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2-9AAAM25525525500000000000000000001105251020100Arial80001010000000000200577356000000000000000000000000000000020000000000000110111000000000000000000000000000000002005773560000000000000000000000000000000200000000000001101110000000000000000000000000000000020057735600000000000000000000000000000000000000000000000020057735600010000000000000000000000000000000000000000000000000010000000000000000002005773560000000000000000000000000000000000000000000200577355is the MDS AssessmentAAAN25525525500000000000000000001105251020000Arial800010100000000002005773550000000000000000000000000000000200000000000001101110000000000000000000000000000000020057735500000000000000000000000000000002000000000000011011100000000000000000000000000000000200577355000000000000000000000000000000000000000000-10000020057735500010000000000000000000000000000000000000000000000000010000000000000000002005773550000000000000000000000000000000000000000000200577354Current as of 2022AAAO25525525500000000000000000001105251020100Arial8000101000000000020057735400000000000000000000000000000002000000000000011011100000000000000000000000000000000200577354000000000000000000000000000000020000000000000110111000000000000000000000000000000002005773540000000000000000000000000000000000000000000000002005773540001000000000000000000000000000000000000000000000000001000000000000000000200577354000000000000000000000000000000000000000000020057745TriggersAABG02552550000010000000000000000100Arial800000179745740000000002005774500000000000000000000000000000000000000000000000020057745000000000000000000000000000000000000000000000000000010100000000000000000020057745000000000000000000000000000000000000000000020057745326824200002000000200577402Social IsolationABAA12812864255255255000000000000000002550101Arial14005010184215040000000002005774020000000000000000000000000000000000000000000000002005774020001000000000000000000000000000000000000000000000000001000000000000000000200577402000000000000000000000000000000000000000000020057713SOCIAL ISOLATIONU09DSUFMIElTT0xBVElPTjogSG93IG9mdGVuIGRvIHlvdSBmZWVsIGxvbmVseSBvciBpc29sYXRl 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-10000020057741000000000000000000000001000000000000000000000000000000100000000000000000020057741000000000000000000000000000000000000000000020057741120057713320057741120057713320057740SometimesABAE22122120000000000100000000001105251020110Arial8000111419443200000000020057740000000000000000000000000000000000000000000-100000200577400000000000000000000000010000000000000000000000000000001000000000000000000200577400000000000000000000000000000000000000000000200577401200577133200577401200577133200577400OftenABAF22122120000000000100000000001105251020110Arial80001114194432000000000200577400000000000000000000000000000000000000000000-100000200577400000000000000000000000001000000000000000000000000000000100000200577140000000000200577400000000000000000000000000000000000000000000020057740012005771332005774001200577133200577399AlwaysABAG22122120000000000100000000001105251020110Arial80001114194432000000000200577399000000000000000000000000000000000000000000-100000200577399000000000000000000000001000000000000000000000000000000100000200577400000000000200577399000000000000000000000000000000000000000000020057739912005771332005773991200577133200577398Resident declines to respondABAH22122120000000000100000000001105251020110Arial80001114194432000000000200577398000000000000000000000000000000000000000000-100000200577398000000000000000000000001000000000000000000000000000000100000200577410000000000200577398000000000000000000000000000000000000000000020057739812005771332005773981200577133200577401Resident unable to respondABAI22122120000000000100000000001105251020110Arial80001114194432000000000200577401000000000000000000000000000000000000000000-100000200577401000000000000000000000001000000000000000000000000000000100000200577398000000000020057740100000000000000000000000000000000000000000002005774011200577133200577401120057713320057710Resident Mood InterviewADAA12812864255255255000000000000000002550001Arial14018050101842150400000000020057710010000000000000002005771000000000000000000000000000000000000000000000000020057710000100000000000000000000000000000000000000000000000000100000000000000000020057711RESIDENT MOOD INTERVIEWADAB21220820000010100100100000001105251021000Arial8000001842150400000000020057711000000000000000000000000000000000000000000000000200577110000010000000000000000110000000000000000000000000000001000000000000000000200577110000000000000000000000000000000000000000000200577111200577349120057711120057734912005771112005778-10000NON0200577349ASSESSMENT DATE:ADAC21220820000010100100000000001105251020100Arial800000184215040000000002005773490000000000000000000000000000000200000000000001101110000000000000000000000000000000020057734900000000000000000000000000000002000000000000011011100000000000000000000000000000000200577349000000000000000000000000000000000000000000000000200577349012//5BAFMAUwBFAFMAUwBNAEUATgBUACAARABBAFQARQA6AA==001000000000000000001000000000000000000000000000000100000000000000000020057734900000000000000000000000000000000000000000002005773491200577113200577349120057711320057715AEAA12812864255255255000000000000000002550001Arial140050101842150400000000020057715000000000000000000000000000000000000000000000000200577150001000000000000000000000000000000000000000000000000001000000000000000000200577109A. < INTEREST DOING THINGSQS4gTGl0dGxlIGludGVyZXN0L3BsZWFzdXJlIGluIGRvaW5nIHRoaW5nczogAEAB21220820000010100010001020001105251021100Arial8000001842150400000000020057710900000000000000000000000000000000000000000000000020057710900000100000000000000000010000000000000000000000000000010000000000000000002005771090000000000000000000000000000000000000000000200577109120057719200577109220057720200577109320057721200577109120057719200577109220057720200577109320057721200577110SYMPTOM PRESENCE:AEAC21220820000010100110001020001105251021000Arial8000001842150400000000020057711000000000000000000000000000000000000000000000000020057711000000100000000000000000110000000000000000000000000000010000000000000000002005771101200577109320057711012005771093200577110120057719200577110220057720200577110320057721200577110120057719200577110220057720200577110320057721200577190. noAEAD22122120000000000100000000001105251020010Arial800011141944320000000002005771900000000000000000000000000000000000000000000000020057719000000000000000000000001000000000000000000000000000000100000000000000000020057719000000000000000000000000000000000000000000020057719120057711032005771922005771111200577193200577112120057719120057711032005771922005771111200577193200577112120057719701-1-10200577201. yesAEAE22122120000000000100000000001105251020010Arial80001114194432000000000200577200000000000000000000000000000000000000000000000002005772000000000000000000000000100000000000000000000000000000010000000000000000002005772012005771103200577201200577110320057720701-1-11200577219. No or nonsensical responseAEAF22122120000000000100000000001105251020010Arial800011141944320000000002005772100000000000000000000000000000000000000000000000020057721000000000000000000000001000000000000000000000000000000100000000000000000020057721120057711032005772112005771103200577111SYMPTOM FREQUENCY:AEAG21220820000010100010001020001105251021000Arial800000184215040000000002005771110000000000000000000000000000000000000000000000002005771110000010000000000000000001000000000000000000000000000001000000000000000000200577111120057711220057711122005771132005771113200577114200577111420057711520057711112005771122005771112200577113200577111320057711420057711142005771152005771120. never or 1 dayAEAH22122120000000000100000000001105251020010Arial8000111419443200000000020057711200000000000000000000000000000000000000000000000020057711200000000000000000000000100000000000000000000000000000010000000000000000002005771121200577111320057711212005771113200577112301-1-102005771131. