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For Office Use Only Scanned: Processed By: Provider: Patient InformationPlease complete this form. Attach copies of any additional information or reports that might assist our evaluationName: Date
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What is 10-20 hp by community?
10-20 hp by community is a form for reporting certain information about community activities.
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Information such as community projects, funding sources, and impact on the community must be reported on 10-20 hp by community.
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