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VOC×HIS×INTAKE×FORM (excludes×SSDF)
Household×Member×1Household×Member×2Household×Member×3Household×Member×4PROJECT×ENTRY×DATE (e.g.×08/24/2014)
SIGNED×ROI×DATE: (Client×Release×of Information)
# in×Household (including×self)
First×Name
Middle×Nameless×Name
Suffix
DATE×OF BIRTH (e.g.) 10/23/1978)
SOCIAL×SECURITY×NUMBER
GENDERMaleFemaleMaleTransMaleTransFemaleMale×to Female
(Female×to Male)
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