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County of Santa Clara Substance Use Treatment Services Offender Treatment Program (OTP) Referral Form CLIENT INFORMATION CLIENT NAME F Transgender OtherGENDERADDRESS TYPE OF HOUSINGCITY/ZIP Homeless

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How to fill out otp referral 71917

01

To fill out OTP referral 71917, follow these steps:

02

Start by entering your personal information, such as your name, date of birth, and contact details.

03

Provide information about your current employment status and details of your employer.

04

Next, fill in the details of your medical history, including any pre-existing conditions or allergies.

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If applicable, include information about your current medications and treatment plans.

06

Finally, review the completed form for accuracy and make any necessary corrections before submitting it.

Who needs otp referral 71917?

01

OTP referral 71917 is required by individuals who need to seek specialized medical care or treatment. It may be needed for medical consultations, diagnostic tests, or access to specific medical procedures prescribed by a healthcare professional. It is typically used to refer patients to specialists or healthcare providers outside of their primary care network.

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