A better word than good
[PDF File]Physician's Order for Personal Care/Consumer Directed ...
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PHYSICIAN’S ORDER FOR PERSONAL CARE/CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES . INSTRUCTIONS . COMPLETE ALL ITEMS. (Attach additional sheets, if necessary). INCOMPLETE FORMS WILL BE RETURNED TO THE PHYSICIAN. INCOMPLETE OR MISSING INFORMATION MAY DELAY SERVICES TO THIS PATIENT. 1. Patient Identifying Information • …
[PDF File]Indiana Parenting Time Guidelines
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Indiana Parenting Time Guidelines and should be specific in their written agreement. 3. Presumption. There is a presumption that the Indiana Parenting Time Guidelines are applicable in all cases. Deviations from these Guidelines by either the parties or the cou rt that result in parenting time less than …
REG 195, Application for Disabled Person Placard or Plates
APPLICATION FOR DISABLED PERSON PLACARD OR PLATES Important: this is page three of the application. ... Central visual acuity does not exceed 20/200 in the better eye, with corrective lenses, as measured by the Snellen test, or visual acuity that is greater than 20/200, but with a limitation in the field of vision such that the widest diameter ...
[PDF File]2018 Form 1120
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If line 33 is smaller than the total of lines 31, 32, and 34, enter amount owed . . . . 35. 36 Overpayment. If line 33 is larger than the total of lines 31, 32, and 34, enter amount overpaid . . . . 36 37. Enter amount from line 36 you want: Credited to 2019 estimated tax Refunded 37. Sign Here
[PDF File]TINETTI BALANCE ASSESSMENT TOOL - Welcome to CHHD …
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TINETTI BALANCE ASSESSMENT TOOL GAIT SECTION Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. Risk Indicators: Tinetti Tool Score Risk of Falls ≤18 High 19-23 Moderate ≥24 Low Date Indication of gait (Immediately after told to ‘go’.) Any hesitancy or multiple attempts = 0 No hesitancy = 1
[PDF File]Form 149 - Sales and Use Tax Exemption Certificate
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Caution to seller: In order for the certificate to be accepted in good faith by the seller, the seller must exercise care that the ... 149 Sales and Use Tax Exemption Certificate. Form 149 (Revised 11-2018) Select the appropriate box for the type of exemption to be claimed and complete any additional information requested.
[PDF File]Wisconsin Statutory Power of Attorney for Finances and ...
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If you wish to name more than one agent, you may name a co-agent in the special instructions. Co-agents are not required to act together unless you include that ... Act in good faith. (3) Do nothing beyond the authority granted in this Power of Attorney. (4) Disclose your identity as an agent whenever you act for the principal by writing or ...
[PDF File]Oswestry Low Back Disability Questionnaire - Rehabilitation
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The Oswestry Disability Index (also known as the Oswestry Low Back Pain Disability Questionnaire) is an extremely important tool that researchers and disability evaluators use to measure a patient's permanent ... Oswestry Low Back Disability Questionnaire Author: Health and Rehabilitation unit
[PDF File]Activity Prescription Form (APF) (F242-385-000)
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As expected / better than expected ... In addition to providing good clinical care, it is important to set expectations for a good recovery and assure patients understand the importance of doing their part. Take just a couple minutes during an initial office visit to explain the …
[PDF File]Patient Health Questionnaire (PHQ-9)
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PHQ-9 Patient Depression Questionnaire For initial diagnosis: 1. Patient completes PHQ-9 Quick Depression Assessment. 2. If there are at least 4 3s in the shaded section (including Questions #1 and #2), consider a depressive
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