DOJ-OGR-00026224.jpg

The image displays a document with several lines of text and some redacted sections where information has been obscured for privacy. The top section of the document appears to be from an organization named "Bureau of Health Services," suggesting it might be related to health or medical services. There are various fields including 'Name', 'Address', 'Day Visits', and 'Accommodations', but the specific details in these sections have been redacted. The text is black on a white background, and the document appears to be a printed form or report with handwritten markings indicating certain areas should not be shared.