This government document is issued by Human Services, Department for use in New Jersey
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https://www.google.com/url?client=internal-element-cse&cx=f1a222ae9af1a47bb&q=https://nj.gov/humanservices/ddd/documents/ddd%2520web%2520current/DDD/Day%2520Program%2520Standars%2520(Manual)/F5MedicalFormforAdults.pdf&sa=U&ved=2ahUKEwjSi8qStZuGAxURgP0HHbt0Cas4ChAWegQIBxAB&usg=AOvVaw3XYakx3Y0iH-sQL_03Pj53&arm=e