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State of Alaska Department of Corrections Inmate Healthcare___ DOB___OBSCIS#:___Age:___Sex:___ Medication Allergies:___ Current Medications:___ 05/16Drug Withdrawal OBTAIN VERIFICATION OF CURRENT

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What is this is an informational?

This is an informational form used to report specific information to the relevant authority.

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Entities or individuals that have the specific information to report are required to file this form.

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