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    • SUICIDE RISK ASSESSMENT GUIDE - Mental Health Home

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      • Withdrawing from friends, family or society • Anxiety, agitation, unable to sleep or sleeping all the time • Dramatic changes in mood • No reason for living, no sense of purpose in life. ... SUICIDE RISK ASSESSMENT GUIDE ...

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    • Table of Contents:

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      Description: 14-item scale designed to measure balance of the older adult in a clinical setting. Equipment needed: Yardstick, 2 standard chairs (one with arm rests, one without), Footstool or step, Stopwatch or wristwatch, 15 ft walkway

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    • Purpose of Form - Internal Revenue Service

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      Part III, to report coverage for those individuals and other family members. For this purpose, a non-employee includes, for ... instructions for Form 1095-C, Part III—Covered Individuals (Lines 17–22), later. Form 1095-C may be used only if the individual identified on line 1 has an SSN.

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    • DAVIS-BACON - United States Department of Housing and ...

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      standards clauses and a Davis-Bacon wage decision. These documents are normally bound into the contract specifications. a. The labor standards clauses. The labor standards clauses describe the responsibilities of the contractor concerning Davis-Bacon wages and obligate the contractor to comply with the labor requirements.

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    • VERIFICATION OF VEHICLE IDENTIFICATION NUMBER

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      Name of Business or Agency Address City State ZIP Code I certify, under penalty of perjury in the second degree, that I have completed a physical inspection of the vehicle/manufactured home described above and the information is true and correct to the best of my knowledge.

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    • APPLICATION FOR CHANGE OF NAME (ADULT)

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      form cc-1411 (master, page one of two) 07/18 . application for change of name (adult) commonwealth of virginia va. code § 8.01-217 . virginia: in the circuit court of the

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    • Disabled Parking Application for Individuals - dol.wa.gov

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      Name (Last, First, Middle initial) Date of birth (mm/dd/yyyy) Gender. Male Female. Mailing address (PO Box or street address and apartment number, if applicable) City State ZIP code (Area code) Daytime phone Email Current license plate, if applicable Registration expiration, if applicable.

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    • The Mini Mental State Examination (MMSE)

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      The Mini Mental State Examination (MMSE) By: Lenore Kurlowicz, PhD, RN, CS and Meredith Wallace, PhD, RN, MSN ... Name 3 objects: 1 second to say each. Then ask the patient all 3 after you have said them. Give 1 point for each correct answer. Then repeat …

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