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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]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]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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[PDF File]Patient Health Questionnaire (PHQ-9)
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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 disorder. Add score to determine severity. Consider Major Depressive Disorder - if there are at least 5 3s in the shaded section (one of which corresponds to Question #1 or #2)
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[PDF File]COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS)
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The approved version of the C-SSRS Risk Assessment follows. This is one recommended option to consider as a risk assessment tool for your center. If applied, it is intended to be followed exactly according to the instructions and cannot be altered. Training is available and recommended (though not required for clinical or center practice) before
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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 of bipolar disorder. Clinical Utility n The MDQ is a brief self-report instrument that takes about 5 minutes to complete.
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[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
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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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[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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Practice english assessment test