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAEAI22122120000000000100000000001105251020010Arial8000111419443200000000020057711300000000000000000000000000000000000000000000000020057711300000000000000000000000100000000000000000000000000000010000000000000000002005771131200577111320057711312005771113200577113301-1-112005771142. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AEAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057711400000000000000000000000000000000000000000000000020057711400000000000000000000000100000000000000000000000000000010000000000000000002005771141200577111320057711412005771113200577114301-1-122005771153. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAEAK22122120000000000100000000001105251020010Arial8000111419443200000000020057711500000000000000000000000000000000000000000000000020057711500000000000000000000000100000000000000000000000000000010000000000000000002005771151200577111320057711512005771113200577115301-1-1320057723AFAA12812864255255255000000000000000002550001Arial140050101842150400000000020057723000000000000000000000000000000000000000000000000200577230001000000000000000000000000000000000000000000000000001000000000000000000200577117B. FEELING DOWN / DEPRESSEDQi4gRmVlbGluZyBkb3duLCBkZXByZXNzZWQsIG9yIGhvcGVsZXNzOiAgAFAB21220820000010100010001020001105251021000Arial800000184215040000000002005771170000000000000000000000000000000000000000000000002005771170000010000000000000000001000000000000000000000000000001000000000000000000200577117120057711920057711722005771202005771173200577121200577117120057711920057711722005771202005771173200577121200577118SYMPTOM PRESENCE:AFAC21220820000010100110001020001105251021000Arial80000018421504000000000200577118000000000000000000000000000000000000000000000000200577118000001000000000000000001100000000000000000000000000000100000000000000000020057711812005771173200577118120057711732005771181200577119200577118220057712020057711832005771212005771181200577119200577118220057712020057711832005771212005771190. noAFAD22122120000000000100000000001105251020010Arial8000111419443200000000020057711900000000000000000000000000000000000000000000000020057711900000000000000000000000100000000000000000000000000000010000000000000000002005771190000000000000000000000000000000000000000000200577119120057711832005771192200577122120057711932005771231200577119120057711832005771192200577122120057711932005771231200577119701-1-102005771201. yesAFAE22122120000000000100000000001105251020010Arial8000111419443200000000020057712000000000000000000000000000000000000000000000000020057712000000000000000000000000100000000000000000000000000000010000000000000000002005771201200577118320057712012005771183200577120701-1-112005771219. No or nonsensical responseAFAF22122120000000000100000000001105251020010Arial8000111419443200000000020057712100000000000000000000000000000000000000000000000020057712100000000000000000000000100000000000000000000000000000010000000000000000002005771211200577118320057712112005771183200577122SYMPTOM FREQUENCY:AFAG21220820000010100010001020001105251021000Arial800000184215040000000002005771220000000000000000000000000000000000000000000000002005771220000010000000000000000001000000000000000000000000000001000000000000000000200577122120057712320057712222005771242005771223200577125200577122420057712620057712212005771232005771222200577124200577122320057712520057712242005771262005771230. never or 1 dayAFAH22122120000000000100000000001105251020010Arial8000111419443200000000020057712300000000000000000000000000000000000000000000000020057712300000000000000000000000100000000000000000000000000000010000000000000000002005771231200577122320057712312005771223200577123301-1-102005771241. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAFAI22122120000000000100000000001105251020010Arial8000111419443200000000020057712400000000000000000000000000000000000000000000000020057712400000000000000000000000100000000000000000000000000000010000000000000000002005771241200577122320057712412005771223200577124301-1-112005771252. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AFAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057712500000000000000000000000000000000000000000000000020057712500000000000000000000000100000000000000000000000000000010000000000000000002005771251200577122320057712512005771223200577125301-1-122005771263. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAFAK22122120000000000100000000001105251020010Arial8000111419443200000000020057712600000000000000000000000000000000000000000000000020057712600000000000000000000000100000000000000000000000000000010000000000000000002005771261200577122320057712612005771223200577126301-1-13200577394AGAA12812864255255255000000000000000002550001Arial1400501018421504000000000200577394000000000000000000000000000000000000000000000000200577394000100000000000000000000000000000000000000000000000000100000000000000000020057712^Score Abbreviated Assm'tAGAC2242241750000000010000000000001110Arial800011179745740000000002005771200000000000000000000000000000000000000000000000020057712000100000000000000000001000000000000000000000000000000100000000000000000020057712000000000000000000000000000000000000000000020057712120057733612005771212005773361200577395Continue interview onlyAGAG25525525500000000000000000001105251020100Arial80001010000000000200577395000000000000000000000000000000020000000000000110111000000000000000000000000000000002005773950000000000000000000000000000000200000000000001101110000000000000000000000000000000020057739500000000000000000000000000000000000000000000000020057739500010000000000000000000000000000000000000000000000000010000000000000000002005773950000000000000000000000000000000000000000000200577396if resident answered "2" orAGAH25525525500000000000000000001105251020100Arial800010100000000002005773960000000000000000000000000000000200000000000001101110000000000000000000000000000000020057739600000000000000000000000000000002000000000000011011100000000000000000000000000000000200577396000000000000000000000000000000000000000000-10000020057739600010000000000000000000000000000000000000000000000000010000000000000000002005773960000000000000000000000000000000000000000000200577397"3" to SYMPTOM FREQUENCYAGAI25525525500000000000000000001105251020100Arial80001010000000000200577397000000000000000000000000000000020000000000000110111000000000000000000000000000000002005773970000000000000000000000000000000200000000000001101110000000000000000000000000000000020057739700000000000000000000000000000000000000000000000020057739700010000000000000000000000000000000000000000000000000010000000000000000002005773970000000000000000000000000000000000000000000200577405in items "A" or "B."AGAJ25525525500000000000000000001105251020100Arial8000101000000000020057740500000000000000000000000000000002000000000000011011100000000000000000000000000000000200577405000000000000000000000000000000020000000000000110111000000000000000000000000000000002005774050000000000000000000000000000000000000000000000002005774050001000000000000000000000000000000000000000000000000001000000000000000000200577405000000000000000000000000000000000000000000020057731AHAA12812864255255255000000000000000002550001Arial140050101842150400000000020057731000000000000000000000000000000000000000000000000200577310001000000000000000000000000000000000000000000000000001000000000000000000200577127C. SLEEP PROBLEMSQy4gVHJvdWJsZSBmYWxsaW5nIG9yIHN0YXlpbmcgYXNsZWVwLCBvciBzbGVlcGluZyB0b28gbXVj aDogIA==AHAB21220820000010100010001020001105251021000Arial800000184215040000000002005771270000000000000000000000000000000000000000000000002005771270000010000000000000000001000000000000000000000000000001000000000000000000200577127120057712920057712722005771302005771273200577131200577127120057712920057712722005771302005771273200577131200577128SYMPTOM