The Dizziness Handicap Inventory ( DHI )
|
|
- Rosamond Morgan
- 6 years ago
- Views:
Transcription
1 The Dizziness Handicap Inventry ( DHI ) P1. Des lking up increase yur prblem? Yes E2. Because f yur prblem, d yu feel frustrated? Yes F3. Because f yur prblem, d yu restrict yur travel fr business r recreatin? Yes P4. Des walking dwn the aisle f a supermarket increase yur prblems? Yes F5. Because f yur prblem, d yu have difficulty getting int r ut f bed? Yes F6. Des yur prblem significantly restrict yur participatin in scial activities, such as Yes ging ut t dinner, ging t the mvies, dancing, r ging t parties? F7. Because f yur prblem, d yu have difficulty reading? Yes P8. Des perfrming mre ambitius activities such as sprts, dancing, husehld Yes chres (sweeping r putting dishes away) increase yur prblems? E9. Because f yur prblem, are yu afraid t leave yur hme withut having withut Yes having smene accmpany yu? E10. Because f yur prblem have yu been embarrassed in frnt f thers? Yes P11. D quick mvements f yur head increase yur prblem? Yes F12. Because f yur prblem, d yu avid heights? Yes P13. Des turning ver in bed increase yur prblem? Yes F14. Because f yur prblem, is it difficult fr yu t d strenuus hmewrk r yard Yes wrk? E15. Because f yur prblem, are yu afraid peple may think yu are intxicated? Yes F16. Because f yur prblem, is it difficult fr yu t g fr a walk by yurself? Yes P17. Des walking dwn a sidewalk increase yur prblem? Yes E18.Because f yur prblem, is it difficult fr yu t cncentrate Yes F19. Because f yur prblem, is it difficult fr yu t walk arund yur huse in the dark? Yes Smetimes N
2 E20. Because f yur prblem, are yu afraid t stay hme alne? Yes E21. Because f yur prblem, d yu feel handicapped? Yes E22. Has the prblem placed stress n yur relatinships with members f yur family Yes r friends? Yes E23. Because f yur prblem, are yu depressed? F24. Des yur prblem interfere with yur jb r husehld respnsibilities? Yes P25. Des bending ver increase yur prblem? Yes Used with permissin frm GP Jacbsn. Jacbsn GP, Newman CW: The develpment f the Dizziness Handicap Inventry. Arch Otlaryngl Head Neck Surg 1990;116: DHI Scring Instructins The patient is asked t answer each questin as it pertains t dizziness r unsteadiness prblems, specifically cnsidering their cnditin during the last mnth. Questins are designed t incrprate functinal (F), physical (P), and emtinal (E) impacts n disability. T each item, the fllwing scres can be assigned: N=0 Smetimes=2 Yes=4 Scres: Scres greater than 10 pints shuld be referred t balance specialists fr further evaluatin Pints (mild handicap) Pints (mderate handicap) 54+ Pints (severe handicap)
3 Vestibular Questinnaire: Patient: Date: Characterize yur dizziness: 1. Light-headedness, faintness, giddiness. 2. Unsteadiness, imbalance 3. Objects are spinning arund yu and yu are still. 4. Yu are spinning arund and bjects arund yu are still. 5. Yu blackut r lse cnsciusness 6. Tendency t fall. Please circle the directin (s) Right Left Frward Backward 7. Lss f balance when walking. If yu als veer r feel pulled t ne side r ther indicatin the directin: T the left T the right 8. My dizziness is cnstant. 9. My dizziness cmes in attacks/spells. 10. My dizziness cmes n suddenly. 11. I have n dizziness r imbalance between episdes. 12. I can tell when an episde is abut t start by: Hw: 13. Date f my first dizzy spell: 14. Date f my mst recent episde: 15. On average, hw ften des yu dizziness happen: Exacerbating and Remitting Factrs: 16. Turning my head left/right makes dizziness start r wrsen. 17. Lying dwn r sitting up brings n my dizziness.
4 Standing up brings n my dizziness. 19. Walking in the dark is especially difficult 20. There is a relatinship between my dizziness and tensin, stress r anxiety in my life. Explain: 21. Des anything make yur dizziness better? What: Assciated Symptms 22. Nausea r vmiting? 23. Sweating? 24. Deafness r difficulty hearing? 25. Nises in ear (buzzing, ringing, raring) 26. Change in the nise in ear when dizzy? 27. Fullness r pain in ears? 28. Drainage frm ears? 29. Headache r pressure in head with dizziness? During After Where? Migraine Headaches? If yes hw ften? 30. Duble visin, blurred visin, blindness? 31. Weakness r clumsiness in arms/legs? 32. Difficulty with speech r swallwing? 33. Neck r back pain? 34. Depressin r anxiety? Predispsing Factrs: 35. Head Injury cncussin, skull fracture, kncked uncnscius?
