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{\fhimajor\f31528\fbidi \froman\fcharset238\fprq2 Cambria CE;}{\fhimajor\f31529\fbidi \froman\fcharset204\fprq2 Cambria Cyr;}{\fhimajor\f31531\fbidi \froman\fcharset161\fprq2 Cambria Greek;}{\fhimajor\f31532\fbidi \froman\fcharset162\fprq2 Cambria Tur;}
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{\flominor\f31551\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flominor\f31552\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flominor\f31553\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\flominor\f31554\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flominor\f31555\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flominor\f31556\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fdbminor\f31558\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
{\fdbminor\f31562\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbminor\f31563\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbminor\f31564\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\fdbminor\f31565\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbminor\f31566\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhiminor\f31568\fbidi \fswiss\fcharset238\fprq2 Calibri CE;}
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\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0\hres0\chhres0 \fi-360\li2520\lin2520 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid201916419\'01o;}{\levelnumbers
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\par }\pard \ltrpar\ql \li0\ri0\sa120\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid15407465\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid8945194 This document is }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11934666\charrsid8945194 not}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid8945194 
 a referral letter. A referral letter must be sent to any additional providers involved in this }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 M}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid8945194 ental }{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 H}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid8945194 ealth }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 T}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid8945194 reatment }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 P}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid8945194 lan.}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid15407465    }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15407465\charrsid11934666 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid15407465\charrsid15407465 Major headings are }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid15407465\charrsid15407465 bold; }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\i\f1\fs20\insrsid15407465\charrsid15407465 prompts to consider lower case. Response fields }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid15407465 can be e}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid15407465\charrsid15407465 
xpand}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid15407465 ed}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid15407465\charrsid15407465  as required}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid15407465 . }{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\ul\insrsid15407465\charrsid15407465 Underlined}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid15407465\charrsid15407465  items of either type are mandatory for compliance with Medicare requirements.}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid15407465\charrsid15407465 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid10361851 \trowd \irow1\irowband0\ltrrow\ts15\trgaph128\trrh344\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16533150\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth9864\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow2\irowband1\ltrrow\ts15\trgaph128\trrh344\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh
\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth9864\clcbpatraw22 \cellx9952\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3765377 Contact and demographic details}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468 \trowd \irow2\irowband1\ltrrow\ts15\trgaph128\trrh344\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 
\trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth9864\clcbpatraw22 \cellx9952\row \ltrrow}\trowd \irow3\irowband2\ltrrow\ts15\trgaph128\trrh462\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 GP name}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536\charrsid11471536 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid11471536\charrsid5244859 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 GP phone}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536\charrsid11011689 \cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3034541\charrsid11011689 \trowd \irow3\irowband2\ltrrow\ts15\trgaph128\trrh462\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536\charrsid5244859 GP }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 p}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid11471536\charrsid5244859 ractice }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 n}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536\charrsid5244859 ame}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid11471536 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536\charrsid5244859 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 GP fax\cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid3034541\charrsid11011689 \trowd \irow4\irowband3\ltrrow\ts15\trgaph128\trrh462\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow5\irowband4\ltrrow\ts15\trgaph128\trrh639\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 GP address\cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536\charrsid2236790 \cell }{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid11471536 Provider number}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536\charrsid2236790 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536\charrsid2236790 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3034541\charrsid2236790 \trowd \irow5\irowband4\ltrrow\ts15\trgaph128\trrh639\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow6\irowband5\ltrrow\ts15\trgaph128\trrh529\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5956\clshdrawnil \cellx7542\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10516324\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid10516324 Relationship\cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid4916476 This pe}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324 rson has been my patient since}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid10516324 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid4916476 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid2690411\charrsid4916476 \trowd \irow6\irowband5\ltrrow\ts15\trgaph128\trrh529\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5956\clshdrawnil \cellx7542\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow7\irowband6\ltrrow\ts15\trgaph128\trrh255\trleft8\trkeep\trbrdrt
\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth8346\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10516324\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3034541\charrsid10516324 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid3034541\charrsid10516324 and/or}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\i\f1\fs20\insrsid3034541\charrsid10516324 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3034541\charrsid4916476 \trowd \irow7\irowband6\ltrrow\ts15\trgaph128\trrh255\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth8346\clshdrawnil \cellx9952\row \ltrrow
}\trowd \irow8\irowband7\ltrrow\ts15\trgaph128\trrh472\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5956\clshdrawnil \cellx7542\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10516324\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid10516324\charrsid7933488 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid4916476 
This person has been a patient at this practice since}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid10516324\charrsid7933488 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid4916476 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid2690411\charrsid4916476 \trowd \irow8\irowband7\ltrrow\ts15\trgaph128\trrh472\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5956\clshdrawnil \cellx7542\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow9\irowband8\ltrrow\ts15\trgaph128\trrh639\trleft8\trkeep\trbrdrt
\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 Patient s}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 urname}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid7933488 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid7933488 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 Date of }{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid13388468  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 b}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 irth}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 
 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536 (dd/mm/yy)}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid7933488 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid7933488 \trowd \irow9\irowband8\ltrrow\ts15\trgaph128\trrh639\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Patient}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid11471536 f}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 irst }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 n}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 ame}
{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2838663 /s}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid7933488 \cell }{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Preferred }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 n}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 ame}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid13458047 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid7933488 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid7933488 
\trowd \irow10\irowband9\ltrrow\ts15\trgaph128\trrh639\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4390\clshdrawnil \cellx5976\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1526\clshdrawnil \cellx7542\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 
\clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2350\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow11\irowband10\ltrrow\ts15\trgaph128\trrh638\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 
\trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8346\clshdrawnil \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid4796966\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid4796966 Gender\cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4796966  FORMCHECKBOX }{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4796966  Female   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid4796966\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26
}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4796966\charrsid6427833  Male}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid4796966    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4796966\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4796966\charrsid6427833  Self-identified gender:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid4796966\charrsid2236790 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid2236790 \trowd \irow11\irowband10\ltrrow\ts15\trgaph128\trrh638\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8346\clshdrawnil \cellx9952\row \ltrrow
}\trowd \irow12\irowband11\ltrrow\ts15\trgaph128\trrh638\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8346\clshdrawnil \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471536\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536 Patient a}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11471536\charrsid7933488 ddress\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536\charrsid2236790 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid2690411\charrsid2236790 \trowd \irow12\irowband11\ltrrow\ts15\trgaph128\trrh638\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8346\clshdrawnil \cellx9952\row \ltrrow
}\trowd \irow13\irowband12\ltrrow\ts15\trgaph128\trrh638\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3706\clshdrawnil \cellx5292\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth4600\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid16059852 Patient phone\cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852 Preferred }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536 n}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852 umber:
\par 
\par 
\par Can leave message?   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852  Yes    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid16059852  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852  No\cell }{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852 Alternative }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11471536 n}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852 umber:
\par 
\par 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852 Can leave message?}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852   }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid16059852  Yes    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid16059852  No\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid16059852 
\trowd \irow13\irowband12\ltrrow\ts15\trgaph128\trrh638\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3706\clshdrawnil \cellx5292\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth4600\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow14\irowband13\ltrrow\ts15\trgaph128\trrh605\trleft8\trkeep
