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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
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[PDF File]Windfall Elimination Provision
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Printed on recycled paper. The Windfall Elimination Provision doesn’t apply to survivors benefits. We may reduce spouses, widows, or widowers benefits because of another law. For more information, read . Government Pension Offset (Publication No. 05-10007). Social Security years of substantial earnings
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[PDF File]AUTHORIZATION, AGREEMENT B. Request Status …
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Purposes and Uses ─ The primary purpose of the information collected is for use in the administration of the Federal Training Program (FTP) to document the nomination of trainees and completion of training. Information collected may also be provided to
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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]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]Vaccine Information Statement: Inactivated Influenza Vaccine
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Influenza vaccine does not cause flu. Influenza vaccine may be given at the same time as other vaccines. 3 Talk with your health care provider Tell your vaccine provider if the person getting the vaccine: Has had an allergic reaction after a previous dose of influenza vaccine, or …
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[PDF File]Instructions for Form 8621 (Rev. December 2018)
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General Instructions Who Must File Qualifying Insurance Corporation A U.S. person that owns stock of a foreign corporation and elects to treat such stock as the stock of a qualifying insurance corporation under the alternative facts and circumstances test within the meaning of section 1297(f)(2) must file a limited-information Form 8621.
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[PDF File]Form I-864A, Contract Between Sponsor and Household …
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I can read and understand English, and I have read and understand every question and instruction on this contract and my answer to every question. 26.a. NOTE: Select the box for either Item Number 26.a. or 26.b. If applicable, select the box for Item Number 27. Part 5. Sponsor's Promise, Statement, Contact
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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
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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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English test paper pdf