PRESENCE:AHAC21220820000010100110001020001105251021000Arial80000018421504000000000200577128000000000000000000000000000000000000000000000000200577128000001000000000000000001100000000000000000000000000000100000000000000000020057712812005771273200577128120057712732005771281200577129200577128220057713020057712832005771312005771281200577129200577128220057713020057712832005771312005771290. noAHAD22122120000000000100000000001105251020010Arial8000111419443200000000020057712900000000000000000000000000000000000000000000000020057712900000000000000000000000100000000000000000000000000000010000000000000000002005771290000000000000000000000000000000000000000000200577129120057712832005771292200577132120057712932005771331200577129120057712832005771292200577132120057712932005771331200577129701-1-102005771301. yesAHAE22122120000000000100000000001105251020010Arial8000111419443200000000020057713000000000000000000000000000000000000000000000000020057713000000000000000000000000100000000000000000000000000000010000000000000000002005771301200577128320057713012005771283200577130701-1-112005771319. No or nonsensical responseAHAF22122120000000000100000000001105251020010Arial8000111419443200000000020057713100000000000000000000000000000000000000000000000020057713100000000000000000000000100000000000000000000000000000010000000000000000002005771311200577128320057713112005771283200577132SYMPTOM FREQUENCY:AHAG21220820000010100010001020001105251021000Arial800000184215040000000002005771320000000000000000000000000000000000000000000000002005771320000010000000000000000001000000000000000000000000000001000000000000000000200577132120057713320057713222005771342005771323200577135200577132420057713620057713212005771332005771322200577134200577132320057713520057713242005771362005771330. never or 1 dayAHAH22122120000000000100000000001105251020010Arial8000111419443200000000020057713300000000000000000000000000000000000000000000000020057713300000000000000000000000100000000000000000000000000000010000000000000000002005771331200577132320057713312005771323200577133301-1-102005771341. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAHAI22122120000000000100000000001105251020010Arial8000111419443200000000020057713400000000000000000000000000000000000000000000000020057713400000000000000000000000100000000000000000000000000000010000000000000000002005771341200577132320057713412005771323200577134301-1-112005771352. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AHAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057713500000000000000000000000000000000000000000000000020057713500000000000000000000000100000000000000000000000000000010000000000000000002005771351200577132320057713512005771323200577135301-1-122005771363. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAHAK22122120000000000100000000001105251020010Arial8000111419443200000000020057713600000000000000000000000000000000000000000000000020057713600000000000000000000000100000000000000000000000000000010000000000000000002005771361200577132320057713612005771323200577136301-1-1320057737AIAA12812864255255255000000000000000002550001Arial140050101842150400000000020057737000000000000000000000000000000000000000000000000200577370001000000000000000000000000000000000000000000000000001000000000000000000200577142D. FEELING TIRED / LOW ENERGYRC4gRmVlbGluZyB0aXJlZCBvciBoYXZpbmcgbGl0dGxlIGVuZXJneTogIA==AIAB21220820000010100010001020001105251021000Arial800000184215040000000002005771420000000000000000000000000000000000000000000000002005771420000010000000000000000001000000000000000000000000000001000000000000000000200577142120057714420057714222005771452005771423200577146200577142120057714420057714222005771452005771423200577146200577143SYMPTOM PRESENCE:AIAC21220820000010100110001020001105251021000Arial80000018421504000000000200577143000000000000000000000000000000000000000000000000200577143000001000000000000000001100000000000000000000000000000100000000000000000020057714312005771423200577143120057714232005771431200577144200577143220057714520057714332005771462005771431200577144200577143220057714520057714332005771462005771440. noAIAD22122120000000000100000000001105251020010Arial8000111419443200000000020057714400000000000000000000000000000000000000000000000020057714400000000000000000000000100000000000000000000000000000010000000000000000002005771440000000000000000000000000000000000000000000200577144120057714332005771442200577147120057714432005771481200577144120057714332005771442200577147120057714432005771481200577144701-1-102005771451. yesAIAE22122120000000000100000000001105251020010Arial8000111419443200000000020057714500000000000000000000000000000000000000000000000020057714500000000000000000000000100000000000000000000000000000010000000000000000002005771451200577143320057714512005771433200577145701-1-112005771469. No or nonsensical responseAIAF22122120000000000100000000001105251020010Arial8000111419443200000000020057714600000000000000000000000000000000000000000000000020057714600000000000000000000000100000000000000000000000000000010000000000000000002005771461200577143320057714612005771433200577147SYMPTOM FREQUENCY:AIAG21220820000010100010001020001105251021000Arial800000184215040000000002005771470000000000000000000000000000000000000000000000002005771470000010000000000000000001000000000000000000000000000001000000000000000000200577147120057714820057714722005771492005771473200577150200577147420057715120057714712005771482005771472200577149200577147320057715020057714742005771512005771480. never or 1 dayAIAH22122120000000000100000000001105251020010Arial8000111419443200000000020057714800000000000000000000000000000000000000000000000020057714800000000000000000000000100000000000000000000000000000010000000000000000002005771481200577147320057714812005771473200577148301-1-102005771491. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAIAI22122120000000000100000000001105251020010Arial8000111419443200000000020057714900000000000000000000000000000000000000000000000020057714900000000000000000000000100000000000000000000000000000010000000000000000002005771491200577147320057714912005771473200577149301-1-112005771502. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AIAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057715000000000000000000000000000000000000000000000000020057715000000000000000000000000100000000000000000000000000000010000000000000000002005771501200577147320057715012005771473200577150301-1-122005771513. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAIAK22122120000000000100000000001105251020010Arial8000111419443200000000020057715100000000000000000000000000000000000000000000000020057715100000000000000000000000100000000000000000000000000000010000000000000000002005771511200577147320057715112005771473200577151301-1-1320057742AJAA12812864255255255000000000000000002550001Arial140050101842150400000000020057742000000000000000000000000000000000000000000000000200577420001000000000000000000000000000000000000000000000000001000000000000000000200577152E. POOR APPETITE / OVEREATINGRS4gUG9vciBhcHBldGl0ZSBvciBvdmVyZWF0aW5nOiAgIA==AJAB21220820000010100010001020001105251021000Arial800000184215040000000002005771520000000000000000000000000000000000000000000000002005771520000010000000000000000001000000000000000000000000000001000000000000000000200577152120057715420057715222005771552005771523200577156200577152120057715420057715222005771552005771523200577156200577153SYMPTOM PRESENCE:AJAC21220820000010100110001020001105251021000Arial80000018421504000000000200577153000000000000000000000000000000000000000000000000200577153000001000000000000000001100000000000000000000000000000100000000000000000020057715312005771523200577153120057715232005771531200577154200577153220057715520057715332005771562005771531200577154200577153220057715520057715332005771562005771540. noAJAD22122120000000000100000000001105251020010Arial8000111419443200000000020057715400000000000000000000000000000000000000000000000020057715400000000000000000000000100000000000000000000000000000010000000000000000002005771540000000000000000000000000000000000000000000200577154120057715332005771542200577157120057715432005771581200577154120057715332005771542200577157120057715432005771581200577154701-1-102005771551. yesAJAE22122120000000000100000000001105251020010Arial8000111419443200000000020057715500000000000000000000000000000000000000000000000020057715500000000000000000000000100000000000000000000000000000010000000000000000002005771551200577153320057715512005771533200577155701-1-112005771569. No or nonsensical responseAJAF22122120000000000100000000001105251020010Arial8000111419443200000000020057715600000000000000000000000000000000000000000000000020057715600000000000000000000000100000000000000000000000000000010000000000000000002005771561200577153320057715612005771533200577157SYMPTOM FREQUENCY:AJAG21220820000010100010001020001105251021000Arial800000184215040000000002005771570000000000000000000000000000000000000000000000002005771570000010000000000000000001000000000000000000000000000001000000000000000000200577157120057715820057715722005771592005771573200577160200577157420057716120057715712005771582005771572200577159200577157320057716020057715742005771612005771580. never or 1 dayAJAH22122120000000000100000000001105251020010Arial8000111419443200000000020057715800000000000000000000000000000000000000000000000020057715800000000000000000000000100000000000000000000000000000010000000000000000002005771581200577157320057715812005771573200577158301-1-102005771591. