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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]NICHQ Vanderbilt Assessment Scale—PARENT Informant
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Symptoms (continued) Never Occasionally Often Very Often 33. Deliberately destroys others’ property 0 1 2 3 34. Has used a weapon that can cause serious harm (bat ...
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[PDF File]RESIDENT CENSUS AND CONDITIONS OF RESIDENTS
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Assist of One or Two Staff, and Dependent) must equal the number in Block F78, Total Residents, for each of the ADL categories (Bathing, Dressing, Transferring, Toilet Use and Eating). Bathing (F79 – F81): This includes a full-body bath/shower,
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[PDF File]TINETTI BALANCE ASSESSMENT TOOL - Welcome to CHHD Home Page!
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TINETTI BALANCE ASSESSMENT TOOL GAIT SECTION Patient stands with therapist, walks across room (+/- aids), first at usual pace, then at rapid pace. Risk Indicators: Tinetti Tool Score Risk of Falls ≤18 High 19-23 Moderate ≥24 Low Date Indication of gait (Immediately after told to ‘go’.) Any hesitancy or multiple attempts = 0 No hesitancy = 1
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[PDF File]EXAMINATION FOR HOUSEBOUND STATUS OR PERMANENT NEED FOR ...
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wants of nature, adjusting prosthetic devices, or protecting him/her from the hazards of his/her daily environment, or are housebound (substantially confined to his/her immediate premises because of permanent disability), may be eligible for Special Monthly Pension (SMP).
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[PDF File]Physician's Order for Personal Care/Consumer Directed ...
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PHYSICIAN’S ORDER FOR PERSONAL CARE/CONSUMER DIRECTED PERSONAL ASSISTANCE SERVICES . INSTRUCTIONS . COMPLETE ALL ITEMS. (Attach additional sheets, if necessary). INCOMPLETE FORMS WILL BE RETURNED TO THE PHYSICIAN. INCOMPLETE OR MISSING INFORMATION MAY DELAY SERVICES TO THIS PATIENT. 1. Patient Identifying Information • Patient Name.
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[PDF File]Form W-9 (Rev. October 2018)
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Number To Give the Requester . for guidelines on whose number to enter. Social security number – – or. Employer identification number – Part II Certification. Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2.
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[PDF File]COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS)
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Columbia-Suicide Severity Rating Scale (C-SSRS) The Columbia-Suicide Severity Rating Scale (C-SSRS) is a questionnaire used for suicide assessment developed by multiple institutions, including Columbia University, with NIMH support. The scale is evidence-supported and is part of a national and international public health initiative involving the
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[PDF File]Form 941 for 2019: Employer’s QUARTERLY Federal Tax Return
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Form 941-V, Payment Voucher. Purpose of Form. Complete Form 941-V if you're making a payment with Form 941. We will use the completed voucher to credit your payment more promptly and accurately, and to improve our service to you. Making Payments With Form 941. To avoid a penalty, make your payment with Form 941 . only if:
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[PDF File]State of California EMPLOYER'S REPORT OF OCCUPATIONAL ...
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California law requires employers to report within five days of knowledge every occupational injury or illness which results in lost time beyond the date of the incident OR requires medical treatment beyond first aid. If an employee subsequently dies as a result of a previously reported injury or
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Ny daily number results