5 Whiplash r neck pain? 37. Eye disrder r eye surgery? 38. Ear infectins r ther ear disease? 39. Did yu begin taking prescriptin r nnprescriptin medicatin regularly befre yur dizziness started? If s what? 40. Drink Alchl: per day: years: Patient: Date:
Name: Date of Birth: Age:
VESTIBULAR HISTORY Name: Date of Birth: Age: Today's Date: Phone number Referring MD Next MD Appt: Briefly describe your problem: Describe: Date of onset: Time of day: What were you doing when it began?
More informationFor our protection, we require verification that you have received this notice. Therefore, please sign below.
PATIENT INFORMATION Dear Patient: Sleep prblems are extremely cmmn. Public health and safety are threatened by the increasing prevalence f bstructive sleep apnea, which nw afflicts at least 25 millin adults
More informationCayuga Center for Healthy Living Health and Lifestyle Questionnaire. Name: Date of Birth: Today s date: Clinic visit date:
Cayuga Center fr Healthy Living Health and Lifestyle Questinnaire Name: Date f Birth: Tday s date: Clinic visit date: Histry f weight lss/gain: Desired r gal weight: Lwest adult weight: Highest adult weight
More informationNew Patient Information Sheet PLEASE COMPLETE THIS ENTIRE FORM. Date of Appointment: / /
New Patient Infrmatin Sheet PLEASE COMPLETE THIS ENTIRE FORM The frm may seem lengthy but it is very imprtant t help us understand yur pain cmplaints. This will help us prvide yu with the highest level
More informationInstructions regarding referral of patients to the Persistent Pain Service
Prtsmuth Persistent Pain Service Lng Term Cnditins Suite Grund Flr, Blck A St Mary s Cmmunity Health Campus Miltn Rad Prtsmuth Hampshire PO3 6AD Tel: 23 9268 485 Fax: 23 9268 21 Dear GP Instructins regarding
More informationNEW PATIENT QUESTIONNAIRE-ADULT
3700 WASHINGTON AVENUE EVANSVILLE, IN 47750 (812) 485-7680 NEW PATIENT QUESTIONNAIRE-ADULT PART 1. PATIENT INFORMATION Name Hme Phne Date f Birth Scial Security Number Wrk Phne Tday s Date Physicians Caring
More informationFor our protection, we require verification that you have received this notice. Therefore, please sign below.
PATIENT INFORMATION Dear Patient: Sleep prblems are extremely cmmn. Public health and safety are threatened by the increasing prevalence f bstructive sleep apnea, which nw afflicts at least 25 millin adults
More information454-8 (Insert) MEDICATION GUIDE ZUBSOLV (Zub-solve) (buprenorphine and naloxone) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place
MEDICATION GUIDE ZUBSOLV (Zub-slve) (buprenrphine and nalxne) Sublingual Tablet (CIII) IMPORTANT: Keep ZUBSOLV in a secure place away frm children. Accidental use by a child is a medical emergency and
More informationHealth and Lifestyle Questionnaire
Health and Lifestyle Questinnaire Name Tday s date Date f birth Clinic visit date Please tell us the reasn fr yur visit Weight histry Desired r gal weight Height Lwest adult weight When? Highest adult
More informationInfluenza (Flu) Fact Sheet
Influenza (Flu) Fact Sheet What is the flu? The flu is a cntagius respiratry illness caused by influenza viruses. It can cause mild t severe illness, and at times can lead t death. Sme peple, such as lder
More information/0515 Medication Guide Aripiprazole Tablets
8415721/0515 Medicatin Guide Aripiprazle Tablets (air-eh-pip-rah-zle) Read this Medicatin Guide befre yu start taking aripiprazle tablets and each time yu get a refill. There may be new infrmatin. This
More informationMEDICATION GUIDE Pioglitazone (pie-oh-glit-ah-zohn) and Metformin (met-fore-min) Hydrochloride Tablets USP
MEDICATION GUIDE Piglitazne (pie-h-glit-ah-zhn) and Metfrmin (met-fore-min) Hydrchlride Tablets USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride tablets
More informationKnee Class Fremont Physical Therapy
Fremnt Knee Facts The knee lses strength and stability after an injury. Stretching, strengthening and stability exercises are recmmended nt nly fr peple wh have injured their knees, but als t prevent injury.