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAJAI22122120000000000100000000001105251020010Arial8000111419443200000000020057715900000000000000000000000000000000000000000000000020057715900000000000000000000000100000000000000000000000000000010000000000000000002005771591200577157320057715912005771573200577159301-1-112005771602. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AJAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057716000000000000000000000000000000000000000000000000020057716000000000000000000000000100000000000000000000000000000010000000000000000002005771601200577157320057716012005771573200577160301-1-122005771613. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAJAK22122120000000000100000000001105251020010Arial8000111419443200000000020057716100000000000000000000000000000000000000000000000020057716100000000000000000000000100000000000000000000000000000010000000000000000002005771611200577157320057716112005771573200577161301-1-1320057748AKAA12812864255255255000000000000000002550001Arial140050101842150400000000020057748000000000000000000000000000000000000000000000000200577480001000000000000000000000000000000000000000000000000001000000000000000000200577162F. FEELING BAD ABOUT SELFRi4gRmVlbGluZyBiYWQgYWJvdXQgeW91cnNlbGYgLSBvciB0aGF0IHlvdSBhcmUgYSBmYWlsdXJl IG9yIGhhdmUgbGV0IHlvdXJzZWxmIG9yIHlvdXIgZmFtaWx5IGRvd246ICA=AKAB21220820000010100010001020001105251021000Arial800000184215040000000002005771620000000000000000000000000000000000000000000000002005771620000010000000000000000001000000000000000000000000000001000000000000000000200577162120057716420057716222005771652005771623200577166200577162120057716420057716222005771652005771623200577166200577163SYMPTOM PRESENCE:AKAC21220820000010100110001020001105251021000Arial80000018421504000000000200577163000000000000000000000000000000000000000000000000200577163000001000000000000000001100000000000000000000000000000100000000000000000020057716312005771623200577163120057716232005771631200577164200577163220057716520057716332005771662005771631200577164200577163220057716520057716332005771662005771640. noAKAD22122120000000000100000000001105251020010Arial8000111419443200000000020057716400000000000000000000000000000000000000000000000020057716400000000000000000000000100000000000000000000000000000010000000000000000002005771640000000000000000000000000000000000000000000200577164120057716332005771642200577167120057716432005771681200577164120057716332005771642200577167120057716432005771681200577164701-1-102005771651. yesAKAE22122120000000000100000000001105251020010Arial8000111419443200000000020057716500000000000000000000000000000000000000000000000020057716500000000000000000000000100000000000000000000000000000010000000000000000002005771651200577163320057716512005771633200577165701-1-112005771669. No or nonsensical responseAKAF22122120000000000100000000001105251020010Arial8000111419443200000000020057716600000000000000000000000000000000000000000000000020057716600000000000000000000000100000000000000000000000000000010000000000000000002005771661200577163320057716612005771633200577167SYMPTOM FREQUENCY:AKAG21220820000010100010001020001105251021000Arial800000184215040000000002005771670000000000000000000000000000000000000000000000002005771670000010000000000000000001000000000000000000000000000001000000000000000000200577167120057716820057716722005771692005771673200577170200577167420057717120057716712005771682005771672200577169200577167320057717020057716742005771712005771680. never or 1 dayAKAH22122120000000000100000000001105251020010Arial8000111419443200000000020057716800000000000000000000000000000000000000000000000020057716800000000000000000000000100000000000000000000000000000010000000000000000002005771681200577167320057716812005771673200577168301-1-102005771691. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAKAI22122120000000000100000000001105251020010Arial8000111419443200000000020057716900000000000000000000000000000000000000000000000020057716900000000000000000000000100000000000000000000000000000010000000000000000002005771691200577167320057716912005771673200577169301-1-112005771702. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AKAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057717000000000000000000000000000000000000000000000000020057717000000000000000000000000100000000000000000000000000000010000000000000000002005771701200577167320057717012005771673200577170301-1-122005771713. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAKAK22122120000000000100000000001105251020010Arial8000111419443200000000020057717100000000000000000000000000000000000000000000000020057717100000000000000000000000100000000000000000000000000000010000000000000000002005771711200577167320057717112005771673200577171301-1-1320057753ALAA12812864255255255000000000000000002550001Arial140050101842150400000000020057753000000000000000000000000000000000000000000000000200577530001000000000000000000000000000000000000000000000000001000000000000000000200577172G. TROUBLE CONCENTRATINGRy4gVHJvdWJsZSBjb25jZW50cmF0aW5nIG9uIHRoaW5ncywgc3VjaCBhcyByZWFkaW5nIHRoZSBu ZXdzcGFwZXIgb3Igd2F0Y2hpbmcgdGVsZXZpc2lvbjogICA=ALAB21220820000010100010001020001105251021000Arial800000184215040000000002005771720000000000000000000000000000000000000000000000002005771720000010000000000000000001000000000000000000000000000001000000000000000000200577172120057717420057717222005771752005771723200577176200577172120057717420057717222005771752005771723200577176200577173SYMPTOM PRESENCE:ALAC21220820000010100110001020001105251021000Arial80000018421504000000000200577173000000000000000000000000000000000000000000000000200577173000001000000000000000001100000000000000000000000000000100000000000000000020057717312005771723200577173120057717232005771731200577174200577173220057717520057717332005771762005771731200577174200577173220057717520057717332005771762005771740. noALAD22122120000000000100000000001105251020010Arial8000111419443200000000020057717400000000000000000000000000000000000000000000000020057717400000000000000000000000100000000000000000000000000000010000000000000000002005771740000000000000000000000000000000000000000000200577174120057717332005771742200577177120057717432005771781200577174120057717332005771742200577177120057717432005771781200577174701-1-102005771751. yesALAE22122120000000000100000000001105251020010Arial8000111419443200000000020057717500000000000000000000000000000000000000000000000020057717500000000000000000000000100000000000000000000000000000010000000000000000002005771751200577173320057717512005771733200577175701-1-112005771769. No or nonsensical responseALAF22122120000000000100000000001105251020010Arial8000111419443200000000020057717600000000000000000000000000000000000000000000000020057717600000000000000000000000100000000000000000000000000000010000000000000000002005771761200577173320057717612005771733200577177SYMPTOM FREQUENCY:ALAG21220820000010100010001020001105251021000Arial800000184215040000000002005771770000000000000000000000000000000000000000000000002005771770000010000000000000000001000000000000000000000000000001000000000000000000200577177120057717820057717722005771792005771773200577180200577177420057718120057717712005771782005771772200577179200577177320057718020057717742005771812005771780. never or 1 dayALAH22122120000000000100000000001105251020010Arial8000111419443200000000020057717800000000000000000000000000000000000000000000000020057717800000000000000000000000100000000000000000000000000000010000000000000000002005771781200577177320057717812005771773200577178301-1-102005771791. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgALAI22122120000000000100000000001105251020010Arial8000111419443200000000020057717900000000000000000000000000000000000000000000000020057717900000000000000000000000100000000000000000000000000000010000000000000000002005771791200577177320057717912005771773200577179301-1-112005771802. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==ALAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057718000000000000000000000000000000000000000000000000020057718000000000000000000000000100000000000000000000000000000010000000000000000002005771801200577177320057718012005771773200577180301-1-122005771813. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgALAK22122120000000000100000000001105251020010Arial8000111419443200000000020057718100000000000000000000000000000000000000000000000020057718100000000000000000000000100000000000000000000000000000010000000000000000002005771811200577177320057718112005771773200577181301-1-1320057758AMAA12812864255255255000000000000000002550001Arial140050101842150400000000020057758000000000000000000000000000000000000000000000000200577580001000000000000000000000000000000000000000000000000001000000000000000000200577182H. >SLOW OR >RESTLESSSC4gTW92aW5nIG9yIHNwZWFraW5nIHNvIHNsb3dseSB0aGF0IG90aGVyIHBlb3BsZSBjb3VsZCBo YXZlIG5vdGljZWQuIE9yIHRoZSBvcHBvc2l0ZSAtIGJlaW5nIHNvIGZpZGdldHkgb3IgcmVzdGxl c3MgdGhhdCB5b3UgaGF2ZSBiZWVuIG1vdmluZyBhcm91bmQgYSBsb3QgbW9yZSB0aGFuIHVzdWFs OiAgIA==AMAB21220820000010100010001020001105251021000Arial800000184215040000000002005771820000000000000000000000000000000000000000000000002005771820000010000000000000000001000000000000000000000000000001000000000000000000200577182120057718420057718222005771852005771823200577186200577182120057718420057718222005771852005771823200577186200577183SYMPTOM PRESENCE:AMAC21220820000010100110001020001105251021000Arial80000018421504000000000200577183000000000000000000000000000000000000000000000000200577183000001000000000000000001100000000000000000000000000000100000000000000000020057718312005771823200577183120057718232005771831200577184200577183220057718520057718332005771862005771831200577184200577183220057718520057718332005771862005771840. noAMAD22122120000000000100000000001105251020010Arial8000111419443200000000020057718400000000000000000000000000000000000000000000000020057718400000000000000000000000100000000000000000000000000000010000000000000000002005771840000000000000000000000000000000000000000000200577184120057718332005771842200577187120057718432005771881200577184120057718332005771842200577187120057718432005771881200577184701-1-102005771851. yesAMAE22122120000000000100000000001105251020010Arial8000111419443200000000020057718500000000000000000000000000000000000000000000000020057718500000000000000000000000100000000000000000000000000000010000000000000000002005771851200577183320057718512005771833200577185701-1-112005771869. No or nonsensical responseAMAF22122120000000000100000000001105251020010Arial8000111419443200000000020057718600000000000000000000000000000000000000000000000020057718600000000000000000000000100000000000000000000000000000010000000000000000002005771861200577183320057718612005771833200577187SYMPTOM FREQUENCY:AMAG21220820000010100010001020001105251021000Arial800000184215040000000002005771870000000000000000000000000000000000000000000000002005771870000010000000000000000001000000000000000000000000000001000000000000000000200577187120057718820057718722005771892005771873200577190200577187420057719120057718712005771882005771872200577189200577187320057719020057718742005771912005771880. never or 1 dayAMAH22122120000000000100000000001105251020010Arial8000111419443200000000020057718800000000000000000000000000000000000000000000000020057718800000000000000000000000100000000000000000000000000000010000000000000000002005771881200577187320057718812005771873200577188301-1-102005771891. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgAMAI22122120000000000100000000001105251020010Arial8000111419443200000000020057718900000000000000000000000000000000000000000000000020057718900000000000000000000000100000000000000000000000000000010000000000000000002005771891200577187320057718912005771873200577189301-1-112005771902. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==AMAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057719000000000000000000000000000000000000000000000000020057719000000000000000000000000100000000000000000000000000000010000000000000000002005771901200577187320057719012005771873200577190301-1-122005771913. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgAMAK22122120000000000100000000001105251020010Arial8000111419443200000000020057719100000000000000000000000000000000000000000000000020057719100000000000000000000000100000000000000000000000000000010000000000000000002005771911200577187320057719112005771873200577191301-1-1320057760ANAA12812864255255255000000000000000002550001Arial140050101842150400000000020057760000000000000000000000000000000000000000000000000200577600001000000000000000000000000000000000000000000000000001000000000000000000200577192I. THOUGHTS OF SELF-HARMSS4gVGhvdWdodHMgdGhhdCB5b3Ugd291bGQgYmUgYmV0dGVyIG9mZiBkZWFkLCBvciBvZiBodXJ0 aW5nIHlvdXJzZWxmIGluIHNvbWUgd2F5OiAgIA==ANAB21220820000010100010001020001105251021000Arial800000184215040000000002005771920000000000000000000000000000000000000000000000002005771920000010000000000000000001000000000000000000000000000001000000000000000000200577192120057719420057719222005771952005771923200577196200577192120057719420057719222005771952005771923200577196200577193SYMPTOM PRESENCE:ANAC21220820000010100110001020001105251021000Arial80000018421504000000000200577193000000000000000000000000000000000000000000000000200577193000001000000000000000001100000000000000000000000000000100000000000000000020057719312005771923200577193120057719232005771931200577194200577193220057719520057719332005771962005771931200577194200577193220057719520057719332005771962005771940. noANAD22122120000000000100000000001105251020010Arial8000111419443200000000020057719400000000000000000000000000000000000000000000000020057719400000000000000000000000100000000000000000000000000000010000000000000000002005771940000000000000000000000000000000000000000000200577194120057719332005771942200577197120057719432005771981200577194120057719332005771942200577197120057719432005771981200577194701-1-102005771951. yesANAE22122120000000000100000000001105251020010Arial80001114194432000000000200577195000000000000000000000000000000000000000000000000200577195000000000000000000000001000000000000000000000000000000100000000000000000020057719500000000000000000000000000000000000000000002005771951200577193320057719512005771933200577195701-1-112005771969. No or nonsensical responseANAF22122120000000000100000000001105251020010Arial80001114194432000000000200577196000000000000000000000000000000000000000000000000200577196000000000000000000000001000000000000000000000000000000100000000000000000020057719600000000000000000000000000000000000000000002005771961200577193320057719612005771933200577197SYMPTOM FREQUENCY:ANAG21220820000010100010001020001105251021000Arial800000184215040000000002005771970000000000000000000000000000000000000000000000002005771970000010000000000000000001000000000000000000000000000001000000000000000000200577197120057719820057719722005771992005771973200577200200577197420057720120057719712005771982005771972200577199200577197320057720020057719742005772012005771980. never or 1 dayANAH22122120000000000100000000001105251020010Arial80001114194432000000000200577198000000000000000000000000000000000000000000000000200577198000000000000000000000001000000000000000000000000000000100000000000000000020057719800000000000000000000000000000000000000000002005771981200577197320057719812005771973200577198301-1-102005771991. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgANAI22122120000000000101000000001105251020010Arial80001114194432000000000200577199000000000000000000000000000000000000000000000000200577199000000000000000000000101000000000000000000000000000000100000000000000000020057719900000000000000000000000000000000000000000002005771991200577364-100102005771991200577197320057719912005771973200577199301-1-112005772002. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==ANAJ22122120000000000101000000001105251020010Arial80001114194432000000000200577200000000000000000000000000000000000000000000000000200577200000000000000000000000101000000000000000000000000000000100000000000000000020057720000000000000000000000000000000000000000000002005772001200577364-100102005772001200577197320057720012005771973200577200301-1-122005772013. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgANAK22122120000000000101000000001105251020010Arial80001114194432000000000200577201000000000000000000000000000000000000000000000000200577201000000000000000000000101000000000000000000000000000000100000000000000000020057720100000000000000000000000000000000000000000002005772011200577364-100102005772011200577197320057720112005771973200577201301-1-13200577324IF YES, WAS PROVIDER NOTIFIED?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 SEVERITY SCORE:AOAB21220820000010100000000000001105251021000Arial800000184215040000000002005773360000000000000000000000000000000000000000000-10000000000000000000000000000000000000002005773360000000000000000000000000000000000000000000-10000000000000000000000000000000000000002005773360000000000000000000000000000000000000000000000002005773360119//5FAG4AdABlAHIAIABzAGMAbwByAGUAIAAgAGIAZQB0AHcAZQBlAG4AIAAwACAALQAgADEANQA6 AA==0010000000000000000000000000000000000000000000000101000000000419852000000000200577342Score must be betweenAOAC25525525500000000000000000001105251020000Arial80001018421504000000000200577342000000000000000000000000000000000000000000000000200577342000100000000000000000000000000000000000000000000000000100000000000000000020057734300 and 27AOAD25525525500000000000000000001105251020000Arial80001018421504000000000200577343000000000000000000000000000000000000000000000000200577343000100000000000000000000000000000000000000000000000000100000000000000000020057716PHQ SEVERITY LEVEL:AOAE21220820000010100000000000001105251021000Arial800000179745740000000002005771600000000000000000000000000000000000000000000000020057716000001000000000000000000000000000000000000000000000000100000000000000000020057716000000000000000000000000000000000000000000020057717minimal (0-4)AOAF025525500000100100000000001105251020000Arial8000001797457400000000020057717000000000000000000000000000000000000000000-10000020057717000000000000000000000001000000000000000000000000000000100000000000000000020057717000000000000000000000000000000000000000000020057717120057716320057717120057716320057718mild (5-9)AOAG025525500000100100000000001105251020000Arial8000001797457400000000020057718000000000000000000000000000000000000000000-10000020057718000000000000000000000001000000000000000000000000000000100000000000000000020057718000000000000000000000000000000000000000000020057718120057716320057718120057716320057722moderate (10-14)AOAH025525500000100100000000001105251020000Arial8000001797457400000000020057722000000000000000000000000000000000000000000-10000020057722000000000000000000000001000000000000000000000000000000100000000000000000020057722000000000000000000000000000000000000000000020057722120057716320057722120057716320057724moderately severe (15-19)AOAI025525500000100100000000001105251020000Arial8000001797457400000000020057724000000000000000000000000000000000000000000-10000020057724000000000000000000000001000000000000000000000000000000100000000000000000020057724000000000000000000000000000000000000000000020057724120057716320057724120057716320057725severe (20-27)AOAJ025525500000100100000000001105251020000Arial8000001797457400000000020057725000000000000000000000000000000000000000000-100000200577250000000000000000000000010000000000000000000000000000001000000000000000000200577250000000000000000000000000000000000000000000200577251200577163200577251200577163200577337unable to complete interviewdW5hYmxlIHRvIGNvbXBsZXRlIGludGVydmlldw==AOAK025525500000100100000000001105251020100Arial80000017974574000000000200577337000000000000000000000000000000000000000000-1000002005773370000000000000000000000010000000000000000000000000000001000000000000000000200577337000000000000000000000000000000000000000000020057733712005771632005773371200577163200577337301-1-199200577403PHQ SEVERITY SCORE:AOAZ21220820000010100000000000001105251021100Arial800000184215040000000002005774030000000000000000000000000000000000000000000-10000000000000000000000000000000000000002005774030000000000000000000000000000000000000000000-1000000000000000000000000000000000000000200577403000000000000000000000000000000000000000000000000200577403000001000000000000000000000000000000000000000000000010100000200577336041985200000000020057740300000000000000000000000000000000000000000002005774399AOBA02552550000010000000000000000100Arial8000001797457400000000020057743000000000000000000000000000000000000000000000000200577430000000000000000000000000000000000000000000000000000001000000000000000000200577430000000000000000000000000000000000000000000200577404unable to complete d/t A/BAOBB025525500000100100000000001105251020100Arial80000017974574000000000200577404000000000000000000000000000000000000000000-1000002005774040116//5JAGYAIABCAE8AVABIACAAbwBmACAAaQB0AGUAbQBzACAAQQAgAGEAbgBkACAAQgAgAGEAcgBl 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1AOBD02552550000010000000000000000100Arial8000001797457400000000020057744000000000000000000000000000000000000000000000000200577440116//5JAGYAIAB0AGgAZQAgAHMAeQBtAHAAdABvAG0AIABmAHIAZQBxAHUAZQBuAGMAeQAgAGYAbwBy ACAAYgBvAHQAaAAgAG8AZgAgAGkAdABlAG0AcwAgAEEAIABhAG4AZAAgAEIAIABpAHMAIAAiADAA IgAgAG8AcgAgACIAMQAsACIAIABlAG4AZAAgAHQAaABlACAAaQBuAHQAZQByAHYAaQBlAHcAIABo AGUAcgBlAC4AIAA=1000000000000000000000000000000000000000000000000001000000000000000000200577440000000000000000000000000000000000000000000200577350ReportAPAA12812864255255255000000000000000002550001Arial140050101842150400000000020057735000000000000000000000000000000000000000000000000020057735000010000000000000000000000000000000000000000000000000010000000000000000002005773500000000000000000000000000000000000000000000200577344^ View PHQ-2 to 9 AssessmentAPAB22422417500000000000000000001105251021100Arial80000018421504000000000200577344000000000000000000000000000000000000000000000000200577344000100000000000000000000000000000000000000000000000065545010000000000000000002005773440000000000000000000000000000000000000000000200577344472811000002000000200577344120200577391^ Preview P4 ScreenerAPAC22422117500000000000000000001105251021000Arial80000018421504000000000200577391000000000000000000000000000000000000000000000000200577391000100000000000000000000000000000000000000000000000065545010000000000000000002005773910000000000000000000000000000000000000000000200577391472911000002000000200577391120200577357Care PlanningAQAA128128642552552550000000000000000184215040001Arial140050101842150400000000020057735700000000000000000000000000000000000000000000000020057735700010000000000000000000000000000000000000000000000000010000000000000000002005773570000000000000000000000000000000000000000000200577358Nursing HomeAQAB2552552550000000000000000000000000Arial8000101797457400000000020057735800000000000000000000000000000000000000000000000020057735800010000000000000000000000000000000000000000000000000010000000000000000002005773580000000000000000000000000000000000000000000200577359^ Update Mental Wellbeing CPAQAC22422417500000000001000000001105251021010Arial8000001797457400000000020057735900000000000000000000000000000000000000000000000020057735900010000000000000000010000000000000000000000000000001010000000000000000002005773590000000000000000000000000000000000000000000200577359120059200040-10010200577360Assisted LivingAQAD2552552550000000000000000000000000Arial8000101797457400000000020057736000000000000000000000000000000000000000000000000020057736000010000000000000000000000000000000000000000000000000010000000000000000002005773600000000000000000000000000000000000000000000200577361^ Update Emotional Serv PlanAQAE22422417500000000001000000001105251021010Arial8000001797457400000000020057736100000000000000000000000000000000000000000000000020057736100010000000000000000010000000000000000000000000000001010000000000000000002005773610000000000000000000000000000000000000000000200577361120034200260-10010200577362^ Update Psychosocial CPAQDJ22422417500000000001000000001105251021010Arial8000001797457400000000020057736200000000000000000000000000000000000000000000000020057736200010000000000000000010000000000000000000000000000001010000000000000000002005773620000000000000000000000000000000000000000000200577362120010200520-10010200577347SignARAA202151179000000000000000000002551001Arial14005010184215040000000002005773470000000000000000000000000000000000000000000000002005773470001000000000000000000000000000000000000000000000000655360100000000000000000020057734700000000000000000000000000000000000000000002005773471502005773470000000000000000000000000000000000000000000-100000000000000200577338^ Staff AssessmentARAB22422417500000000001000000001105251021000Arial800000184215040000000002005773380000000000000000000000000000000000000000000000002005773380001000000000000000001000000000000000000000000000000901000000000000000000200577338120057764-1001020057764Staff AssessmentBNAA12812864255255255000000000000000002550001Arial140050101842150400000000020057764000000000000000000000000000000000000000000000000200577640001000000000000000000000000000000000000000000000000001000000000000000000200577640000000000000000000000000000000000000000000200577330STAFF ASMT OF RESIDENT MOODU1RBRkYgQVNTRVNTTUVOVCBPRiBSRVNJREVOVCBNT09EOiA=BNAB21220820000010100100000000001105251021100Arial80000018421504000000000200577330000000000000000000000000000000000000000000000000200577330000001000000000001000001000000000000000000000000000000100000000000000000020057733000000000000000000000000000000000000000000002005773301200577353120057733012005773531200577353ASSESSMENT DATE:BNAC21220820000010100100000000001105251020100Arial800000184215040000000002005773530000000000000000000000000000000200000000000001101110000000000000000000000000000000020057735300000000000000000000000000000002000000000000011011100000000000000000000000000000000200577353000000000000000000000000000000000000000000000000200577353012001000000000000000001000000000000000000000000000000100000000000000000020057735300000000000000000000000000000000000000000002005773531200577330320057735312005773303200577331Do NOT complete this sectionBNAD25525525500000000000000000001105251020000Arial800010184215040000000002005773310000000000000000000000000000000000000000000000002005773310001000000000000000000000000000000000000000000000000001000000000000000000200577332if Resident Mood InterviewBNAE25525525500000000000000000001105251020000Arial800010184215040000000002005773320000000000000000000000000000000000000000000000002005773320001000000000000000000000000000000000000000000000000001000000000000000000200577333was completedBNAF25525525500000000000000000001105251020000Arial800010184215040000000002005773330000000000000000000000000000000000000000000000002005773330001000000000000000000000000000000000000000000000000001000000000000000000200577334BOAA12812864255255255000000000000000002550001Arial14005010184215040000000002005773340000000000000000000000000000000000000000000000002005773340001000000000000000000000000000000000000000000000000001000000000000000000200577216A. < INTEREST DOING THINGSQS4gTGl0dGxlIGludGVyZXN0IG9yIHBsZWFzdXJlIGluIGRvaW5nIHRoaW5nczogBOAB21220820000010100010001020001105251021000Arial80000018421504000000000200577216000000000000000000000000000000000000000000000000200577216000001000000000000000000100000000000000000000000000000100000000000000000020057721600000000000000000000000000000000000000000002005772161200577209200577216220057721020057721612005772092005772162200577210200577208SYMPTOM PRESENCE:BOAC21220820000010100100000000001105251021000Arial80000018421504000000000200577208000000000000000000000000000000000000000000000000200577208000001000000000000000001000000000000000000000000000000100000000000000000020057720812005772163200577208120057721632005772090. 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dayBXAG22122120000000000100000000001105251020010Arial8000111419443200000000020057730300000000000000000000000000000000000000000000000020057730300000000000000000000000100000000000000000000000000000010000000000000000002005773031200577302320057730312005773023200577303301-1-102005773041. 2-6 daysMS4gMi02IGRheXMgKHNldmVyYWwgZGF5cykgBXAH22122120000000000100000000001105251020010Arial8000111419443200000000020057730400000000000000000000000000000000000000000000000020057730400000000000000000000000100000000000000000000000000000010000000000000000002005773041200577302320057730412005773023200577304301-1-112005773052. 7-11 daysMi4gNy0xMSBkYXlzIChoYWxmIG9yIG1vcmUgb2YgdGhlIGRheXMpIA==BXAI22122120000000000100000000001105251020010Arial8000111419443200000000020057730500000000000000000000000000000000000000000000000020057730500000000000000000000000100000000000000000000000000000010000000000000000002005773051200577302320057730512005773023200577305301-1-122005773063. 12-14 daysMy4gMTItMTQgZGF5cyAobmVhcmx5IGV2ZXJ5IGRheSkgBXAJ22122120000000000100000000001105251020010Arial8000111419443200000000020057730600000000000000000000000000000000000000000000000020057730600000000000000000000000100000000000000000000000000000010000000000000000002005773061200577302320057730612005773023200577306301-1-13200577313BYAA12812864255255255000000000000000002550001Arial14005010184215040000000002005773130000000000000000000000000000000000000000000000002005773130001000000000000000000000000000000000000000000000000001000000000000000000200577339TOTAL SEVERITY SCORE:BYAB21220820000010100000000000001105251021000Arial800000184215040000000002005773390000000000000000000000000000000000000000000-10000000000000000000000000000000000000002005773390000000000000000000000000000000000000000000-10000000000000000000000000000000000000002005773390000000000000000000000000000000000000000000000002005773390119//5FAG4AdABlAHIAIABzAGMAbwByAGUAIAAgAGIAZQB0AHcAZQBlAG4AIAAwACAALQAgADEANQA6 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AssessmentBZAB22422117500000000000000000001105251021000Arial80000018421504000000000200577345000000000000000000000000000000000000000000000000200577345000100000000000000000000000000000000000000000000000065545010000000000000000002005773450000000000000000000000000000000000000000000200577345473011000002000000200577345120200577348SignCAAA202151179000000000000000000002551001Arial14005010184215040000000002005773480000000000000000000000000000000000000000000000002005773480001000000000000000000000000000000000000000000000000655360100000000000000000020057734800000000000000000000000000000000000000000002005773481502005773480000000000000000000000000000000000000000000-100000000000000200577364P4 Suicidality ScreenerEHAA12812864255255255000000000000000002550001Arial14015050101842150400000000020057736400000000000000000000000000000000000000000000000020057736400010000000000000000000000000000000000000000000000000010000000000000000002005773640000000000000000000000000000000000000000000200577390^ Question