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New York Codes Rules Regulations (Last Updated: March 27,2024) |
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TITLE 9. Executive Department |
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Appendices |
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Appendix H-8. |
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RETURN TO IN-PATIENT CARE Probation Case No. ____ DACC Case No. ____ 1. Probation Department 2. Name of Probationer Last Middle First 3. S. S. No. ___________ 4. Male Female 5. Street Address ______________ 6. Apt. No. 7. City ______________ 8. State/Zip 9. Original Sentence Date 10. Maximum expiration of probation sentence 11. Time in inpatient care ___ (days) 12. Facility(s) 13. Release date _____ 14. Type of aftercare supervision: (Direct) (Special) 15. Public and private agencies involved: 16. Return recommendation summary: (refer to recommended criteria) (attach extra sheets if needed) Signature ______________ Title Date ____________ |