Form 4119 dads-2025

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The document is a service delivery log form from the Texas Department of Aging and Disability Services, specifically for Home and Community-based Services. It is used to record the activities and support provided to individuals receiving Residential Support Services (RSS) or Supervised Living (SL) during a specified week. The form includes sections for daily tasks related to personal care, skill development, community integration, and health monitoring, along with space for documenting any incidents or special events.

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