Document outline template

    • [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]BILL OF SALE

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      BILL OF SALE VEHICLE INFORMATION Make: _____ Model: _____ Year: _____ Style: _____ Color: _____ VIN# _____

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    • [PDF File]Funding Fee Tables - Veterans Benefits Administration Home

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      Funding Fee Tables Purchase And Construction Loans The enactment of Public Law 112-56 established funding fee rates at the levels in the following tables. Public Law 115-182 extended these rates through September 30, 2028. Type of Veteran Regular Military Reserves/National Guard

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    • [PDF File]Vaccine Information Statement: Inactivated Influenza Vaccine

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      Influenza vaccine does not cause flu. Influenza vaccine may be given at the same time as other vaccines. 3 Talk with your health care provider Tell your vaccine provider if the person getting the vaccine: Has had an allergic reaction after a previous dose of influenza vaccine, or …

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    • [PDF File]Form 966 (Rev. October 2016)

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      Form 966 (Rev. 10-2016) Page . 2 distributed assets are valued at fair market value. Exceptions to this rule apply to a liquidation of a subsidiary and to a distribution that is made according to

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    • [PDF File]2018 Form 1041

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      Form 1041 Department of the Treasury—Internal Revenue Service . U.S. Income Tax Return for Estates and Trusts. 2018. OMB No. 1545-0092. For calendar year 2018 or fiscal year beginning

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    • [PDF File]FL-150 INCOME AND EXPENSE DECLARATION

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      Income (For average monthly, add up all the income you received in each category in the last 12 months and divide the total by 12.) FL-150 [Rev. January 1, 2019]

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    • [PDF File]PDPM Calculation Worksheet for SNFs

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      This document is a draft worksheet that is intended to aid stakeholders in their review of the FY 2019 SNF PPS Notice of Proposed Rulemaking (NPRM) and in the development of comments on the NPRM. This worksheet follows the logic outlined in the NPRM and accompanying Technical Report for consideration and comment by stakeholders.

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    • [PDF File]Form I-693, Report of Medical Examination and Vaccination ...

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      Form I-693 07/15/19. Page 1 of 14. Report of Medical Examination and Vaccination Record . Department of Homeland Security . U.S. Citizenship and Immigration Services

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    • [PDF File]Uniform and Insignia Wear and Appearance of Army Uniforms ...

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      SUMMARY of CHANGE AR 670–1 Wear and Appearance of Army Uniforms and Insignia This major revision, dated 31 March 2014--o Notifies Soldiers of which portions of the regulation are punitive and

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