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With this form you can send a message to
a patient currently at JCHC.
The message will then be delivered by our Social Services Staff.
Attention:
Anything put on this form should not be considered confidential.
Do not put anything in this form you would not put on a postcard.
If you need to discuss private matters please do not use this form.
| Your Name | |
| Patient Name | |
|
Message |