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AAC Evaluation for an SGD
Date of Evaluation:
Date of Report:Client Information
Name:
Address:
Phone:
Place of Residence: Home
Date of Birth:
Age:
Gender: Male
Physician Referral:Medicaid ID #:
Medicare
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What is place of residence home?
The place of residence home is the primary location where an individual resides.
Who is required to file place of residence home?
Individuals who have changed their primary residence or moved to a new location are required to file their place of residence home.
How to fill out place of residence home?
To fill out place of residence home, individuals need to provide their current address and any previous addresses if they have moved recently.
What is the purpose of place of residence home?
The purpose of place of residence home is to update and maintain accurate records of individuals' primary residence for legal and administrative purposes.
What information must be reported on place of residence home?
The information that must be reported on place of residence home includes the individual's current address, previous addresses, and the date of the change in residency.
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