More informationHealth for Life Chiropractic At Cloverdale Mall Unit # The East Mall Etobicoke, ON, M9B 3Y
Health fr Life Chirpractic At Clverdale Mall Unit #143-250 The East Mall Etbicke, ON, M9B 3Y8 416-232-1822 416-232-0060 Child and Adlescent Health Questinnaire Name:_ Birth date: Address:_ Telephne: Medical
More informationANXIETY SYMPTOMS INTERVENTION SESSION HANDOUTS. Introduction to Fighting Fear by Facing Fear. Making a Fears and Worries List
SESSION ANXIETY SYMPTOMS INTERVENTION 5 SESSION HANDOUTS Handut 5.1: Handut 5.2: Handut 5.3: Handut 5.4: Handut 5.5: Handut 5.6: When Yu Face Yur Fears STOP! Intrductin t Fighting Fear by Facing Fear The
More informationManaging the Symptoms of Stroke
Unit 26: Recgnising and Managing the Symptms f Strke Unit reference number: F/616/7312 Level: 2 Unit type: Optinal Credit value: 3 Guided learning hurs: 28 Unit summary A strke can be a life-threatening
More informationMedication Guide MORPHINE SULFATE (mor-pheen) Oral Solution (CII)
Medicatin Guide MORPHINE SULFATE (mr-pheen) Oral Slutin (CII) IMPORTANT: Keep Mrphine Sulfate Oral Slutin in a safe place away frm children. Accidental use by a child is a medical emergency and can cause
More informationMEDICATION GUIDE Pioglitazone and Metformin Hydrochloride (PYE o GLI ta zone and met FOR min HYE-droe- KLOR-ide)Tablets, USP
MEDICATION GUIDE Piglitazne and Metfrmin Hydrchlride (PYE GLI ta zne and met FOR min HYE-dre- KLOR-ide)Tablets, USP Read this Medicatin Guide carefully befre yu start taking piglitazne and metfrmin hydrchlride
More informationYou may have a higher risk of bleeding if you take warfarin sodium tablets and:
MEDICATION GUIDE Warfarin (WAR-far-in) Sdium (SO-dee-um) Tablets USP The 7.5 mg tablets cntain FD&C Yellw N. 5 (tartrazine), which may cause allergic-type reactins (including brnchial asthma) in certain
More informationAdvantage EAP Employee Assistance Program
Advantage EAP Emplyee Assistance Prgram July 2014 In This Issue What might we face? Symptms f SAD Seasnal changes in biplar disrder Tips fr cmbating summer truble When t seek help Tips fr helping thse
More informationUniversity College Hospital. Pump school Starting on an insulin pump. Children and Young People s Diabetes Service
University Cllege Hspital Pump schl Starting n an insulin pump Children and Yung Peple s Diabetes Service 2 If yu wuld like this dcument in anther language r frmat, r require the services f an interpreter,
More informationFOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES
Appendix h STUDY NUMBER: COST OF UNSAFE ABORTION FOLLOW-UP IN-DEPTH INTERVIEW GUIDELINES T be administered abut 2-3 weeks after leaving the health facility 1. IDENTIFICATION 101. Patient identificatin
More informationScottsdale Family Health
Scttsdale Family Health New Patient Frm Patient Name: Date f Birth: Tday s Date PHARMACY: (Please list name and number f pharmacy yu wish t have prescriptins sent t.) Pharmacy Pharmacy Number MEDICAL HISTORY
More informationSay Goodbye to Test Anxiety. Kortschak Center for Learning and Creativity University of Southern California Presented by: Eliza Peña
Say Gdbye t Test Anxiety Krtschak Center fr Learning and Creativity University f Suthern Califrnia Presented by: Eliza Peña 1 Learning Objective By the end f this wrkshp, students will be able t: Recgnize
More informationList the health concerns that brought you into this office
New Practice Member Applicatin Name Date f Birth / / Age Male/Female Address City State Zip Cell Phne Hme Phne Cellular Prvider Email Address Occupatin Emplyer s Name Single / Married / Divrced / Widwed
More informationBrief Addiction Monitor (BAM) With Scoring & Clinical Guidelines
Brief Addictin Mnitr (BAM) With Scring & Clinical Guidelines Participant ID: Interviewer ID (Clinician Initials): Date: Methd f Administratin: Clinician Interview Self Reprt Phne Time Started: : Instructins
More informationDo you have any of the symptoms listed below? Please circle all that apply.
D yu have any f the symptms listed belw? Please circle all that apply. Parkinsn s Symptms: Truble walking Falls Feet sticking t the flr Tremr Medicatins wearing ff Truble sleeping Vivid dreams Thrashing
More information3/3/2014. Parenting challenges related to diabetes management and preferences for accessing parenting support. What does management involve?
