Date: / / Study Name: (month) (day) (year) Protocol ...

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Capital Health Guidelines for using the Edmonton Symptom Assessment System (ESAS) CH-0373 Mar 2001 Regional Palliative Care Program Purpose of the ESAS This tool is designed to assist in the assessment of …

  Assessment, Tool, Symptom, Edmonton, Edmonton symptom assessment

The Brief Pain Inventory - NPCRC

25) I take my pain medicine (in a 24 hour period): 1. Not every day 4. 5 to 6 times per day 2. 1 to 2 times per day 5. More than 6 times per day

  Brief, Medicine, Inventory, Pain, The brief pain inventory

Brief Fatigue Inventory - NPCRC

Date: / / Time:_____ Name:_____ _____ _____ Last First Middle Initial Brief Fatigue Inventory

  Brief, Inventory, Fatigue, Brief fatigue inventory

HAMILTON DEPRESSION RATING SCALE - NPCRC

The total Hamilton Depression (HAM-D) Rating Scale provides and indication of depression and, over time, provides a valuable guide to progress. • Classification of symptoms which may be difficult to obtain can be scored as:

  Scale, Ratings, Hamilton, Depression, Hamilton depression rating scale, Hamilton depression, Rating scale

Caregiver Strain Index (CSI) - NPCRC

Caregiver Strain Index (CSI) I am going to read a list of things that other people have found to be difficult. Would you tell me whether any of these apply to you?

  Caregivers, Strain, Caregiver strain

McGILL QUALITY OF LIFE QUESTIONNAIRE - NPCRC

McGILL QUALITY OF LIFE QUESTIONNAIRE STUDY IDENTIFICATION #: DATE: Instructions The questions in this questionnaire begin with a statement followed by two opposite answers. Numbers extend from one extreme answer to its opposite. Please circle the number between 0 and 10 which is most true for you. There are no right or wrong answers.

  Quality, Questionnaire, Life, Circle, Quality of life questionnaire

Geriatric Depression Scale (GDS) Short Form - NPCRC

Scoring for Geriatric Depression Scale • Score 1 point for every “yes” in questions 2, 3, 4, 6, 8, 9, 10, 12, 14, 15 • Score 1 point for every “no” in ...

  Scale, Depression, Geriatric, Geriatric depression scale

Provincial Report Card, Grades 9–12

83-0470E (2010/01) © Queen's Printer for Ontario, 2010 Page 1 of 4 Semester Reporting Period Date Provincial Report Card, Grades 9–12

NUMBER NUMBER REMAINING VERIFIED BY: FULL NAME OF …

Initials Initials DATE TIME FULL NAME OF PERSON ADMINISTERING Please print name, sign, and initial below to identify initials used above. Name (print) / Signature NUMBER ON HAND NUMBER GIVEN TO CLIENT NUMBER REMAINING NUMBER REMAINING VERIFIED BY: (INITIAL at end of shift))

  Initial, Initials initials

CV Writing: How to Cite Publications in APA

Surname, Initials. (in press). Title of article. Title of Periodical. Example: Student, A. & Supervisor, B. (in press). Effects of sleep deprivation on word recall in university students. Journal of Sleep Psychology. Unpublished work Unpublished work includes those manuscripts that have been submitted for

  Initial

New Employee Safety Orientation Checklist

Initials Trainer’s Initials Facility emergency numbers are posted on telephones. (When reporting facility emergencies, always provide location of incident and details.) Facility emergency responders’ names are posted and visible to all employees. Emergency responders are identified to all new employees.

  Initial

Fill in the initials for each numerical holiday-themed ...

Fill in the initials for each numerical holiday-themed abbreviation: 1. 8 M a M 2. 12 D of C (between C D & E) 3. 3 S the G H G on C D 4. 1 P in a P T 5. 2 F T (is A I W for C) 6. 4 C B 7. 2 T D 8. 3 K of O are B G ...

  Initial

CHRISTMAS INITIALS Each set of initials represent the ...

INITIALS NAME OF SONG 1 WC White Christmas 2 JBR Jingle Bell Rock 3 HYAMLC Have Yourself a Merry Little Christmas 4 TLDB The Little Drummer Boy 5 RTRNR Rudolf, The Red-Nosed Reindeer 6 WW Winter Wonderland 7 AIWFCIY All I Want For Christmas is You 8 FTONY Fairy Tale of New York ...

  Initial

Participant ID: Date: Interviewer ID (Clinician Initials):

Jan 04, 2011 · Interviewer ID (Clinician Initials): _____ Method of Administration:  Clinician Interview  Self Report  Phone. Time Started: _____ : _____ Instructions This is a standard set of questions about several areas of your life such as your health, alcohol and drug use, etc. The questions generally ask about the past 30 days.

  Date, Initial, Participant, Clinician, Interviewer, Participant id, Interviewer id, Clinician initials

Daily Refrigerator / Freezer Temperature Log

the facility. A designated food service employee willrecord the time, air temperature ad theinr initials. The food service supervisor for each facility will verify that food service employees have taken therequired temperatures by visually monitoring food service employees and reviewing, initialing, and dating a saple of m logs each month.

  Initial