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Adult Diversion/Aftercare Program
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[Neighborhood of Residence]
[Encounter Location]
[Religious Affiliation Info]
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[Health Coverage]
[Medical History]
[Mental Health History]
[Substance Use History]
[Other Mental Health..]
[Justice Involvement]
[Personal/Family History]
[Education]
[Military Service]
[Employment Status]
[Personal Identification]
[Emergency Contact]
[Client Testimony..]
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