// Parenting challenges related t diabetes management and preferences fr accessing parenting supprt Diabetes is a chrnic illness in which there are high levels f sugar/ glucse in the bld. Why des this
More informationo Check here if you want a free 2 week pass to
THIS SURVEY SHOULD BE COMPLETELY FILLED OUT BY THE FOLLOWING PERSON, WHO MUST BE AT LEAST 8 YEARS OLD: The lady f the huse. If the lady f The man f the huse. If the man f D the huse is nt available, then
More informationo New or sudden changes in mood, behavior, actions, thoughts, or feelings, especially if severe.
MEDICATION GUIDE FLUOXETINE CAPSULES, USP (fl xʹ e teen) 10 mg and 20 mg Read the Medicatin Guide that cmes with fluxetine capsules befre yu start taking it and each time yu get a refill. There may be
More informationPersonal Information Date:
Persnal Infrmatin Date: Name Address City Zip Scial Security # Cell Phne ( ) - Wrk/Hme Phne( ) - E-mail Address What is the best way t cntact yu? Phne E-mail r Text (cell phne carrier) Wh May We Thank
More informationModule 6: Goal Setting
Mdule 6: Gal Setting Objectives T understand the cncept f gal setting in Brief CBT T acquire skills t set feasible and apprpriate gals in Brief CBT What is gal setting, and why is it imprtant t set gals
More informationVaccine Information Statement: LIVE INTRANASAL INFLUENZA VACCINE
Vaccine Infrmatin Statement: LIVE INTRANASAL INFLUENZA VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationMEDICATION GUIDE SUBOXONE (Sub OX own) (buprenorphine and naloxone) Sublingual Film for Sublingual or Buccal Administration (CIII)
MEDICATION GUIDE SUBOXONE (Sub OX wn) (buprenrphine and nalxne) Sublingual Film fr Sublingual r Buccal Administratin (CIII) IMPORTANT: Keep SUBOXONE sublingual film in a secure place away frm children.
More informationThese are medical emergencies that can cause death. If possible, remove OTFC from the mouth.
MEDICATION GUIDE Oral Transmucsal Fentanyl Citrate (OTFC) CII (fentanyl citrate) ral transmucsal lzenge 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1200 mcg, 1600 mcg IMPORTANT: D nt use Oral Transmucsal Fentanyl
More informationWhat is Asthma? A collaborative effort of Children s Hospital of Pittsburgh of UPMC and The Pennsylvania Child Welfare Resource Center
A cllabrative effrt f Children s Hspital f Pittsburgh f UPMC and The Pennsylvania Child Welfare Resurce Center What is Asthma? Jennifer E. Wlfrd, DO, MPH, FAAP Children s Hspital f Pittsburgh, Divisin
More informationPercutaneous Nephrolithotomy (PCNL)
Percutaneus Nephrlithtmy (PCNL) What is a percutaneus nephrlithtmy? is the mst effective f the cmmnly perfrmed prcedures fr kidney stnes. It is the best prcedure fr large and cmplex stnes. T perfrm this
More informationBROCKTON AREA MULTI-SERVICES, INC. MEDICAL PROCEDURE GUIDE. Date(s) Reviewed/Revised:
Page 1 f 6 Subject: Range f Mtin Exercises Date Develped: 4/2010 PROTOCOL FOR: All trained staff PURPOSE: Range f Mtin (ROM) exercises are very imprtant if an individual has t stay in bed r in a wheelchair.
