WebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 H (Rev 12/13) SHA (Adult) Page 2 of 2 19 In the past year, have you had: (men) No5 or more alcohol drinks in one day? (women) 4 or more alcohol drinks in one day? Yes Skip 20 Do you use any drugs or medicines to help you sleep, relax, WebState of California – Health and Human Services Agency Department of Health Care Services DHCS 7098 I VIETNAMESE (Rev 12/13) SHA (Senior) Page 1 of 3 (Staying Healthy Assessment) (Senior) Tên Bệnh Nhân Ngày Sinh Nữ Nam Hôm Nay Ngày b ệnh nhân Có Không ệ Có Không Clinic Use Only: 1

Staying Healthy Assessment

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Form DHCS7098 C "Staying Healthy Assessment: 1-2 Years" - California

WebState of California – Health and Human Services Agency Department of Health Care Services DHCS 7098 A (Rev 12/14) SHA (0 – 6 Months) Page 1 of 2 Staying Healthy Assessment 0 – 6 Months Child’s Name (first & last) Female ... Health and Human Services Agency Department of Health Care Services . DHCS 7098 A (Rev 12/14) SHA (0 – 6 … WebState of California — Health and Human Services Agency Department of Health Care Services DHCS 7098 H (Rev 12/13) SHA (Adult) Page 1 of 2 Staying Healthy … WebState of California – Health and Human Services Agency Department of Health Care Services DHCS 7098 A (Rev 12/13) SHA (0 – 6 Months) Page 1 of 2 Staying Healthy Assessment 0 – 6 Months Child’s Name (first & last) Date of Birth Female Male Yes Today’s Date In Child/Day Care? No Person Completing Form Other how to remove video background in clipchamp