is designed for individuals who are ready and committed to addressing their substance abuse issues and are seeking professional help to overcome their addiction.

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What is rehab - 01 applicationdoc?

Rehab - 01 applicationdoc is a form used for applying for rehabilitation services.

Who is required to file rehab - 01 applicationdoc?

Individuals seeking rehabilitation services are required to file rehab - 01 applicationdoc.

How to fill out rehab - 01 applicationdoc?

Rehab - 01 applicationdoc can be filled out by providing the necessary personal and medical information requested on the form.

What is the purpose of rehab - 01 applicationdoc?

The purpose of rehab - 01 applicationdoc is to assess eligibility for rehabilitation services and determine appropriate treatment.

What information must be reported on rehab - 01 applicationdoc?

Rehab - 01 applicationdoc requires information such as personal details, medical history, and reasons for seeking rehabilitation.

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