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EHI Request

Centria is committed to a culture of transparency

Should you not have the information necessary to complete the form, please consult with your treatment team
(Supervising Clinician, Field Staff Manager/Operations Director, RN Clinical Supervisor, Client Service Manager).

Note: All documentation will be sent to the contact information we have on file. Please allow 10 Business Days for delivery.

If you encounter difficulties in completing this form please contact your treatment team for assistance.

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(877) 299-1655
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