DiagramIA==EHAB2242241750000000000000000000001000Arial8000101797457400000000020057739000000000000000000000000000000000000000000000000020057739000010000000000000000000000000000000000000000000000001010000000000000000002005773900000000000000000000000000000000000000000000200577390473111000002000000200577384Source for the P4 SuicidalityEHAM255255255000000000000000000002550000Arial80001010000000000200577384000000000000000000000000000000020000000000000110111000000000000000000000000000000002005773840000000000000000000000000000000200000000000001101110000000000000000000000000000000020057738400000000000000000000000000000000000000000000000020057738400010000000000000000000000000000000000000000000000000010000000000000000002005773840000000000000000000000000000000000000000000200577385Screener is ©Copyright 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InIA==EHCU2242241750000000000000000000001000Arial8000101797457400000000020057739200000000000000000000000000000000000000000000000020057739200010000000000000000000000000000000000000000000000001010000000000000000002005773920000000000000000000000000000000000000000000200577392317224200002000000200577365Q1EIAA12812864255255255000000000000000002550001Arial140050101842150400000000020057736500000000000000000000000000000000000000000000000020057736500010000000000000000000000000000000000000000000000000010000000000000000002005773650000000000000000000000000000000000000000000200577369ATTEMPTED SELF HARM IN 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SELF?SVMgVEhFUkUgQU5ZVEhJTkcgVEhBVCBXT1VMRCBQUkVWRU5UIE9SIEtFRVAgWU9VIEZST00gSEFS 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CategoryEMAA12812864255255255000000000000000002550001Arial14005010184215040000000002005773800000000000000000000000000000000000000000000000002005773800001000000000000000000000000000000000000000000000000001000000000000000000200577380000000000000000000000000000000000000000000020057739Calculate Risk CategoryIA==EMAB2242241750000000000000000000001000Arial8000101797457400000000020057739000000000000000000000000000000000000000000000000200577390000000000000000000000000000000000000000000000000000101000000000000000000200577390000000000000000000000000000000000000000000200577382RISK CATEGORY:EMAD21220820000010100000000000001105251021000Arial800000184215040000000002005773820000000000000000000000000000000000000000000000002005773820000010000000000000000000000000000000000000000000000001000000000000000000200577382000000000000000000000000000000000000000000020057735MinimalEMAE025525500000100100000000001105251020000Arial80000017974574000000000200577350000000000000000000000000000000000000000000000002005773500000000000000000000000100000000000000000000000000000010000000000000000002005773500000000000000000000000000000000000000000002005773512005773823200577351200577382320057736LowerEMAF025525500000100100000000001105251020000Arial80000017974574000000000200577360000000000000000000000000000000000000000000000002005773600000000000000000000000100000000000000000000000000000010000000000000000002005773600000000000000000000000000000000000000000002005773612005773823200577361200577382320057738HigherEMAG025525500000100100000000001105251020000Arial800000179745740000000002005773800000000000000000000000000000000000000000000000020057738000000000000000000000001000000000000000000000000000000100000000000000000020057738000000000000000000000000000000000000000000020057738120057738232005773812005773823200577383ENAA12812864255255255000000000000000002550001Arial140050101842150400000000020057738300000000000000000000000000000000000000000000000020057738300010000000000000000000000000000000000000000000000000010000000000000000002005773830000000000000000000000000000000000000000000200577363^ Back to assessmentENAB22422417500000000001000000001105251021000Arial8000001842150400000000020057736300000000000000000000000000000000000000000000000020057736300010000000000000000010000000000000000000000000000009010000000000000000002005773630000000000000000000000000000000000000000000200577363120057760-100102005772Conduct Interview?HGAA12812864255255255000000000000000002550001Arial14005010184215040000000002005772000000000000000000000000000000000000000000000000200577200010000000000000000000000000000000000000000000000000010000000000000000002005773MAKES SELF UNDERSTOOD:HGAB21220820000010100000000000001105251021000Arial80000018421504000000000200577300000000000000000000000000000000000000000000000020057730000010000000000000000000000000000000000000000000000001000000000000000000200577300000000000000000000000000000000000000000002005775understoodHGAC22122120000000000100000000001105251020010Arial8000111419443200000000020057750000000000000000000000000000000000000000000000002005775000000000000000000000001000000000000000000000000000000100000000000000000020057750000000000000000000000000000000000000000000200577512005773320057751200577332005776usually understoodHGAD22122120000000000100000000001105251020010Arial8000111419443200000000020057760000000000000000000000000000000000000000000000002005776000000000000000000000001000000000000000000000000000000100000000000000000020057760000000000000000000000000000000000000000000200577612005773320057761200577332005777sometimes 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(T)2101638511163851115004163851226001016385132010016385111200577336-1-1-1-1016385112200577403-1-1-1-1016385121200577336-1-1-1-101638513120057718-1-1-1-1016402PHQ - Unable to Complete A/B (T)21016402111640211100001640212211001640211120057721-1-1-1-1016402112200577121-1-1-1-1016402121200577336-1-1-1-1016402122200577403-1-1-1-1016410PHQ - Unable to complete >3 (T)210164101116410111170201641012211001641011120057721-1-1-1-1016410112200577121-1-1-1-1016410113200577131-1-1-1-1016410114200577146-1-1-1-1016410115200577156-1-1-1-1016410116200577166-1-1-1-1016410117200577176-1-1-1-1016410118200577186-1-1-1-1016410119200577196-1-1-1-1016410121200577336-1-1-1-1016410122200577403-1-1-1-1016397PHQ - Staff - Severe, 20-30 (T)21016397111639711150019163971226003116397132010016397111200577339-1-1-1-1016397121200577339-1-1-1-101639713120057732-1-1-1-1016392PHQ - Severe, 20-27 (T)21016392111639211150019163921226002816392132010016392111200577336-1-1-1-1016392112200577403-1-1-1-101639212120057716-1-1-1-101639213120057725-1-1-1-1016409PHQ - PHQ2 only (T)210164091116409111102016409122100016409132110016409111200577123-1-1-1-1016409112200577124-1-1-1-1016409121200577112-1-1-1-1016409122200577113-1-1-1-1016409131200577336-1-1-1-1016409132200577403-1-1-1-1016388PHQ - Moderately Severe, 15-19 (T)21016388111638811150014163881226002016388132010016388111200577336-1-1-1-1016388112200577403-1-1-1-101638812120057716-1-1-1-101638813120057724-1-1-1-1016387PHQ - Moderate, 10-14 (T)2101638711163871115009163871226001516387132010016387111200577336-1-1-1-1016387112200577403-1-1-1-1016387121200577336-1-1-1-101638713120057722-1-1-1-1016386PHQ - Minimal, 0-4 (T)210163861116386111500016386122600516386132010016386111200577336-1-1-1-1016386112200577403-1-1-1-1016386121200577336-1-1-1-101638613120057717-1-1-1-1016391P4 Screener - Minimal (T)2101639110163911150000163911220000163911320100163911112005774-1-1-1-1016391112200577371-1-1-1-1016391113200577374-1-1-1-1016391114200577379-1-1-1-101639112120057739-1-1-1-1016391131200577382-1-1-1-1016390P4 Screener - Lower (T)21016390101639011510001639012200001639013200001639014201001639011120057733-1-1-1-1016390112200577372-1-1-1-1016390121200577374-1-1-1-1016390122200577379-1-1-1-101639013120057739-1-1-1-1016390141200577382-1-1-1-1016389P4 Screener - Higher (T)210163891016389111100016389122000016389132010016389111200577378-1-1-1-1016389112200577375-1-1-1-1016389113200577376-1-1-1-101638912120057739-1-1-1-1016389131200577382-1-1-1-1016395PHQ - Staff - Moderate, 10-14 (T)2101639511163951115009163951226001516395132010016395111200577339-1-1-1-1016395121200577339-1-1-1-101639513120057729-1-1-1-1016394PHQ - Staff - Minimal, 1-4 (T)210163941116394111500016394122600516394132010016394111200577339-1-1-1-1016394121200577339-1-1-1-101639413120057727-1-1-1-1014887P4 Screener - Minimal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