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    • [PDF File]TINETTI BALANCE ASSESSMENT TOOL

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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

    • [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 of bipolar disorder. Clinical Utility n The MDQ is a brief self-report instrument that takes about 5 minutes to complete.

    • [PDF File]2018 Instructions for Form 709

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      a debt, to making an interest-free or below market interest rate loan, to transferring the benefits of an insurance policy, to certain property settlements in divorce cases, and to giving up of some amount of annuity in exchange for the creation of a survivor annuity. The gift tax applies to any digital asset,

    • [PDF File]DEVELOPMENTAL COUNSELING FORM - United States Army

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      Plan of Action (Outlines actions that the subordinate will do after the counseling session to reach the agreed upon goal(s). The actions must be

    • [PDF File]2018 Instructions for Form 1116 - Internal Revenue Service

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      267-941-1000 (not toll free). Write to Internal Revenue Service, International Accounts, Philadelphia, PA 19255-0725. General Instructions Election To Claim the Foreign Tax Credit Without Filing Form 1116 You may be able to claim the foreign tax credit without filing Form 1116. By making this election, the foreign tax

    • [PDF File]Form 149 - Sales and Use Tax Exemption Certificate

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      149 Sales and Use Tax Exemption Certificate Form 149 (Revised 11-2018) Select the appropriate box for the type of exemption to be claimed and complete any additional information requested.

    • [PDF File]Thrift Savings Plan

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      If you have questions, call the toll-free ThriftLine at 1-877-968-3778 or the TDD at 1-877-847-4385. Outside the U.S. and Canada, please call 404-233-4400 (not toll free). You will receive a confirmation of your designation once your form is processed. For federal civilian employees, members of the uniformed services, and beneficiary participants

    • [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 parenting time less than the minimum

    • [PDF File]Health Benefits Election Form

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      Office toll-free at 1-888-767-6738. 3. Former spouses eligible to enroll in or currently enrolled in the FEHB Program under the Spouse Equity law or similar statutes. 4. Individuals eligible for Temporary Continuation of Coverage (TCC) under the FEHB Program, including: • Former employees (who separated from service); •

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