| Document Date: 2013-05-20 08:34:58
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Company Assessor / Personal Care Services / / IndustryTerm assessment tool / health insurance policy / objective tool / health insurer / insurance / home telephone number / / MedicalCondition Other Pervasive Developmental Disorders / mental retardation / Asperger’s Disorder / phobic disorder / obsessive compulsive disorder / organic mental disorders / psychiatric/behavioral disorder / tic disorders / depressive syndrome / avoidant disorders / anxiety disorders / separation anxiety disorder / autistic disorder / attention deficit hyperactivity disorder / psychotic disorders / Mood disorder / Emotional Disorders / mood disorders / psychiatric/behavioral disorders / Mental Retardation N/A Anxiety Disorders N/A Attention Deficit Hyperactivity Disorder N/A Autistic Disorder / diagnosis specific psychiatric/behavioral disorders / either depression / Other Psychotic Disorders / disorders / mental disorders / developmental and emotional disorders / pervasive developmental disorders / / Organization Social Security Administration / NPI / / Person Duty Nursing / Child / Licensed Master / / Position nursing assistant / Social Worker / care physician / Clinical Social Worker / Clinical Professional Counselor / personal support specialist / Advanced Practice Registered Nurse / licensed practical nurse / registered nurse / nurse / Physician / Psychiatrist / Physician / General / Private / Psychiatrist / Clinical Psychologist / Professional Counselor / Mental Health Clinical Nurse Specialist / / Product Section G. Medication / Section F. Medication / /
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Instructions for Completing the Medical Eligibility Determination Assessment For Private Duty Nursing and Personal Care Services For