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<br />Indicate which of the following medical data is presently obtained for each <br />client category. <br /> <br />Medical Data Pregnant, Lactating Infants Olildren <br /> or Postpart18 r.bmen <br />Height Measurements x x x <br />Weight Measurements x x X <br />:lead Circumference <Infants Œlly) <br />iemoglobin Count <br />jematocrit Count x X X <br />Serum or Plasma Concentrations <br />of Iron, Albumin, Vitamin A, and <br />Ascorbic Acid <br />Other Laboratory Tests Routinely <br />Performed <br />UA. Chemstrip <br />PPD <br />Specific Gravity <br />Urinalysis (Mlcro) <br />SED Rate <br />WEC <br />RBC <br />Dextrostix <br />PREG Test <br />VDRL <br />GC Culture <br />PAP Smear <br />PKU <br />Rubella Titer <br />CBC <br />Differential <br />Other Pertinent Medical Data <br />Routinely Obtained <br /> 24 Hnl1't" nip,tA't"V 1?0,..",,11 )1' )1" )1' <br /> D...",~^...^1 Mo..1-1,..,,1 H-Ict-,...,.-I"",:, )1" )1" )1" <br /> <br /> <br />List the agencies from which you accept referrals and those to whom you refer <br />clients for additional services. Describe the services to which clients are <br />referred. <br /> <br />AGENCIES FROM <br />WHICH YOU <br />ACCEPT REFERRALS <br /> <br />AGENCIES TO WHOM YOU REFER <br />FOR ADDITIONAL SERVICES <br /> <br />LIST SERVICE OR <br />WHICH REFERRED <br /> <br /> <br />HPAd StÇlrL <br />Legal Aid <br />Famil Violence Shelter <br />Crisis Pregnane Center <br />Community Council Community <br />Community Service Center <br />Teen Connection <br /> <br />Service <br /> <br /> <br />tment of H <br /> <br />9 <br />