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Client Name: DOB: Intake Date: Client ID#: Primary Diagnosis: DD Diagnosis: Intake GAS/GAF: Problems: 1: 2: 3. 4. Intake Forms (all items in regular type must be turned into the office for a case
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Problem 123 is a form used for reporting specific issues or challenges.
Problem 123 must be filed by individuals or organizations experiencing the specified issues.
Problem 123 can be filled out by providing details of the problems, potential solutions, and any other relevant information.
The purpose of problem 123 is to document and address specific issues in a structured manner.
Information such as the nature of the problem, impact, proposed solutions, and any supporting data should be reported on problem 123.
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