\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3706\clshdrawnil \cellx5292\clvertalc
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1833\clshdrawnil \cellx7165\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2727\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Medicare No.}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2058257\yts15 {\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7803740 Healthcare Card/}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2058257 Pension }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 No.}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow14\irowband13\ltrrow\ts15\trgaph128\trrh605\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1478\clshdrawnil \cellx1546\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3706\clshdrawnil \cellx5292\clvertalc
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1833\clshdrawnil \cellx7165\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2727\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow15\irowband14\ltrrow\ts15\trgaph128\trrh329\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3667\clshdrawnil \cellx3735\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6157\clshdrawnil \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12715093\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12715093 Highest level of education completed\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12715093\yts15 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12715093 
 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12715093  Primary school
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12715093  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid12715093  Secondary school
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12715093  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid12715093  TAFE
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12715093  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid12715093  Tertiary degree
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11216505\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12715093 Comments:

\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11216505\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid11216505 \trowd \irow15\irowband14\ltrrow\ts15\trgaph128\trrh329\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3667\clshdrawnil \cellx3735\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6157\clshdrawnil \cellx9952\row \ltrrow
}\trowd \irow16\irowband15\ltrrow\ts15\trgaph128\trrh329\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2690411\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth6482\clshdrawnil \cellx6550\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3342\clshdrawnil \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11216505\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\highlight7\insrsid11216505\charrsid11216505 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11216505\charrsid4354138 Is this person a parent of a child }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15676657 aged <18 years? }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid11216505\charrsid4354138  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11216505\charrsid4354138  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11216505\charrsid4354138  Yes   }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11216505\charrsid4354138  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11216505\charrsid4354138  No
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\highlight7\insrsid11216505\charrsid11216505 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2058257\yts15 
{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\highlight7\insrsid11216505\charrsid11216505 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11216505\charrsid6427833 \trowd \irow16\irowband15\ltrrow\ts15\trgaph128\trrh329\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2690411\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth6482\clshdrawnil \cellx6550\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3342\clshdrawnil \cellx9952\row \ltrrow
}\trowd \irow17\irowband16\ltrrow\ts15\trgaph128\trrh329\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth6482\clcbpatraw22 \cellx6550\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3342\clshdrawnil \cellx9952
\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16740066\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2058257 Carer/support person contact}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833  }{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 d}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 etails\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl
\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2058257\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 
Has patient consented for }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 this}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2058257 
healthcare team to contact carer/support persons}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 ?\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 
\trowd \irow17\irowband16\ltrrow\ts15\trgaph128\trrh329\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth6482\clcbpatraw22 \cellx6550\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3342\clshdrawnil \cellx9952
\row \ltrrow}\trowd \irow18\irowband17\ltrrow\ts15\trgaph128\trrh789\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368\clshdrawnil \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802\clshdrawnil \cellx4278\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232\clshdrawnil \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1942\clshdrawnil \cellx8532\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1360\clshdrawnil \cellx9952\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2058257\yts15 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 First }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid2058257 contact}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid13388468 :}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid9701055 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 Relationship:}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid7933488 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl
\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833 Phone number 1:
\par 
\par Phone number 2:
\par 
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  Yes
\par 
\par With the following restrictions:
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  No\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 
\trowd \irow18\irowband17\ltrrow\ts15\trgaph128\trrh789\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368\clshdrawnil \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802\clshdrawnil \cellx4278\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232\clshdrawnil \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1942\clshdrawnil \cellx8532\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1360\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow19\irowband18\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368 \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802 \cellx4278\clvertalt\clbrdrt\brdrinset\brdrw15 
\clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232 \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1942 \cellx8532\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1360 \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2058257\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 Second }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid2058257 contact}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 :
\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 
Relationship:\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833 Phone number 1:
\par 
\par Phone number 2:
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  Yes
\par 
\par With the following restrictions:
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  No\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 
\trowd \irow19\irowband18\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368 \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802 \cellx4278\clvertalt\clbrdrt\brdrinset\brdrw15 
\clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232 \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1942 \cellx8532\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1360 \cellx9952\row 
\ltrrow}\trowd \irow20\irowband19\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth6482\clcbpatraw22 \cellx6550\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3342 \cellx9952
\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16740066\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 Emergency contact person details\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl
\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7803740\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2690411\charrsid6427833 
Has patient consented for }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2690411 this}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2690411\charrsid6427833  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2690411 
healthcare }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 team to contact emergency }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 contacts}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid6427833 ?}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 
\trowd \irow20\irowband19\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth6482\clcbpatraw22 \cellx6550\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3342 \cellx9952\row \ltrrow
}\trowd \irow21\irowband20\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368 \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802 \cellx4278\clvertalt\clbrdrt\brdrinset\brdrw15 
\clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232 \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2086 \cellx8676\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1216 \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 First contact:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid9701055 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833 Relationship:\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 
{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833 Phone number 1:
\par 
\par Phone number 2:
\par \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  Yes\cell }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833  No\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow21\irowband20\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368 \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802 \cellx4278\clvertalt\clbrdrt\brdrinset\brdrw15 
\clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232 \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2086 \cellx8676\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1216 \cellx9952\row 
\ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 Second contact:\cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833 Relationship:\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833 Phone number 1:
\par 
\par Phone number 2:
\par \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  Yes\cell }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833  No\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow22\irowband21\ltrrow\ts15\trgaph128\trrh547\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2368 \cellx2436\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1802 \cellx4278\clvertalt\clbrdrt\brdrinset\brdrw15 
\clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2232 \cellx6550\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2086 \cellx8676\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1216 \cellx9952\row 
\ltrrow}\trowd \irow23\irowband22\ltrrow\ts15\trgaph128\trrh402\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth9864\clcbpatraw22 \cellx9952\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16198341 Salient communication and cultural factors}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid6427833 \trowd \irow23\irowband22\ltrrow\ts15\trgaph128\trrh402\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16198341\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth9864\clcbpatraw22 \cellx9952\row \ltrrow}\trowd \irow24\irowband23\ltrrow\ts15\trgaph128\trrh402\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1378\clshdrawnil \cellx4424\clvertalc
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5468\clshdrawnil \cellx9952\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Language spoken at home\cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  FORMCHECKBOX }
{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  English}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid656542 \cell }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833  Other:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 
\trowd \irow24\irowband23\ltrrow\ts15\trgaph128\trrh402\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1378\clshdrawnil \cellx4424\clvertalc
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5468\clshdrawnil \cellx9952\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Interpreter required}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\delrsid4260315 \cell }{\field\fldpriv{\*\fldinst 
{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468  No\cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  Yes}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 
, Comments:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow25\irowband24\ltrrow\ts15\trgaph128\trrh402\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1378\clshdrawnil \cellx4424\clvertalc
