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Child disability report

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HOW TO COMPLETE THIS FORM The information that you give us on this form will be used by the office that makes the disability decision on your disability claim* You can help them by completing as much of the form as you can* DO NOT LEAVE ANSWERS BLANK. If you do not know the answers or the answer is none or does not apply write don t know or none or does not apply. IN SECTION 4 PUT INFORMATION ON ONLY ONE DOCTOR/HMO/THERAPIST/ OTHER/ HOSPITAL/CLINIC IN EACH SPACE* Each address should include a ...

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