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Receiving Facility __________________________________ | |
Transfer-Out Date (Date transfer-out takes effect) ␣␣-␣␣-␣␣␣␣ 📆 | |
Transfer-out Verified *** 🔘 Yes 🔘 No 🔘 Unknown797e0073-1f3f-46b1-8b1a-8cdad134d2b3 | |
Date verification done ␣␣-␣␣-␣␣␣␣ 📆 | |
Notes __________________________________ | |
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