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5468\clshdrawnil \cellx9952\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Country of birth\cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  FORMCHECKBOX }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  Australia\cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid6427833  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid6427833  Other:\cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow26\irowband25\ltrrow\ts15\trgaph128\trrh402\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1378\clshdrawnil \cellx4424\clvertalc
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5468\clshdrawnil \cellx9952\row \ltrrow}\trowd \irow27\irowband26\ltrrow
\ts15\trgaph128\trrh425\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6886\clshdrawnil \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16385792\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324 Other communication }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16385792 factors}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid10516324 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10516324\yts15 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow27\irowband26\ltrrow\ts15\trgaph128\trrh425\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6886\clshdrawnil \cellx9952\row \ltrrow
}\trowd \irow28\irowband27\lastrow \ltrrow\ts15\trgaph128\trrh489\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6886\clshdrawnil \cellx9952
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16385792\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid6427833 Other }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16385792 relevant cultural factors}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid10516324 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10516324\yts15 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid10516324\charrsid6427833 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2690411\charrsid6427833 \trowd \irow28\irowband27\lastrow \ltrrow\ts15\trgaph128\trrh489\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3034541\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth2938\clshdrawnil \cellx3006\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6886\clshdrawnil \cellx9952\row 
}\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468 \page 
\par \ltrrow}\trowd \irow0\irowband-1\ltrrow\ts15\trgaph128\trrh405\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16533150\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat20\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw20 \cellx10236\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\tscfirstrow\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid11934666 Patient wellbeing and assessment}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\cf19\insrsid13388468\charrsid10771107 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid13388468\charrsid10771107 \trowd \irow0\irowband-1\ltrrow\ts15\trgaph128\trrh405\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16533150\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat20\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw20 \cellx10236\row \ltrrow}\trowd \irow1\irowband0\ltrrow\ts15\trgaph128\trrh45\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid13388468\charrsid7340884 Reasons for presenting
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid11478531 Consider asking:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 What are the patient\rquote s current mental health issues?
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 What r}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 equests and hopes}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666  does the patient have?}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid11934666 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid14447178 
\trowd \irow1\irowband0\ltrrow\ts15\trgaph128\trrh45\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 History of current episode
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10516324\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid10516324 Consider:}
{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid10516324\charrsid10516324 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13388468 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid13388468\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 Symptom onset, duration, intensity, time course}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid9710890 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid14447178 
\trowd \irow2\irowband1\ltrrow\ts15\trgaph128\trrh45\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow3\irowband2\ltrrow\ts15\trgaph128\trrh461\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrs\brdrw30 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrs\brdrw30 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid13388468\charrsid7340884 Patient }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid11471536 h}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\ul\insrsid13388468\charrsid7340884 istory
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid6384604\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid10779032 Consider:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12201781\charrsid6384604 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid13388468\charrsid14447178 \trowd \irow3\irowband2\ltrrow\ts15\trgaph128\trrh461\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrs\brdrw30 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrs\brdrw30 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow4\irowband3\ltrrow\ts15\trgaph128\trrh341\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236{\listtext
\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid6384604\charrsid10779032 \loch\af3\dbch\af0\hich\f3 \'b7\tab}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid16533150\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid6384604\charrsid10779032 Mental health history }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid6384604\charrsid6384604 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid14447178 
\trowd \irow4\irowband3\ltrrow\ts15\trgaph128\trrh341\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow5\irowband4\ltrrow\ts15\trgaph128\trrh362\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236{\listtext
\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid6384604\charrsid10779032 \loch\af3\dbch\af0\hich\f3 \'b7\tab}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid16533150\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid6384604\charrsid10779032 Salient social history}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid6384604\charrsid6384604 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid14447178 
\trowd \irow5\irowband4\ltrrow\ts15\trgaph128\trrh362\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow6\irowband5\ltrrow\ts15\trgaph128\trrh521\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236{\listtext
\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid6384604\charrsid10779032 \loch\af3\dbch\af0\hich\f3 \'b7\tab}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid6384604\charrsid10779032 Salient medical}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid6384604 /biological}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\ul\insrsid6384604\charrsid10779032  history}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6384604\charrsid10779032  
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid2962803 Consider asking:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid6836102 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid11934666 \u9792\'3f \endash  menarche, menstruation, pregnancy, menopause}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid6384604\charrsid11934666 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14447178 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid6384604\charrsid14447178 \trowd \irow6\irowband5\ltrrow\ts15\trgaph128\trrh521\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow7\irowband6\ltrrow\ts15\trgaph128\trrh325\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236{\listtext
\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid6384604\charrsid10779032 \loch\af3\dbch\af0\hich\f3 \'b7\tab}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid6384604\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6384604\charrsid10779032 Salient deve}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6384604\charrsid12201781 lopmental issues}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6384604\charrsid6384604 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid14447178 
\trowd \irow7\irowband6\ltrrow\ts15\trgaph128\trrh325\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow8\irowband7\ltrrow\ts15\trgaph128\trrh1230\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Family }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401 h}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468 istory of }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401 m}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 ental }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401 i}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 llness
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid2962803 Consider asking}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666  about}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid2962803 :
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls3\adjustright\rin0\lin360\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 Family history of suicidal behaviour
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Genogram}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid11934666 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid14447178 
\trowd \irow8\irowband7\ltrrow\ts15\trgaph128\trrh1230\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow9\irowband8\ltrrow\ts15\trgaph128\trrh1585\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11216505 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11216505\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\ul\insrsid11216505\charrsid4354138 Parent and children needs
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid10974711 Record:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li720\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls29\adjustright\rin0\lin720\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 N}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 ame and date of birth of any children }{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 aged \u706\'3f}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 18 years.  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}
Impact of mental health difficulties on their parenting, the parent}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666 \endash }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 
child relationship and their children}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11216505\charrsid11934666 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11216505\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11216505\charrsid14447178 
\trowd \irow9\irowband8\ltrrow\ts15\trgaph128\trrh1585\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Current }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401 d}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468 omestic and }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401 s}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 ocial }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401 c}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 ircumstances
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid10974711 Consider asking about:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid6250655 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin360\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 Living arrangements}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid10490134 Social relationships
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Occupation}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid7803740\charrsid11934666 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid14447178 
\trowd \irow10\irowband9\ltrrow\ts15\trgaph128\trrh1585\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow11\irowband10\ltrrow\ts15\trgaph128\trrh1820\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Salient substance use issues
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid2962803 Consider asking about:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid2962803 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin360\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 Nicotine use
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Alcohol use
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Illicit substances
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Is patient willing to address the issues?}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid11083749 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid14447178 
\trowd \irow11\irowband10\ltrrow\ts15\trgaph128\trrh1820\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow12\irowband11\ltrrow\ts15\trgaph128\trrh891\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Current medications
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11934666\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11934666\charrsid2962803 Consider asking about:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid2962803 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid11934666\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11934666\charrsid10490134 Dosage, date of commencement, date of change in dosage
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Reason for the prescription 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}
Are there other practitioners involved in the prescription of medication?
