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[PDF File]VAMC SLUMS Examination - School of Medicine
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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 ...
[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 …
[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]
[PDF File]FW-003 Order on Court Fee Waiver (Superior Court)
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Order on Court Fee Waiver (Superior Court) FW-003, Page 3 of 3. This is a Court Order. Request for Accommodations . Assistive listening systems, computer-assisted real-time captioning, or sign language interpreter services are available if you ask at least five days before the …
[PDF File]AUTHORIZATION, AGREEMENT B. Request Status …
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Education Level (click link to view codes or go to page 7) 14. Pay Plan 15. Series 16. Grade 17. Step 1a. Name and Mailing Address of Training Vendor (No., Street, City, State, ZIP Code) 2a. Course Title 2b. Course Number Code 3. Training Start Date (Enter Date as yyyy-mm-dd) 4. Training End Date
[PDF File]An IRS individual taxpayer identification number (ITIN) is ...
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Form W-7 (Rev. September 2016) Department of the Treasury Internal Revenue Service . Application for IRS Individual Taxpayer Identification Number
[PDF File]2018 Form 5329
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Additional Tax on Certain Distributions From Education Accounts and ABLE Accounts. Complete this part if you included an amount in income, on Schedule 1 (Form 1040), line 21, or Form 1040NR, line 21, from a Coverdell education savings account (ESA), a qualified tuition program (QTP), or …
[PDF File]Patient Health Questionnaire (PHQ-9)
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PATIENT HEALTH QUESTIONNAIRE (PHQ-9) NAME: DATE: Over the last 2 weeks, how often have you been bothered by any of the following problems? Not at all Several days More than half the days Nearly every day (use " ü " to indicate your answer) 1. Little interest or pleasure in doing things 0 1 2 3
[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 …
[PDF File]Form SSA-89 (02-2018) Discontinue Previous Editions Page 1 ...
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Form SSA-89 (02-2018) Discontinue Previous Editions Social Security Administration. Page 1 of 2 OMB No.0960-0760. Authorization for the Social Security Administration (SSA)
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