More informationGetting Around Safely With Your Crutches (Partial Weight Bearing)
OrthBethesda Therapy Services Getting Arund Safely With Yur Crutches (Partial Weight Bearing) Yur physician will decide whether yu are t be nn weight bearing, te-tuch weight bearing, partial weight bearing,
More informationGetting Around Safely With Your Crutches (Toe-Touch Weight Bearing)
OrthBethesda Therapy Services Getting Arund Safely With Yur Crutches (Te-Tuch Weight Bearing) Yur physician will decide whether yu are t be nn weight bearing, te-tuch weight bearing, partial weight bearing,
More informationPain relief after surgery
Pain relief after surgery Imprtant infrmatin fr patients www.mchft.nhs.uk We care because yu matter This leaflet is designed t help yu cntrl any pain yu may have at hme fllwing yur peratin. Please read
More informationPediatric Health History Form
Pediatric Health Histry Frm Child s Name Date f Birth Mther s Name Father s Name Parent Cncerns - Please explain any ther cncerns r questins yu have abut yur child Des yur child have any allergies? Yes
More informationPILI Ohana Facilitator s Guide
Previus Versin: September 10, 2007 Updated Versin: Octber 2, 2007 PILI Ohana Facilitatr s Guide Lessn 5: Managing and Reducing Negative Thughts and Emtins. Questin/Tpic Script Reminder/Activity Welcming
More informationPART III: CONSUMER INFORMATION
IMPORTANT: PLEASE READ PART III: CONSUMER INFORMATION Pr ZERIT Stavudine This leaflet is Part III f a three-part Prduct Mngaph published when ZERIT was apprved fr sale in Canada and is designed specifically
More informationGetting Around Safely With Your Crutches (Non Weight Bearing)
OrthBethesda Therapy Services Getting Arund Safely With Yur Crutches (Nn Weight Bearing) Yur physician will decide whether yu are t be nn weight bearing, te-tuch weight bearing, partial weight bearing,
More informationGlaucoma Interviews: Due Tuesday, May 22 nd
Glaucma Interviews: Due Tuesday, May 22 nd 1) Read the glaucma article well! It will explain what it is, plus tell yu sme symptms and risk factrs. Yu may want t use a highlighter r pen t mark imprtant
More informationINSTRUCTIONS FOR USE ZINBRYTA (zin-bry-tuh) (daclizumab) Injection, for Subcutaneous Use Single-Dose Prefilled Syringe 150 mg
INSTRUCTIONS FOR USE ZINBRYTA (zin-bry-tuh) (daclizumab) Injectin, fr Subcutaneus Use Single-Dse Prefilled Syringe 150 mg Read this Instructins fr Use befre yu start using ZINBRYTA and each time yu get
More information8 -Driving. 9 -Sleeping
NECK PAIN DISABILITY INDEX QUESTIONNAIRE PLEASE READ: This questinnaire is designed t enable us t understand hw much yur neck pain has affected yur ability t manage yur everyday activities. Please answer
More informationUnderstanding and Recognizing Anxiety
Understanding and Recgnizing Anxiety Mst peple d nt recgnize their anxiety fr what it is, and instead think there is smething mre serius ging n. Myth: Reading, thinking, and learning abut anxiety will
More informationThe Magazine About Your Health and Caring for Your Body Issue 6 PERSONAL MESSAGE The facts about. by Steve Ryan, PT, MPT and Debbie Ryan, PT, MPT.
The Magazine Abut Yur Health and Caring fr Yur Bdy Issue 6 PERSONAL MESSAGE The facts abut FALLS & FALL PREVENTION IN THIS ISSUE 2 POSITION YOURSELF TO STAY WELL 3 TIPS & TRICKS Exercises fr imprved balance
More informationMEDICATION GUIDE. (canagliflozin) Tablets
MEDICATION GUIDE INVOKANA (in-v-kahn-uh) (canagliflzin) Tablets What is the mst imprtant infrmatin I shuld knw abut INVOKANA? INVOKANA can cause imprtant side effects, including: Dehydratin. INVOKANA can
More informationBedfordshire and Hertfordshire DRAFT Priorities forum statement Number: Subject: Prostatism Date of decision: January 2010 Date of review:
Bedfrdshire and Hertfrdshire DRAFT Pririties frum statement Number: Subject: Prstatism Date f decisin: January 2010 Date f review: Referral criteria Mst men with lwer urinary tract symptms due t benign
More informationDEMENTIA. DESCRIPTION: a progressive, degenerative disease of the brain, which causes impairment of thinking and memory
DEMENTIA Dementia a syndrme cnsisting f a number f symptms including lss f memry, judgment and reasning, and changes in md and behavir the changes may affect a persn's ability t functin at wrk, in scial
More informationPATIENT INFORMATION. effective for the treatment of the flu in people with long-time (chronic) heart problems or breathing problems.
