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| Refusals of Service | |||||||||||||||||||||||
| Use this sheet to record clients who refuse a service and clients that you refuse services to. This information can be useful for HACC planning purposes. | |||||||||||||||||||||||
| Client Name | Date | Who did the Refusing? | Service Refused | Reason for Refusal | |||||||||||||||||||
| (Client or Service?) | |||||||||||||||||||||||