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Change Details
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Living Arrangement Details
| Household Member | [Full Name] |
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| Arrangement Type | [field-value] | Arrangement Status | |||||
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| Start Date |
| End Date |
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| Probable End Date |
| Number of Meals per Day | |||||
| Addicted to Drugs or Alcohol |
Facility Details
| Facility Participant | [Full Name] | ||||
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If the facility is a case participant, please select from below.
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If the facility is not a case participant but is registered on the system, please select from below.
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If the facility is not registered on the system, complete the facility details below.
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