Intake Information
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Intake Information Needed:

Name, address and telephone number for the following:


    *  Psychiatrist (include date of last visit)
    *  Psychologosit (include date of last visit)
    *  Dentist (include date of last visit)
    *  Doctor (include date of last visit)
    *  School
    *  Social Worker
    *  Probation Officer
    *  Guardian as Litem
    *  Former Placements
    *  Pharmacy

Immunization records

School IEP (Individual Education Plan)

Copy of Social Security Card

Copy of Birth Certificate

Copies of all Insurance/MA cards

Name of Parents' Employers

Parents' social security numbers

Parents' birthdates

List of restricted contact people

List of approved contact people

Medicatins in original bottles

Copy of court order or voluntary placement agreement

Items Needed:

One piece swinsuit (FH)

Tennis shoes                                                                                                                           

                                                                                                                                                                     
2/18/2008r