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[PDF File]Clinical Opiate Withdrawl Scale - National Institute on ...
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Clinical Opiate Withdrawal Scale For each item, circle the number that best describes the patient' s signs or symptom. Rate on just the apparent relationship to opiate withdrawal. For example, if heart rate is increased because the patient was jogging just prior to assessment, the increase pulse rate would not add to the score.
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[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
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[PDF File]BRADEN SCALE For Predicting Pressure Sore Risk
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BRADEN SCALE – For Predicting Pressure Sore Risk Use the form only for the approved purpose. Any use of the form in publications (other than internal policy manuals and training material) or for profit-making ventures requires additional permission and/or negotiation.
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[PDF File]COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS)
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3. Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act Subject endorses thoughts of suicide and has thought of at least one method during the assessment period. This is different tha n a specific plan with time, place or method details worked out (e.g., thought of method to kill self but not a specific plan). Includes person
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[PDF File]Form W-9 (Rev. October 2018)
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not the trust; and • In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9.
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[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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starts on a non-workday, the starting hour may be 0001 if not contrary to command policy. b. Block 15 - The hour for ending leave may not be later than the beginning of your normal workday if the day of return is a workday. If leave ends on a non-workday the ending hour may be 2400 if not …
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[PDF File]The Mood Disorder Questionnaire (MDQ) - Overview
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The MDQ is best at screening for bipolar I (depression and mania) disorder and is not as sensitive to bipolar II (depression and hypomania) or bipolar not otherwise specified (NOS) disorder. Population /type Sensitivity & Specificity Out-patient clinic serving primarily Sensitivity 0.73 a …
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[PDF File]International Prostate Symptom Score (I-PSS)
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“delighted” to “terrible” or 0 to 6. Although this single question may or may not capture the global impact of benign prostatic hyperplasia (BPH) Symptoms or quality of life, it may serve as a valuable starting point for a doctor-patient conversation. The SCI has agreed to use the symptom index for BPH, which has been developed by the AUA
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[PDF File]Sport concussion assessment tool - 5th edition
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• Do not attempt to move the athlete (other than that required for airway management) unless trained to do so. • Assessment for a spinal cord injury is a critical part of the initial on-field assessment. • Do not remove a helmet or any other equipment unless trained to do so safely. SPORT CONCUSSION ASSESSMENT TOOL — 5TH EDITION
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[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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If a recipient has an unmet Share of Cost (SOC), an aid code is not returned, since the recipient is not considered eligible until the SOC is met. A recipient may have more than one aid code, and may be eligible for multiple programs and services. ... Aid Codes Master Chart (aid codes) ...
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