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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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