History of heart surgery
[PDF File]Generalized Anxiety Disorder 7-item (GAD-7) scale
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Generalized Anxiety Disorder 7-item (GAD-7) scale Over the last 2 weeks, how often have you been bothered by the following problems? Not at all sure
[PDF File]ASSESSMENT Timed Up & Go (TUG) - Centers for Disease ...
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ASSESSMENT Purpose: To assess mobility Equipment: A stopwatch Directions: Patients wear their regular footwear and can use a walking aid, if needed. Begin by having the patient sit back in a standard arm chair and identify a line 3 meters, or 10 feet away, on the floor. 2 On the word “Go,” begin timing. 3 Stop timing after patient sits back ...
[PDF File]STOP-BANG Sleep Apnea Questionnaire
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www.sleepmedicine.com OHIOSLEEPMEDICINEINSTITUTE CENTER OF SLEEP MEDICINE EXCELLENCE TM 4975 Bradenton Avenue, Dublin Ohio 43017 T 614.766.0773
[PDF File]Summary Chart of U.S. Medical Eligibility Criteria for ...
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c) DVT/PE and established on : anticoagulant therapy for at least 3 months i) higher risk for recurrent DVT/PE
[PDF File]Hamilton Anxiety Rating Scale (HAM-A)
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Rating Clinician-rated Administration time10–15 minutes Main purposeTo assess the severity of symptoms of anxiety PopulationAdults,adolescents and children Commentary The HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms, and is still
[PDF File]VA Form 21-526EZ
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If claiming dependents, submit a completed VA Form 21-686c, Application Request to Add and/or Remove Dependents. If claiming a child in school between the ages of 18 and 23; also submit a completed VA Form 21-674,
[DOC File]Aid Codes Master Chart (aid codes) - Medi-Cal
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The Aid Codes Master Chart was developed for use in conjunction with the Medi-Cal Automated Eligibility Verification System (AEVS). Providers must submit an inquiry to AEVS to verify a recipient’s eligibility for
[DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy
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navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,
[PDF File]VA Presumptive Disability Benefits Factsheet
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• Ischemic heart disease • • Non-Hodgkin’s lymphoma • Parkinson’s disease • Prostate cancer • Respiratory cancers • Soft-tissue sarcoma (not including osteosarcoma, chondrosarcoma, Kaposi’s sarcoma or mesothelioma) The following conditions, if they …
[PDF File]Patient Health Questionnaire (PHQ-9)
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history of a Manic Episode (Bipolar Disorder), and a physical disorder, medication, or other drug as the biological cause of the depressive symptoms. To monitor severity over time for newly diagnosed patients or patients in current treatment for depression: 1.
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