Get the Form OMH 270 (4/04) page 1

Greene County Mental Health- Children t Single Point of Access SPOA Participating agencies include GC Mental Health DSS Parsons HCBW Youth Bureau Mental Health Association Home school district please specify A. I have the right to revoke take back this authorization at any time. My revocation must be in writing on the form provided to me Greene County Children s SPOA I am aware that revocation will not be...
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