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11934666\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Are there issues with compliance or misuse}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid15628762 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468 \trowd \irow12\irowband11\ltrrow\ts15\trgaph128\trrh891\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl
\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow13\irowband12\ltrrow\ts15\trgaph128\trrh294\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 History of medication and other treatments for mental illness
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid488849\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid488849\charrsid2962803 Consider asking about:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849\charrsid2962803 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid488849\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849\charrsid10490134 Past referrals
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Effectiveness of previous treatments}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid488849\charrsid10490134 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid488849\charrsid10490134 Side}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849\charrsid10490134 effects and complications associated with previous treatments}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid488849\charrsid10490134 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid488849\charrsid10490134 Patient\rquote s preference for medications}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid488849 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468 \trowd \irow13\irowband12\ltrrow\ts15\trgaph128\trrh294\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl
\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 A}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 llergies}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid2916096 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468 \trowd \irow14\irowband13\ltrrow\ts15\trgaph128\trrh294\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl
\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow15\irowband14\ltrrow\ts15\trgaph128\trrh366\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Relevant physical examination and other investigations}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid7933488 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14447178 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid14447178 
\trowd \irow15\irowband14\ltrrow\ts15\trgaph128\trrh366\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow16\irowband15\ltrrow\ts15\trgaph128\trrh498\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 Results of relevant previous psychological and developmental testing}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid7933488 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid7933488 \trowd \irow16\irowband15\ltrrow\ts15\trgaph128\trrh498\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow17\irowband16\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 Other care plan}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 e.}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid7933488 g}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 .}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid7933488  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid12796156  GP Management Plans and Team Care Arrangements}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468 ; 
\par Wellness Recovery Action Plan}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12932054 ; }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12932054\charrsid4354138 Family Care Plan}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13388468\charrsid7933488 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  Yes,  Specify:  
\par  
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2409\tx2976\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid13388468  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323700000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check27}
\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468  No }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid13388468   }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid7933488 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid7933488 \trowd \irow17\irowband16\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3213\clshdrawnil \cellx3295\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6895\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow18\irowband17\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14423067\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid488849 {\*\bkmkstart _Hlk41039545}Comments on }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid11553098\charrsid488849 Strengths and Positive Dispositions}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid13388468\charrsid13388468 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid7933488 
\trowd \irow18\irowband17\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14423067\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\row \ltrrow}\trowd \irow19\irowband18\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid488849\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849\charrsid2371385 Consider asking about:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid488849\charrsid2371385 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid2371385 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls19\adjustright\rin0\lin360\pararsid488849\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849\charrsid2371385 Abilities, talents and interests}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid488849\charrsid2371385 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid2371385 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid488849\charrsid2371385 Competencies and accomplishments }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid488849\charrsid2371385 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid2371385 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid488849\charrsid2371385 Previous self-help strategies used and those available in the family support network }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid488849\charrsid2371385 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid488849\charrsid2371385 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid488849\charrsid2371385 Service system and the community at large}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid488849\charrsid2371385 
\par }\pard \ltrpar\s19\ql \li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin360\pararsid488849\yts15\contextualspace {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf6\insrsid11553098\charrsid11553098 \cell }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid11553098\charrsid11553098 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11553098\charrsid7933488 
\trowd \irow19\irowband18\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow20\irowband19\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14423067\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11553098\charrsid6384604 {\*\bkmkend _Hlk41039545}Comments on Current }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid11553098 
Mental State Examination}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11553098\charrsid6384604 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11553098\charrsid7933488 \trowd \irow20\irowband19\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14423067\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\row \ltrrow}\trowd \irow21\irowband20\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9968037\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037 Consider asking about:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037\charrsid16023418 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid9968037\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid9968037\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037\charrsid10490134 
Appearance, cognition, thought process, thought content, attention, memory, insight, behaviour, speech, mood and affect, perception, judgement, orientation
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid9968037\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar\s19\ql \fi-360\li360\ri0\widctlpar\intbl
\tx2985\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid9968037\yts15\contextualspace {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037\charrsid10490134 
Appropriateness of Mini}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037 -}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037\charrsid10490134 Mental State Examination }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid9968037 (MMSE) }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037\charrsid10490134 for patients }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037 aged}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid9968037\charrsid10490134  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037 \u707\'3f}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9968037\charrsid10490134 75 years or if otherwise indicated}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid12201781\charrsid9968037 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid8009412\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12201781 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\tx2985\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid8009412\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4593618 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid12201781\charrsid7933488 \trowd \irow21\irowband20\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow22\irowband21\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6516666\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9117080\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11228992\charrsid11891569 Trauma Informed Care and Practice (TICP) assessment}{\rtlch\fcs1 
\af31503 \ltrch\fcs0 \f31503\insrsid11228992\charrsid11891569 .}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid11228992\charrsid15206503 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11228992\charrsid7933488 
\trowd \irow22\irowband21\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6516666\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\row \ltrrow}\trowd \irow23\irowband22\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11891569\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8979659\charrsid11891569 Consid}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11891569 er possible influence of trauma
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 Trauma can be defined as:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls34\adjustright\rin0\lin360\pararsid11891569\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569 E}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 xposure to death
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569 T}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 hreatened death
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569 A}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 ctual serious injury 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569 T}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 hreatened serious injury
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569 A}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 ctual sexual violence 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11891569\charrsid11891569 Threatened sexual violence}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11228992\charrsid11891569 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid8009412\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid15945889\charrsid15206503 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid15945889\charrsid7933488 
\trowd \irow23\irowband22\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid86837\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid8074810\charrsid11891569 Consider possible indicators of gende}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11891569 
r-based violence}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5582553 -}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11891569 related trauma}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid86837 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11891569\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11891569\charrsid10490134 Possible indicators may include:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid11891569\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11891569\charrsid10490134 Stress, anxiety, depression
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Substance use disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Thoughts, plans or acts of self-harm/suicide
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Injuries that are repeated and unexplained
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Repeated sexually transmitted infections
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Unwanted pregnancies
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}
Unexplained chronic pain or conditions (pelvic pain, gastrointestinal problems, kidney or bladder infections) 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid11891569\charrsid11891569 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11891569\charrsid11891569 Other unexplained mental health complaints
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11891569\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid15008064\charrsid11891569 \cell }\pard \ltrpar
\ql \fi-278\li278\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin278\pararsid11228992\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\cf6\insrsid11228992\charrsid15206503 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11228992\charrsid7933488 \trowd \irow24\irowband23\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow25\irowband24\ltrrow\ts15\trgaph128\trrh120\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid6384604\charrsid14970352 Risk assessment 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 If high level of risk indicated, document actions taken in}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14636150  the treatment p}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 lan below 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14636150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid14636150\charrsid16392241 Consider asking:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid5966776 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid14636150\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150\charrsid5966776 Does the patient have a timeline for acting on a plan?
