Questions | Concepts |
|---|---|
Visit Date ␣␣-␣␣-␣␣␣␣ 📆 | 163137AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Receiving Facility __________________________________ | 162724AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Transfer-Out Date (Date transfer-out takes effect) ␣␣-␣␣-␣␣␣␣ 📆 | 160649AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Transfer-out Verified 🔘 Yes 🔘 No 🔘 Unknown | 797e0073-1f3f-46b1-8b1a-8cdad134d2b3 |
Date verification done ␣␣-␣␣-␣␣␣␣ 📆 | 160753AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
Notes __________________________________ | 165095AAAAAAAAAAAAAAAAAAAAAAAAAAAAAA |
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