General Information Form
Page
3
Please check yes or no for each of the following health services as to whether or
mot they are avaitable in a clinic serving area? If you check yes, please describe
the service, its availability, and reliability.
Type of Health Service
No
Optical services
CJC]
Medicines or pharmacy
CIC]
Rehabilitation service
Cf] {]
Care for the ages
{] ( ]
Psychiatry services
f]C]
services
16.
Yes
17.
Suicide prevention services [ ] [ ]
18.
Alcohol rehabilitation
fJC]
19.
Alcoholism prevention
CIC]
20
Drug abuse rehabilitation
[ ] [ ]
Drug abuse prevention
CIC]
STD services
CIC]
Other health services
Nature of Service, Availability, Reliability