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid5966776 \loch\af3\dbch\af0\hich\f3 \'b7\tab}How bad is the pain/distress experienced?}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14636150\charrsid5966776 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid5966776 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid14636150\charrsid5966776 Is it interminable, inescapable, intolerable}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 
Ideation/ thoughts}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 Intent}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 Plan}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid6384604\charrsid7933488 \trowd \irow25\irowband24\ltrrow\ts15\trgaph128\trrh120\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\row \ltrrow}\trowd \irow26\irowband25\ltrrow\ts15\trgaph128\trrh120\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 
Suicide}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid7933488 \trowd \irow26\irowband25\ltrrow\ts15\trgaph128\trrh120\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14636150\charrsid14970352 Self-harm}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid7933488 \trowd \irow27\irowband26\ltrrow\ts15\trgaph128\trrh120\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\row \ltrrow}\trowd \irow28\irowband27\ltrrow\ts15\trgaph128\trrh479\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\charrsid14970352 
Harm to others}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604\delrsid14360678\charrsid14970352 \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid7933488 \trowd \irow28\irowband27\ltrrow\ts15\trgaph128\trrh479\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1137\clshdrawnil \cellx4430\clvertalt
\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2081\clshdrawnil \cellx6547\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1798\clshdrawnil \cellx8381\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth1779\clshdrawnil \cellx10236\row \ltrrow}\trowd \irow29\irowband28\ltrrow\ts15\trgaph128\trrh299\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7015358\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7015358 Comments or details of}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604  any identified risks\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid7933488 \trowd \irow29\irowband28\ltrrow\ts15\trgaph128\trrh299\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow30\irowband29\ltrrow\ts15\trgaph128\trrh787\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16533150\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6384604 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid6384604\charrsid7933488 
\trowd \irow30\irowband29\ltrrow\ts15\trgaph128\trrh787\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5520306\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3193\clshdrawnil \cellx3255\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6915\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow31\irowband30\ltrrow\ts15\trgaph128\trrh527\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7803740\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14249401 Assessment}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid2516808 /outcome }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\ul\insrsid14249401 tool used}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid2890314  
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150 (}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid2890314\charrsid2890314 except}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150  where clinically inappropriate)}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid2890314 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid14970352 
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid13388468\charrsid7933488 \trowd \irow31\irowband30\ltrrow\ts15\trgaph128\trrh527\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow32\irowband31\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14249401\charrsid14970352 Date of assessment}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401\charrsid14249401 \cell }{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14249401\charrsid14970352 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid14249401\charrsid7933488 \trowd \irow32\irowband31\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14249401\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14249401\charrsid14970352 Results}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid14249401\charrsid14970352 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\ul\insrsid14249401\charrsid14970352 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14249401 
\par 
\par 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7015358\yts15 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid14249401\charrsid14970352  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7015358  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid14249401\charrsid14970352 Copy of completed tool provided to referred }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7015358 practitioner}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid14249401\charrsid14970352 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14249401\charrsid7933488 \trowd \irow33\irowband32\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid13388468\charrsid14970352 Provisional diagnosis of mental health disorder
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14636150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid14636150\charrsid1901100 Consider conditions specified in the }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150\charrsid1901100 International }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150 c}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150\charrsid1901100 lassification of }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150 p}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150\charrsid1901100 
rimary }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150 c}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150\charrsid1901100 are}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150\charrsid4684008 ,}{
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \i\f1\fs20\insrsid14636150  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150\charrsid4684008 2nd edition}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150 :}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \f1\fs20\cf6\insrsid14636150 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls11\rin0\lin360\pararsid7803740\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf23\insrsid7803740\charrsid7803740 Depression
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Bipolar disorder
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Other mood disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Anxiety disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Panic disorder
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Phobic disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Post-traumatic stress disorder
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Schizophrenia
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Other psychotic disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Adjustment disorder
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Dissociative disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Eating disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Impulse-control disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Sexual disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Sleep disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Somatoform disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Substance-related disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Personality disorders
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\cf23\lang3081\langfe3081\langfenp3081\insrsid7803740\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid7803740\yts15\contextualspace {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\cf23\insrsid7803740\charrsid7803740 Unknown}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid11955880 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid14360678 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid7933488 
\trowd \irow34\irowband33\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid13388468\charrsid14970352 Case formulation
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14636150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid14636150\charrsid2962803 Consider asking about:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid14636150\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150\charrsid10490134 Predisposing factors
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Precipitating factors
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Perpetuating factors
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Protective factors}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13388468\charrsid14636150 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid14360678 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13388468\charrsid7933488 
\trowd \irow35\irowband34\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11955880 Other relevant information from carer/informants
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14636150\yts15 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150 
Consider asking about:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid14636150 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li402\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls37\adjustright\rin0\lin402\pararsid14636150\yts15\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14636150\charrsid14636150 Specific concerns of carer/family
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid14636150 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Impact on carer/family
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid14636150 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Contextual information from members of patient\rquote s community

\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid14636150\charrsid14636150 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Content from individuals other than the patient}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11955880\charrsid14636150 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11955880\charrsid14360678 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid11955880\charrsid7933488 
\trowd \irow36\irowband35\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13388468\charrsid13388468 Any other comments\cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13388468\charrsid14360678 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid13388468\charrsid7933488 \trowd \irow37\irowband36\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 
\trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth4203\clshdrawnil \cellx4263\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth5905\clshdrawnil \cellx10236\row \ltrrow
}\trowd \irow38\irowband37\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6516666\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\pard\plain \ltrpar
\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7353498\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841 Record of patient consent}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841\charrsid4329626  }{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841 for personal recovery plan}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid13115273\charrsid10632896 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13115273\charrsid7933488 
\trowd \irow38\irowband37\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6516666\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\row \ltrrow}\trowd \irow39\irowband38\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid12202919 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5529942\charrsid12405841 I, __________________________________________________}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12405841\charrsid12405841 _}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\i\f1\fs20\insrsid12405841  [name of patient]}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5529942\charrsid12405841 , agree to }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12405841\charrsid12405841 complete }{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid6516666 the }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12405841\charrsid12405841 recovery plan.}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5199199\charrsid12405841 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid5199199 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid4420108\charrsid5199199 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5529942\charrsid7933488 \trowd \irow39\irowband38\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\row \ltrrow}\pard\plain \ltrpar
