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DBH

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02/28/2026Click to Sign

Baseline Assessment Due Date

6 Month Reassessment Due Date

Annual Reassessment Due Date

On this form we collect information that will help us contact you when it is time for your six (6) month follow-up reassessment, as well as your annual reassessments. This information will remain confidential to protect your privacy and will not be distributed to anyone outside of the District of Columbia Department of Behavioral Health and its uators. Please answer each of these questions accurately to the best of your ability.

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