PATIENT INFORMATION capsules, fr ral use fr ral suspensin What is TAMIFLU? TAMIFLU is a prescriptin medicine used t: treat the flu (influenza) in peple 2 weeks f age and lder wh have had flu symptms fr
More information2019 Canada Winter Games Team NT Female Hockey Selection Camp August 16-19, 2018
2019 Canada Winter Games Team NT Female Hckey Selectin Camp August 16-19, 2018 Strength and Cnditining Recmmendatins As discussed in the Call Fr Players letter, it is critical fr players t get their bdies
More informationMedication Guide SIGNIFOR [sig-na-for] (pasireotide) Injection
Medicatin Guide SIGNIFOR [sig-na-fr] (pasiretide) Injectin Read this Medicatin Guide befre yu start using SIGNIFOR and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take
More informationSuicidal thoughts or actions:
MEDICATION GUIDE Venlafaxine (VEN la fax een) Hydrchlride Extended-release Capsules USP Read the Medicatin Guide that cmes with venlafaxine hydrchlride extended-release capsulesbefre yu start taking them
More informationMEDICATION GUIDE. (fingolimod) capsules
MEDICATION GUIDE GILENYA (je-len-yah) (finglimd) capsules Read this Medicatin Guide befre yu start using GILENYA and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take the
More informationPatrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction Surgery Instructions Hip
Patrick J McGahan, MD Orthpaedic Surgen Specializing in Sprts Medicine/Shulder Recnstructin 2801 K St, Ste 330, Sacrament, CA, 95816 (p) 916-733-5049 (f) 916-733-8914 www.patrickmcgahanmd.cm Befre Surgery
More informationNEW PATIENT FORMS FOR ADULT. Patient Last Name First Name Middle Name. DOB Age Race SSN. Sex Single Married Widowed Divorced
The Allergy and Asthma Center f Crpus Christi 1718 Braeswd Dr, Crpus Christi TX 78412 text: 361-992-8500 Fax: 361-992-6711 www.allergycrpustx.cm NEW PATIENT FORMS FOR ADULT Patient Last Name First Name
More informationNew Patient Registration and Medical History. Address City State Zip code
Wexfrd Allergy, Asthma & Immunlgy, LLC Phne (724)719 2441 / Fax (724)719 2451 100 Bradfrd Rad, Suite 410, Wexfrd, PA 15090 www.wexfrdallergy.cm New Patient Registratin and Medical Histry Name Tday s date
More informationUpdate on Concussions in Soccer
Update n Cncussins in Sccer Ricard E. Clberg, M.D., RMSK Andrews Sprts Medicine & Orthpedic Center American Sprts Medicine Institute Hw many here have had a cncussin? Definitins Signs & symptms Management
More informationSelf-Awareness Exercise:
Self-Awareness Exercise: Spend 5 minutes t write dwn answers t the fllwing questins: 1. What were the rules and ways f cmmunicating within my family? Hw has this affected the way I see the wrld? 2. What
More informationVaccine Information Statement: PNEUMOCOCCAL CONJUGATE VACCINE
Vaccine Infrmatin Statement: PNEUMOCOCCAL CONJUGATE VACCINE Many Vaccine Infrmatin Statements are available in Spanish and ther languages. See www.immunize.rg/vis. Hjas de Infrmacián Sbre Vacunas están
More informationInstructions for Use INTRON A (In-tron-aye) (Interferon alfa-2b, recombinant) Powder for Solution
Instructins fr Use INTRON A (In-trn-aye) (Interfern alfa-2b, recmbinant) Pwder fr Slutin Be sure that yu read, understand, and fllw these instructins befre injecting INTRON A. Yur healthcare prvider shuld
More informationINCISIONAL HERNIA INFORMATION SHEET DR. JULIE MILLER BA, MD, FRACS. Specialist Endocrine and General Surgeon
INCISIONAL HERNIA INFORMATION SHEET DR. JULIE MILLER BA, MD, FRACS Specialist Endcrine and General Surgen Suite 12, Level 2, The Wmen s Hspital (03) 9347 6301 Yu have an incisinal hernia. Because f yur
More informationMEDICATION GUIDE. Reference ID:
MEDICATION GUIDE GLYXAMBI (glik-sam-bee) (empagliflzin and linagliptin) Tablets Read this Medicatin Guide carefully befre yu start taking GLYXAMBI and each time yu get a refill. There may be new infrmatin.
More informationSESSION HANDOUTS ANXIETY SYMPTOMS INTERVENTION. Assertiveness Checklist and Stepladders Fighting Fear by Facing Fear Form SESSION
SESSION ANXIETY SYMPTOMS INTERVENTION SESSION HANDOUTS 9 Handut 9.1: Handut 9.2: Handut 9.3: Handut 9.4: Why Be a Cnfident Persn? Becming Assertive Assertiveness Checklist and Stepladders Fighting Fear
More informationPlease read carefully & check any of the symptoms that you have noticed since the accident or injury.
127 W. Juanita Ave., Suite #110 Mesa, Arizna 85210 Patient s Accident Accunt Office (480) 668-1199 Fax (480) 668-7300 Patient Name Emplyer Patient Address Emplyer Address Patient Phne N. Emplyer Phne N.
