Meeting Record

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The Commonwealth of Massachusetts
Department of Public Health
Division of Health Professions Licensure
Board of Registration in Nursing
239 Causeway Street Boston, Massachusetts 02114
Substance Abuse Rehabilitation Program
Meeting Record
Participant ____________________________
Period from: __________ to: __________
DATE
Meeting
Initials
DATE
Meeting
Initials
DATE
Meeting
Initials
Attended
Attended
Attended
Meeting
Meeting
Meeting
DATE
Attended
Initials
DATE
Attended
DATE
Attended
Initials
Initials
Please indicate men’s / women’s group with notation (*, x, hi-liter)

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