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MRN: TBH-00421 · DOB: 03/14/1992
Program
ACT Team — Uptown
Clinician
Jordan Mills, MSW
Note type
Client Present
Service Details
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Clinician Attestation

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I have reviewed and edited this note for accuracy. This documentation reflects services personally provided by me on the date of service listed below. The information documented is true, accurate, and complete to the best of my knowledge.

Date of ServiceJune 26, 2026
Duration—
Activity CodeACTI
Service Location12 — Home
Diagnosis—
ModalityIn-person / Community
Clinician Signature
Jordan Mills
Date Signed
06/26/2026

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