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VERIFICACIN DE HABER RECIBIDO EL PROCESO DE MEDIACIN (Westside Regional Center)

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VERIFICACIÓN DE HABER RECIBIDO EL PROCESO DE MEDIACIÓN
Y AUDIENCIA DE INTERVENCIÓN TEMPRANA
Y LOS DERECHOS Y RESPONSABILIDADES DE LOS PADRES
EN EL PROGRAMA DE COMENZAR TEMPRANO
He recibido una copia del Proceso de Mediación y Audiencia de Intervención Temprana
_______________________________________ ___________________
Consumidor, Padre, Conservador o Guardián Fecha
He recibido una copia de “Los Derechos y Responsabilidades de los Padres en el Programa de
Intervención Temprana.”
_______________________________________ ___________________
Consumidor, Padre, Conservador o Guardián Fecha
Nombre del Consumidor:____________________________________
Fecha de Nacimiento:_______________________________________
Número de UCI:___________________________________________
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VERIFICACIN DE HABER RECIBIDO EL PROCESO DE MEDIACIN (Westside Regional Center)

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Completed 7 February 2021

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