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    • [PDF File]Edinburgh Postnatal Depression Scale (EPDS)

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      4. The mother should complete the scale herself, unless she has limited English or has difficulty with reading. 1 Source: Cox, J.L., Holden, J.M., and Sagovsky , R. 1987. Detect ion of postnatal depression: Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry 150:782-786 . 2

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    • [PDF File]Form W-9 (Rev. October 2018)

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      Form W-9 (Rev. 10-2018) Page . 2 By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a

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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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    • REG 195, Application for Disabled Person Placard or Plates

      REG 195 (REV. 4/2018) WWW 1 of 3 APPLICATION FOR DISABLED PERSON PLACARD OR PLATES IMPORTANT INFORMATION, DISCLOSURES AND CERTIFICATIONS Use this form to apply for a disabled person (DP) parking placard or license plates.

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    • [PDF File]Workers’ Compensation Claim Form (DWC 1) & Notice of ...

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      Workers’ Compensation Claim Form (DWC 1) & Notice of Potential Eligibility Formulario de Reclamo de Compensación de Trabajadores (DWC 1) y Notificación de Posible Elegibilidad If you are injured or become ill, either physically or mentally, because of your job, including injuries resulting from a workplace crime, you may be entitled to

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

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      I can read and understand English, and I have read and understand every question and instruction on this form and my ... Name of Medical Practice, Facility, or Health Department. 1. Given Name (First Name) Middle Name (if applicable) 2. ... Chest X-ray required due to initial screening test results. Chest X-ray required due to TB signs or ...

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    • [PDF File]PHQ-9* Questionnaire for Depression Scoring and ...

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      PHQ-9* Questionnaire for Depression Scoring and Interpretation Guide For physician use only Scoring: Count the number (#) of boxes checked in a column. Multiply that number by the value indicated below, then add the subtotal to produce a total score. The possible range is 0-27. Use the table below to interpret the PHQ-9 score.

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    • [PDF File]Form N-648, Medical Certification for Disability Exceptions

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      English and/or civics requirements due to a physical or developmental disability or mental impairment that has lasted, or is ... While staff of the medical practice associated with the medical professional certifying the form may assist in its completion, the medical professional is responsible for the accuracy of the form's content. Type or ...

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    • [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]The Mood Disorder Questionnaire (MDQ) - Overview

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      The Mood Disorder Questionnaire (MDQ) - Overview The Mood Disorder Questionnaire (MDQ) was developed by a team of psychiatrists, researchers and consumer advocates to address the need for timely and accurate evaluation

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    • [PDF File]Disability Report- Adult

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      Form SSA-3368-BK (10-2015) UF (10-2015). DISABILITY REPORT - ADULT SSA-3368-BK PLEASE READ THIS INFORMATION BEFORE COMPLETING THIS REPORT. The information you give us on this report will be used by the office that makes the disability

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