Medical student documentation and cms

    • [DOC File]LEAVE REQUEST FORM/AUTHORIZATION - United States Navy

      https://info.5y1.org/medical-student-documentation-and-cms_1_6955d1.html

      navcompt form 3065 (3pt) (rev. 2-83) 1. date of request. 2. for . admin. use only. approval of this leave is . not valid . without control no,


    • [PDF File]Mini-Mental State Examination

      https://info.5y1.org/medical-student-documentation-and-cms_1_7e9d12.html

      2 Instructions for administration and scoring of the MMSE Orientation (10 points): • Ask for the date. Then specifically ask for parts omitted (e.g., "Can you also tell me what season it


    • [PDF File]Pneumococcal Vaccine Timing for Adults

      https://info.5y1.org/medical-student-documentation-and-cms_1_d707c1.html

      19 through 64 years with certain medical conditions. – A second dose may be indicated depending on the medical condition. See Table 1 for specific guidance. Pneumococcal vaccine timing for adults 65 years or older. For those who have not received any pneumococcal vaccines, or those with unknown vaccination history. PCV13 (at ≥ 65 years)


    • [PDF File]APPLICATION FOR 10-POINT VETERAN PREFERENCE (TO BE USED BY ...

      https://info.5y1.org/medical-student-documentation-and-cms_1_b73145.html

      The Required Documentation column refers you to information provided on the back of this form regarding the types of documents that are acceptable proof of your claim for preference. (Please note that eligibility for veterans’ preference is governed by 5 U.S.C. 2108,


    • [PDF File]COLUMBIA-SUICIDE SEVERITY RATING SCALE (C-SSRS)

      https://info.5y1.org/medical-student-documentation-and-cms_1_1a9a4c.html

      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.


    • [PDF File]Patient Health Questionnaire (PHQ-9)

      https://info.5y1.org/medical-student-documentation-and-cms_1_e7feef.html

      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


    • [PDF File]Vaccine Information Statement: Inactivated Influenza Vaccine

      https://info.5y1.org/medical-student-documentation-and-cms_1_2ab478.html

      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 has any severe, life-threatening allergies.


    • [PDF File]END STAGE RENAL DISEASE MEDICAL EVIDENCE REPORT ...

      https://info.5y1.org/medical-student-documentation-and-cms_1_2b6ed0.html

      form cms-2728-u3 (03/06) 1 department of health and human services centers for medicare & medicaid services form approved omb no. 0938-0046 end stage renal disease medical evidence report medicare entitlement and/or patient registration a. complete for all esrd patients check one: initial . re-entitlement supplemental . 1. name


    • [PDF File]Form W-9 (Rev. October 2018)

      https://info.5y1.org/medical-student-documentation-and-cms_1_7ff93a.html

      student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States.


    • [PDF File]Application for Social Security Card

      https://info.5y1.org/medical-student-documentation-and-cms_1_2f3b83.html

      9.B., 10.B. If you are applying for an original Social Security card for a child under age 18, you MUST show the parents' Social Security numbers unless the parent was never assigned a Social Security number. If the number is not known and you cannot obtain it, check the “unknown” box. 13.


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