\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid222508\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841\charrsid4329626 Considering the }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841 r}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid12405841\charrsid4329626 ecovery }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841 j}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid12405841\charrsid4329626 ourney}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid12405841  \endash  Optional frameworks, stages and tasks to consider}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid13115273\charrsid10632896 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid13115273\charrsid7933488 
\trowd \irow40\irowband39\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\row }\pard\plain \ltrpar
\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid467102\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid3610744 Stage of personal recovery}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid467102 {\*\nesttableprops\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trrh533\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13008056\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth2\clwWidth5000\clcbpatraw22\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid467102\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 1. Feeling overwhelmed }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang3081\langfe1033\langfenp1033\insrsid467102\charrsid12405841 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 2. Acknowledging change is needed}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang3081\langfe1033\langfenp1033\insrsid467102\charrsid12405841 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 3. Actively struggling with mental health}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang3081\langfe1033\langfenp1033\insrsid467102\charrsid12405841 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 4. Living }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 with}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841  impact of illness or vulnerability}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang3081\langfe1033\langfenp1033\insrsid467102\charrsid12405841 
\nestcell{\nonesttables
\par }}\pard \ltrpar\ql \li35\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin35\itap2\pararsid467102\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 5. Living }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 beyond}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841 
illness or vulnerability}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid12405841  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang3081\langfe1033\langfenp1033\insrsid467102\charrsid12405841 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid467102 {\*\nesttableprops\trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trrh916\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6815976\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth1110\clshdrawnil\clhidemark \cellx2285\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth973\clshdrawnil\clhidemark \cellx4164\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth902\clshdrawnil\clhidemark \cellx5906\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth833\clshdrawnil\clhidemark \cellx7515\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth1182\clshdrawnil\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li35\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin35\itap2\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12405841\charrsid9990265 Notes informed by stages 1}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12405841 \endash }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12405841\charrsid9990265 5 above; consider small, }{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12405841 comprehensible}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12405841\charrsid9990265  and achievable steps}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11285029 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid11285029 {\*\nesttableprops\trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trrh329\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li35\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin35\itap2\pararsid467102\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11285029 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14712513 
\par 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid10357236\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4420108 
\par }\pard \ltrpar\ql \li35\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin35\itap2\pararsid467102\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid753456 
\par 
\par 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14712513 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid8015353\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid8015353 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid11285029 {\*\nesttableprops\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trrh916\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid467102\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3280783 Recovery task 1 \endash  }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid9990265 Understanding my mental health}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 ,}{\rtlch\fcs1 
\ab\ai\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid9990265  and what it means for me}{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102 
\nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid467102 {\*\nesttableprops\trowd \irow4\irowband4\ltrrow\ts23\trgaph108\trrh545\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13008056\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth2\clwWidth5000\clcbpatraw22\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid467102\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 Has c}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid4329626 onfusion about what happened }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 and}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid4329626  what it means}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang3081\langfe1033\langfenp1033\insrsid467102 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 Is a}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid4329626 
ware that something needs to be understood or sorted out\~}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang3081\langfe1033\langfenp1033\insrsid467102 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid3610744 Has a beginning explanatory model}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13008056  of causal attributions}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang3081\langfe1033\langfenp1033\insrsid467102 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid467102\charrsid3610744 Has co}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid8675384 
me to terms with mental health and what it means to them}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang3081\langfe1033\langfenp1033\insrsid467102 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 Is c}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid4329626 
omfortable with own personal understanding of experiences}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang3081\langfe1033\langfenp1033\insrsid467102 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid467102 {\*\nesttableprops\trowd \irow5\irowband5\ltrrow\ts23\trgaph108\trrh1244\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6815976\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth1110\clshdrawnil\clhidemark \cellx2285\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth973\clshdrawnil\clhidemark \cellx4164\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth902\clshdrawnil\clhidemark \cellx5906\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth833\clshdrawnil\clhidemark \cellx7515\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth1182\clshdrawnil\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid4329626 Notes informed by dimensions of task 1}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 : consider small, comprehensible and achievable steps}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744\charrsid11285029 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow6\irowband6\ltrrow\ts23\trgaph108\trrh346\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 
\par 
\par 
\par 
\par 
\par \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow7\irowband7\ltrrow\ts23\trgaph108\trrh1244\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14711309\charrsid6422769 Recovery }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14711309 t}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3280783 ask 2 \endash  }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14711309\charrsid6422769 Taking charge of my mental health}{\rtlch\fcs1 \ai\af1\afs20 \ltrch\fcs0 \i\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 
\nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow8\irowband8\ltrrow\ts23\trgaph108\trrh574\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid8675384\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth2\clwWidth5000\clcbpatraw22\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang3081\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langfenp1033\insrsid14711309 \hich\af1\dbch\af39\loch\f1 Is not making a deliberate effort to cope}
{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\s28\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\tx567\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap2\pararsid3610744\yts23 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \fs22\cf1\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf0\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309\charrsid4329626 
\hich\af1\dbch\af39\loch\f1 Realises }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf0\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309 \hich\af1\dbch\af39\loch\f1 the }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\fs20\cf0\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309\charrsid4329626 \hich\af1\dbch\af39\loch\f1 need to cope or change}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309\charrsid4329626 \hich\af1\dbch\af39\loch\f1 
Is sometimes trying ways to cope or change}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309 \hich\af1\dbch\af39\loch\f1 Is g}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309\charrsid4329626 \hich\af1\dbch\af39\loch\f1 enerally confident in managing \hich\af1\dbch\af39\loch\f1 persisting illness or vulnerability}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14711309\charrsid4329626 \hich\af1\dbch\af39\loch\f1 Mental health experiences interfere little with life}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\lang1033\langfe1033\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow9\irowband9\ltrrow\ts23\trgaph108\trrh1376\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6815976\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth1110\clshdrawnil\clhidemark \cellx2285\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth973\clshdrawnil\clhidemark \cellx4164\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth902\clshdrawnil\clhidemark \cellx5906\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth833\clshdrawnil\clhidemark \cellx7515\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth1182\clshdrawnil\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 Notes informed by dimensions of task }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14549474 2}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14549474 : consider small,  comprehensible and achievable steps}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow10\irowband10\ltrrow\ts23\trgaph108\trrh386\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 
\par 
\par \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow11\irowband11\ltrrow\ts23\trgaph108\trrh1376\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid6422769 \hich\af1\dbch\af39\loch\f1 
