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PROGRESSIVE STEP REHABILITATION of ORANGE PARK CONFIDENTIAL PATIENT INTAKE AND CONSENT FORM Primary Care or Referring physician PATIENT INFORMATION Patients Last telephone Number FirstNicknameMiddle

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What is alcohol abuse and addiction form?

The alcohol abuse and addiction form is a document used to assess an individual's pattern of alcohol consumption, identify signs of alcohol misuse, and determine the level of addiction or dependency. It is typically utilized by healthcare professionals for diagnosis and treatment planning.

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The information that must be reported includes personal identification details, frequency and quantity of alcohol consumption, history of alcohol-related problems, mental health status, and any previous treatment experiences.

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