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Updated On[date-and-time]Received Date[Date]
Effective Date of Change[Date]Change Reason[field-value]
Approval Requested[True]Approval Status[Approved]
Status[Active]Updated By[User Name]

Absence Details

Household Member[Full Name] 
Absence Reason[field-value] 
Start Date[Date]Intention To Return Home[True]
Treatment Facility[field-value]Out of State[True]
End Date[Date] 

Address

[address-data]

Comments

[Comments]