More informationFLORIDA ORTHOPAEDIC INSTITUTE SPINE FIRST VISIT QUESTIONNAIRE
FLORIA ORTHOPAEIC INSTITUTE SPINE FIRST VISIT QUESTIONNAIRE Please circle answers t questins that pertain t yur prblem. Yu may select mre than ne answer per questin. This infrmatin will help get an accurate
More informationFrequently Asked Questions: IS RT-Q-PCR Testing
Questins 1. What is chrnic myelid leukemia (CML)? 2. Hw des smene knw if they have CML? 3. Hw is smene diagnsed with CML? Frequently Asked Questins: IS RT-Q-PCR Testing Answers CML is a cancer f the bld
More informationPatient Name: Address City State Zip Code. H. Phone W. Phone Cell Phone
Name yu prefer t g by: Address City State Zip Cde H. Phne W. Phne Cell Phne Email Address: Sex: M F Date f Birth Age Marital Status: M S D W Spuse s Name if Married: Scial Security # Referred by: Persn
More informationNeighborhood Chiropractic and Acupuncture LLC Registration and History
PATIENT INFORMATION Neighbrhd Chirpractic and Acupuncture LLC Registratin and Histry Last Name: Date: First Name Middle Initial: Address: City: State: Zip: Cell Phne Number: Hme Phne Number: Email: May
More informationCONSENT FOR KYBELLA INJECTABLE FAT REDUCTION
CONSENT FOR KYBELLA INJECTABLE FAT REDUCTION INSTRUCTIONS This is an infrmed cnsent dcument which has been prepared t help yur Dctr infrm yu cncerning fat reductin with an injectable medicatin, its risks,
More informationNew Patient Registration and Medical History. Address City State Zip code
Wexfrd Allergy, Asthma & Immunlgy, LLC Phne (724)719-2441 / Fax (724)719-2451 100 Bradfrd Rad, Suite 410, Wexfrd, PA 15090 www.wexfrdallergy.cm New Patient Registratin and Medical Histry Name Tday s date
More informationHead and neck cancers are often treated with radiotherapy. Radiotherapy can lead to faster rates of tooth decay and poor healing in the mouth.
DENTAL EXTRACTION This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins that
More informationMedication Guide ABSTRAL (AB-stral) CII (fentanyl) Sublingual tablets
Medicatin Guide ABSTRAL (AB-stral) CII (fentanyl) Sublingual tablets IMPORTANT: D nt use ABSTRAL unless yu are regularly using anther piid pain medicine arund-the-clck fr at least ne week r lnger fr yur
More informationEDPS 475: Instructional Objectives for Midterm Exam Behaviorism
EDPS 475: Instructinal Objectives fr Midterm Exam Behavirism 1. Given a nvel example t chse frm, identify the characteristics f classical cnditining. General mdel: Stimulus (S) elicits >Respnse (R) Based
More informationMEDICATION GUIDE. (Interferon alfa-2b)
MEDICATION GUIDE INTRON A (In-trn-aye) (Interfern alfa-2b) Read this Medicatin Guide befre yu start taking INTRON A, and each time yu get a refill. There may be new infrmatin. This infrmatin des nt take
More informationUnderstanding Your Total-Cholesterol-to-HDL Ratio
Understanding Yur Ttal-Chlesterl-t-HDL Rati Yur ttal-chlesterl-t-hdl rati is measured during a bld test called a lipid prfile. This wrksheet will help yu learn mre abut this rati. It will als help yu:
More informationI am having a Rotator Cuff Repair
I am having a Rtatr Cuff Repair A rtatr cuff repair is surgery t repair a trn tendn in the shulder. The rtatr cuff is a grup f muscles and tendns that frm a cuff ver the shulder jint. The muscles and tendns
More informationSLEEP-WAKE QUESTIONNAIRE
Shasta Critical Care Specialists Sleep Center: (530) 232-3017, 2701 Old Eureka Way, Suite 1J, Redding, CA 96001 Office: (530) 232-3000, 2701 Old Eureka Way, Suite 1E, Redding, CA 96001 Fax: (530) 242-8545
More informationTopic PHOBIAS. (Student name) (Department name) (Professor name) (Date)
Tpic PHOBIAS (Student name) (Department name) (Prfessr name) (Date) Phbias: hw peple develp phbias and why? What is a Phbia? Phbia may be defined as an irresistibly unreasnable feeling f fear anything
More informationWelcome! You will also learn about Deaf culture and Deaf history. What will we study?
