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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]Edinburgh Postnatal Depression Scale (EPDS)
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No, not very often Please complete the other questions in the same way. No, not at all In the past 7 days: 1. I have been able to laugh and see the funny side of things *6. Things have been getting on top of me As much as I always could Yes, most of the time I haven’t been …
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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]Request for Social Security Earnings Information
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4. To facilitate statistical research, audit, or investigative activities necessary to assure the integrity and improvement of Social Security programs. A complete list of routine uses for earnings information is available in our Systems of Records Notices entitled, the
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[PDF File]Form 149 - Sales and Use Tax Exemption Certificate
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r Research and Development of Agricultural Biotechnology ... If you have questions, please contact the Department of Revenue at: ... 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.
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[PDF File]Form 941 for 2019: Employer’s QUARTERLY Federal Tax Return
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Part 1: Answer these questions for this quarter. ... 11 Qualified small business payroll tax credit for increasing research activities. ... Form 941, write “Applied For” and the date you applied in this entry space. Box 2—Amount paid. Enter the amount paid with Form 941.
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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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PHQ-9 Patient Depression Questionnaire For initial diagnosis: 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
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[PDF File]2018 Form 4562
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to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for those vehicles. 30 : Total business/investment miles driven during the year (don’t: include commuting miles) . (a) Vehicle 1 (b) Vehicle 2 (c) Vehicle 3 (d) Vehicle 4 (e)
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[PDF File]Application for Social Security Card
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Application for a Social Security Card. ... If you have any questions about this form or about the evidence documents you must provide, please visit our website at www.socialsecurity.gov for additional information as well as locations of our offices and Social Security Card Centers. You may also call Social Security at 1-800-772-1213.
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List of research questions