Department of education medical form: free download. On-line document store on 5y1.org

[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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[PDF File]RECOMMENDATION FOR AWARD - United States Army
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[PDF File]Request for Social Security Earnings Information
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Form SSA-7050-F4 (03-2019) Discontinue Prior Editions Social Security Administration. Page 1 of 4 OMB No. 0960-0525. REQUEST FOR SOCIAL SECURITY EARNING INFORMATION *Use This Form If You Need . 1. Certified/Non-Certified Detailed Earnings Information . Includes periods of employment or self-employment and the names and addresses of employers. 2.
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[PDF File]VAMC SLUMS Examination - Saint Louis University
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SH Tariq, N Tumosa, JT Chibnall, HM Perry III, and JE Morley. The Saint Louis University Mental Status (SLUMS) Examination for Detecting Mild Cognitive Impairment and Dementia is more sensitive than the Mini-Mental Status Examination (MMSE) - A pilot study. J am Geriatri Psych ( in press). 2 3 Questions about this assessment tool? E-mail aging ...
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[PDF File]PERSONNEL ACTION
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For use of this form, see PAM 600-8; the proponent agency is DCS, G-1. 11. I certify that the duty status change (Section II) or that the request for personnel action (Section III) contained herein - SECTION II - DUTY STATUS CHANGE (AR 600-8-6) SECTION IV - REMARKS (Applies to Sections II, III, and V) (Continue on separate sheet) 8.
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[PDF File]TINETTI BALANCE ASSESSMENT TOOL
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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
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[PDF File]Request for Leave or Approved Absence
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under the Family and Medical Leave Act. Medical certification of a serious health condition may be ... including medical certification, if required) and that falsification on this form may be grounds for disciplinary action, including removal. 7a. Employee Signature: 7b. ... to the Department of Labor when processing a claim for compensation ...
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[PDF File]Application for Social Security Card
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Form SS-5 (08-2011) ef (08-2011) Destroy Prior Editions. Page 1. Application for a Social Security Card. Applying for a Social Security Card is . free! USE THIS APPLICATION TO: Apply for …
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[PDF File]2018 Form 1040
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Form 1040 Department of the Treasury—Internal Revenue Service . U.S. Individual Income Tax Return . 2018. OMB No. 1545-0074. IRS Use Only—Do not write or staple in this space.
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[PDF File]Form W-9 (Rev. October 2018)
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Form W-9 (Rev. October 2018) Department of the Treasury Internal Revenue Service . Request for Taxpayer ... • Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN.
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Department of education medical form