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PDF-22941 Atherton Street, Hayward, CA 945416633Tel.510.538.8876 TDD510.7 PDF document

REQUEST FOR A REASONABLE ACCOMMODATIONInstructions I authorize the Care Providerlisted above to disclosrelevant information to HACA regarding the needI have described

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22941 Atherton Street, Hayward, CA 945416633Tel.510.538.8876 TDD510.7: Transcript

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