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Click ‘Get Form’ to open the DCH-3877 in the editor.
Begin by filling out Section I, which requires patient information such as name, date of birth, and address. Ensure all fields are accurately completed.
Indicate whether the patient has a court-appointed guardian. If yes, provide the guardian's details including name and contact information.
In Section II, answer all six screening criteria questions. Circle 'YES' or 'NO' based on the patient's condition and ensure clarity in your responses.
If any answers in Section II are 'YES', proceed to complete Section III with a clinician’s statement certifying the accuracy of the provided information.
Review all sections for completeness before saving or exporting your filled form for submission.
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