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State of Idaho Department of Health and Welfare  HW 0954 08 12 Section II  DISABILITY REPORT FOR CHILDREN PLEASE PRINT, TY...
4A. Has the child seen any other doctors since your disabling condition began  If Yes, show the following  NAME  TELEPHONE...
5A. Has the child ever been hospitalized or treated at a clinic for the disabling condition  NAME OF HOSPITAL OR CLINIC  Y...
If the child has been in other hospitals or clinics for your illness or injury, list the names, addresses, patient or clin...
11. Is the child in special education   Yes  12. Is the child in speech or language therapy   No  Yes  If  Yes,  provide t...
Yes  16. Has the child ever worked  including sheltered work    No  If  Yes,  complete the following   NAME OF EMPLOYER AD...
PART VI     REMARKS Use this section for additional space to answer any previous questions. Also use this space to give an...