data, oejoIrst & Sant . • : . . ••• . NAME: TOTAL AMOUNT: $ Addidonal iimputtiom ordered, including verde monthlyernowit, begin date, due due, 'Dilator & severe:: SPECIAL CONDITIONS — CONTINUED C S. You will *rater the Departmord of Calraititollti Non•Socuro Aug Treatment Program or otter residentia