Action Counseling

Action Counseling

729 Prospect St. Suite 200 Port Orchard, WA 98366 Phone (360) 895-1307 Fax (360) 895-4805

APPOINTMENT LETTER

January 25, 2018

Daddy Lewis 221 Elm St Apt B Bremerton, WA 98310

DOB: 12-1-1995 CASE: 23021201

Mr. Lewis has an appointment on January 29, 2018 to update his previous evaluation and enroll into treatment.

If there are any questions, please feel free to contact me@ (360) 895-1307.

Respectfully,

~.~~ Action Counseling

This information has been disclosed to you from records whose confidentiality is protected by Federal Regulation (42CFR, Part 2) prohibits you from making any further disclosure of it without the specific written consent of the person to whom it pertains, or as otherwise permitted by such regulations. A general authorization for the release of medical or other information is NOT sufficient for this program.

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