American Sign Language IA ASL IA Where d I find Welcme! Everyday cmmunicatin is the centerpiece f every lessn Tpics evlve arund sharing infrmatin abut ur envirnment and urselves Grammar is intrduced in
More informationPostoperative Anterior Cruciate Ligament Reconstruction Care WITH meniscus repair:
Pstperative Anterir Cruciate Ligament Recnstructin Care WITH meniscus repair: Imprtant Phne Numbers: - Please see the cntact infrmatin abve fr imprtant phne numbers t call. - If yu have cncerns after hurs,
More informationInstructions for BPPV Testing
Instructions for BPPV Testing You are scheduled for a balance workup on With: Paige Pierozynski, AuD Bernice A. McKenzie, AuD Please report to: The Hearing & Dizziness Clinic 35 Victoria Ave, Essex ON
More informationDr. Tozzi s and Dr. Roehrig s Patient Guide to Total Hip Replacement
Dr. Tzzi s and Dr. Rehrig s Patient Guide t Ttal Hip Replacement This guide is meant t help yu better understand yur upcming hip surgery. It is generalized infrmatin, and individual patients have unique,
More informationContinuous Nerve Blocks at Home
What is a peripheral nerve blck? Making a difference in the lives f children, yuth and families Cntinuus Nerve Blcks at Hme This nerve blck is a way t treat and prevent pain after surgery. Yur child s
More informationFrench III/IV Syllabus Thomas County Central High School Ashley Olson-Room E
French III/IV Syllabus Thmas Cunty Central High Schl Ashley Olsn-Rm E9 2013-2014 Schl Phne #: 225-5050 Email: alsn@thmas.k12.ga.us aklsn85@gmail.cm Text: Bn Vyage! Level 3 Glence *By receiving this syllabus
More informationTendon problems can happen in people of all ages who take levofloxacin. Tendons are tough cords of tissue that connect muscles to bones.
Medicatin Guide LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION, 25 mg/ml and LEVOFLOXACIN (LEE ve FLOX a sin) INJECTION in 5% Dextrse fr Intravenus Use Read this Medicatin Guide befre yu start taking levflxacin
More informationPHARYNGO-OESOPHAGECTOMY
PHARYNGO-OESOPHAGECTOMY This infrmatin aims t help yu understand the peratin, what is invlved and sme cmmn cmplicatins that may ccur. It may help answer sme f yur questins and help yu think f ther questins
More informationPATIENT INFORMATION. Rosuvastatin calcium tablets are used along with diet to:
PATIENT INFORMATION Rsuvastatin Calcium (re-soo-va-stat-in KAL-see-um) Tablets Read this Patient Infrmatin carefully befre yu start taking rsuvastatin calcium tablets and each time yu get a refill. If
More informationPsychological aspects of breast cancer. Dr Caroline Dancyger & Dr Esther Hansen
Psychlgical aspects f breast cancer Dr Carline Dancyger & Dr Esther Hansen Cmmn acrss all cancers Adjustment as the nrm Diagnsis End f active treatment r Discharge Palliative Care Recurrence distress t
More informationInitial Postoperative Knee Care Patella or Quadriceps Tendon Repairs: - Videos are available on Dr. Witty s website: drjeffreywitty.
Initial Pstperative Knee Care Patella r Quadriceps Tendn Repairs: - Vides are available n Dr. Witty s website: drjeffreywitty.cm Imprtant Phne Numbers: - Please see the cntact infrmatin abve fr imprtant
More informationPatrick J McGahan, MD Orthopaedic Surgeon Specializing in Sports Medicine/Shoulder Reconstruction
Patrick J McGahan, MD Orthpaedic Surgen Specializing in Sprts Medicine/Shulder Recnstructin 2801 K St, Ste 330, Sacrament, CA, 95816 (p) 916-733-5049 (f) 916-733-8914 www.patrickmcgahanmd.cm Befre Surgery
More informationAnterior Total Hip Arthroplasty Patient Guide & Common Questions
Intrductin: Anterir Ttal Hip Arthrplasty Patient Guide & Cmmn Questins This handut is a general guide t cmmn indicatins fr anterir ttal hip arthrplasty, what t expect when underging the prcedure, risks,
More informationSwindon Joint Strategic Needs Assessment Bulletin
Swindn Jint Strategic Needs Assessment Bulletin Swindn Diabetes 2017 Key Pints: This JSNA gives health facts abut peple with diabetes r peple wh might get diabetes in Swindn. This helps us t plan fr medical
More informationADULT CHILDREN OF ALCOHOLICS Characteristics. Adult Children of Alcoholics
ADULT CHILDREN OF ALCOHOLICS Characteristics Adult Children f Alchlics 1. guess at what nrmal is 2. have difficulty in fllwing a prject thrugh frm beginning t end 3. lie when it wuld be just as easy t
More information