This government document is issued by Department of Human Services for use in District of Columbia
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https://www.google.com/url?client=internal-element-cse&cx=2d618894035d0d742&q=https://dhs.dc.gov/sites/default/files/dc/sites/dhs/page_content/attachments/Youth%2520HOPE%2520Triage%2520Form.pdf&sa=U&ved=2ahUKEwid_cLq5fj8AhV5VaQEHbX_Bo44FBAWegQIBhAB&usg=AOvVaw0vl69-gJrtkuW0LbT5OC5y