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Patient Name: Date of Birth:MAN/File No:Physician Name:Date:SNAP IV 26 Teacher and Parent Rating Scale Name: Gender: Age: Grade: Ethnicity:AfricanAmericanAsianCaucasianHispanicOther: Completed by:

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Completed by type of refers to indicating who completed a certain form or document.

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The individual or entity responsible for completing the form or document is required to file completed by type of.

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The purpose of completed by type of is to provide transparency about who completed a particular form or document.

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