Recovery }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474 \hich\af1\dbch\af39\loch\f1 t}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3280783 \hich\af1\dbch\af39\loch\f1 ask 3 \hich\f1 \endash \loch\f1  }{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid6422769 \hich\af1\dbch\af39\loch\f1 Living a life that I value}{\rtlch\fcs1 \ab\ai\af1\afs20 \ltrch\fcs0 
\b\i\fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow12\irowband12\ltrrow\ts23\trgaph108\trrh531\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid8675384\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth2\clwWidth5000\clcbpatraw22\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474 \hich\af1\dbch\af39\loch\f1 Feels d}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 \hich\af1\dbch\af39\loch\f1 isconnected \hich\af1\dbch\af39\loch\f1 
from people, social roles and personal growth}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf6\lang3081\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\s28\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\tx567\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap2\pararsid14549474\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\cf1\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf0\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 \hich\af1\dbch\af39\loch\f1 
Would like to be more connected to people, social roles and personal growth}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf0\lang3081\langfe1033\langfenp1033\insrsid14549474\charrsid4329626 
\par }\pard \ltrpar\s28\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\tx567\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\rtlgutter\itap2\pararsid3610744\yts23 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \~\nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 \hich\af1\dbch\af39\loch\f1 
Is sometimes trying ways to connect and change}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 \hich\af1\dbch\af39\loch\f1 Has found a place in life but still limited by disabilities}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 \hich\af1\dbch\af39\loch\f1 Has a \hich\f1 \lquote \loch\f1 contributing life\hich\f1 \rquote }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow13\irowband13\ltrrow\ts23\trgaph108\trrh1805\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6815976\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth1110\clshdrawnil\clhidemark \cellx2285\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth973\clshdrawnil\clhidemark \cellx4164\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth902\clshdrawnil\clhidemark \cellx5906\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth833\clshdrawnil\clhidemark \cellx7515\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth2\clwWidth1182\clshdrawnil\clhidemark \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid14549474\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14549474\charrsid4329626 Notes informed by dimensions of task }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14549474 3}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14549474 : consider small, comprehensible and achievable steps}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid14549474 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid14549474 {\*\nesttableprops\trowd \irow14\irowband14\ltrrow\ts23\trgaph108\trrh348\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3610744\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\cf6\lang1033\langfe1033\kerning24\loch\af1\hich\af1\dbch\af39\langnp1033\langfenp1033\insrsid3610744 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3610744 {\*\nesttableprops\trowd \irow15\irowband15\lastrow \ltrrow\ts23\trgaph108\trrh1805\trleft142\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth2\trwWidth4880\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind137\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 
\clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth2\clwWidth5000\clshdrawnil \cellx9797\nestrow}{\nonesttables
\par }\ltrrow}\trowd \irow41\irowband40\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13388468\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid8988358\charrsid10632896 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8988358\charrsid7933488 
\trowd \irow41\irowband40\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\row \ltrrow}\trowd \irow42\irowband41\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid8675384\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\pard\plain \ltrpar
\qc \li0\ri0\sb240\sa240\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3609293\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15544683\charrsid12483914 Setting }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15544683 p}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid15544683\charrsid12483914 ersonal }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15544683 r}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15544683\charrsid12483914 ecovery }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid15544683 g}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15544683\charrsid12483914 oals}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid8988358\charrsid10632896 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8988358\charrsid7933488 
\trowd \irow42\irowband41\ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid8675384\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth10148\clcbpatraw22 \cellx10236\row }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid15544683\tscfirstrow\yts33 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid3961170 A}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 lso consider}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid15544683\charrsid3961170 :
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid15544683\charrsid16457418 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\sa160\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls24\adjustright\rin0\lin360\itap2\pararsid15544683\tscfirstrow\yts33\contextualspace \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 The person themselves prioritising the goal}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid15544683 /}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 s to focus on 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid15544683 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 T}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 he CHIME framework}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 :}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 
 connectedness, hope, identity, meaning and purpose}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 ,}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418  and empowerment
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid15544683 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 W}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 hich strengths are relevant and can be built on to pursue goal}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 /}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid15544683\charrsid16457418 s 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid15544683 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 H}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 ow the person\rquote s values, treatment and support preferences will impact on the action plan 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid15544683\charrsid16457418 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Breaking goals down into smal
ler manageable steps and making plans for who will do what and when }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 \endash  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 informally or using the SMART (}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 s}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 pecific, }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 m}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid15544683\charrsid16457418 eaningful, }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 a}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 ttainable, }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid15544683 r}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 ealistic, }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid15544683 t}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid15544683\charrsid16457418 imetabled) approach
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid15544683\charrsid16457418 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls24\adjustright\rin0\lin360\itap2\pararsid15544683\tscfirstrow\yts33\contextualspace {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid15544683\charrsid16457418 Supporting the person to undertake independent or joint actions rather than accepting passive actions}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid3618737\charrsid15544683 
\nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2\pararsid3618737\tscfirstrow\yts33 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid3618737 \nestcell{\nonesttables
\par }}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap2 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid3618737 {\*\nesttableprops\trowd \irow0\irowband-1\lastrow \ltrrow\ts33\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh
\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 \tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10238\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3942701\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth3476\clshdrawnil \cellx3544\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth6642\clshdrawnil \cellx10246
\nestrow}{\nonesttables
\par }\ltrrow}\trowd \irow43\irowband42\lastrow \ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy364\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9784634\yts15 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid467102\charrsid10632896 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid467102\charrsid7933488 
\trowd \irow43\irowband42\lastrow \ltrrow\ts15\trgaph128\trrh484\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy364\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10228\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10632896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\cltxlrtb\clftsWidth3\clwWidth10148\clshdrawnil \cellx10236\row \ltrrow}\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh
\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \clcbpat20\cltxlrtb\clftsWidth3\clwWidth15302\clcbpatraw20 \cellx10458\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf19\insrsid13523705 Personal recovery plan}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid5178880\charrsid16533150 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 \trowd \irow0\irowband0\ltrrow
\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \clcbpat20\cltxlrtb\clftsWidth3\clwWidth15302\clcbpatraw20 \cellx10458\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft8
\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth9097\clshdrawnil \cellx10458\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid13388468 \cell \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880 Actions}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid13388468 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 \trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth9097\clshdrawnil \cellx10458\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh
\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3038\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2972\clshdrawnil \cellx8683\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3007\clshdrawnil \cellx10458\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid13388468 Identified issues/problems}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880 Consider:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin360\pararsid5178880\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880 As presented by patient
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Developed during consultation
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Formulated by GP}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid745315 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid5178880\charrsid14703373 Goals
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid7803740 Consider:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin360\pararsid13523705\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 Goals made in collaboration with patient
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}What does the patient want to see as an outcome from this plan?

\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Wellbeing, function, occupation, relationships
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Any reference to special outcome measures
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Time frame}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid5178880\charrsid14703373 Treatments & interventions
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid7803740 Consider:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls9\adjustright\rin0\lin360\pararsid5178880\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid7803740 Suggested psychological interventions
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Medications
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Key }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\ul\insrsid5178880\charrsid4063763 actions to be taken by patient}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid7803740  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid14703373 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\ul\insrsid5178880\charrsid14703373 Support services to achieve patient goals
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid7803740 Role of GP
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\ul\insrsid5178880\charrsid7803740 Psycho-education
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid7803740 Time frame}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid5178880\charrsid9438081 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid5178880 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880 I}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid2243126 nternet-based options }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}\pard \ltrpar
\s19\ql \fi-360\li1080\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls15\ilvl1\adjustright\rin0\lin1080\pararsid5178880\yts23\contextualspace {\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://www.mycompass.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid16397513 myCompass}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid16397513  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://thiswayup.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid16397513 THIS WAY UP}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "http://www.mindspot.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid16397513 MindSpot}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://ecouch.anu.edu.au/welcome" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid16397513 e-couch}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://moodgym.anu.edu.au/welcome" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid16397513 MoodGYM}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://www.mentalhealthonline.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid16397513 Mental Health Online}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid16397513  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://www.ontrack.org.au/web/ontrack" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid5178880\charrsid9438081 OnTrack}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid9438081 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\ul\insrsid5178880\charrsid14703373 Referrals
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid7803740 Consider:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls9\adjustright\rin0\lin360\pararsid13523705\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 Practitioner, service or agency}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705  \endash  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13523705\charrsid10490134 referred to whom}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 ,}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134  and }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid13523705 for }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 what
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Specific referral request
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Opinion, planning, treatment
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Case conferences
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Time frame
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Referral to internet mental health programs for education}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 :}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}\pard \ltrpar
\s19\ql \fi-360\li1080\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls9\ilvl1\adjustright\rin0\lin1080\pararsid13523705\yts23\contextualspace {\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://www.mycompass.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid16397513 myCompass}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid16397513  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://thiswayup.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid16397513 THIS WAY UP}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "http://www.mindspot.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid16397513 MindSpot}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://ecouch.anu.edu.au/welcome" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid16397513 e-couch}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid16397513  
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://moodgym.anu.edu.au/welcome" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705 m}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid16397513 ood}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705 gym}}}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid16397513  

\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://www.mentalhealthonline.org.au/" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid16397513 Mental Health Online}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid16397513  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \f2\fs22\lang3081\langfe3081\langfenp3081 \loch\af2\dbch\af0\hich\f2 \'ad\tab}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4798275 
 HYPERLINK "https://www.ontrack.org.au/web/ontrack" }}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \cs26\f1\fs20\ul\cf17\insrsid13523705\charrsid13523705 OnTrack}}}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid13523705 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13523705\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid13523705\charrsid7803740 Any role of carer/support person}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13523705 /}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid13523705\charrsid7803740 s
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls9\adjustright\rin0\lin360\pararsid13523705\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 Identified role or task}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 /}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 s }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 (}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 eg monitoring, intervention, support}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705 )}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid13523705\charrsid10490134 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Discussed, agreed, and negotiated with carer?
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Any necessary supports for carer
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid13523705\charrsid10490134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Time frame}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 \trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3038\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2972\clshdrawnil \cellx8683\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3007\clshdrawnil \cellx10458\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trrh1331\trleft8\trbrdrt
\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3038\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2972\clshdrawnil \cellx8683\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3007\clshdrawnil \cellx10458\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid724893 Issue 1:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12922352 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 \cell \cell \cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 
\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trrh1331\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3038\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2972\clshdrawnil \cellx8683\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3007\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid724893 Issue 2:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12922352 \cell }{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 \cell \cell \cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880 
\trowd \irow4\irowband4\ltrrow\ts23\trgaph108\trrh1331\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3038\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2972\clshdrawnil \cellx8683\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3007\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid12871205 Issue 3:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12871205 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12871205 \cell \cell \cell \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid5178880\charrsid12871205 \trowd \irow5\irowband5\ltrrow\ts23\trgaph108\trrh1331\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3015\clshdrawnil \cellx1909\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl
\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3110\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3038\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2972\clshdrawnil \cellx8683\clvertalt\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3007\clshdrawnil \cellx10458\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 
\trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6165\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9097\clshdrawnil \cellx10458\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid5178880\charrsid14703373 Intervention/relapse prevention plan}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid12871205  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12411857 (if appropriate at this stage)}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12411857\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12411857 Consider asking about}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid12411857\charrsid13379383 :
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid12411857\charrsid12411857 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin360\pararsid12411857\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12411857\charrsid12411857 Warning signs from past experiences
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid12411857\charrsid12411857 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Arrangements to intervene in case of relapse or crisis
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid12411857\charrsid12411857 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Support services currently in place
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid12411857\charrsid12411857 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Any past effective strategies}{\rtlch\fcs1 \ab\af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid12411857 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880 
\par 
\par 
\par 
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b313900000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check19}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880   }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12411857 Preparation of plan for delegation of patient\rquote s responsibilities (e.g. care for dependants, pets)}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid12871205 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880\charrsid12871205 \trowd \irow6\irowband6\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 
\trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6165\clshdrawnil \cellx3710\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9097\clshdrawnil \cellx10458\row \ltrrow}\trowd \irow7\irowband7\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 
\trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9243\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6019\clshdrawnil \cellx10458\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid5178880\charrsid14703373 Psycho-education provided if not already addressed in \'93
treatments and interventions\'94 above}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880 ?}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12871205 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880\charrsid14970352  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880  Yes}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880 \tab \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid14970352  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880  No}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880\charrsid12871205 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid5178880\charrsid12871205 \trowd \irow7\irowband7\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9243\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl
\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6019\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid5178880\charrsid12871205 Plan added to the patient\rquote s records?\cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid14970352  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880  Yes}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5178880 \tab \tab }
{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid14970352  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid16061755\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid5178880  No}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5178880\charrsid14970352 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5178880\charrsid12871205 \trowd \irow8\irowband8\lastrow \ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl
\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15604288\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9243\clshdrawnil \cellx6197\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth6019\clshdrawnil \cellx10458\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16453115 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid5178880 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091 
\par \sect }\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj \ltrrow\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10289\clshdrawnil \cellx10377\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16347479\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid16347479 Other healthcare providers and service providers involved in }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16347479\charrsid8856093 patient\rquote s care}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid16347479\delrsid8856093\charrsid8856093  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16347479\charrsid13379383 
(e.g. psychologist, psychiatrist, social worker, occupational therapist, other GPs, other medical specialists, case worker, community mental health services)}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid12871205 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid7013091 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10289\clshdrawnil \cellx10377\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft8\trbrdrt
\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2021\clshdrawnil \cellx2089\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2318\clshdrawnil \cellx4447\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth4275\clshdrawnil \cellx8762\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1555\clshdrawnil \cellx10377\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091 Role}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid6631826 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091 Name}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091\charrsid6631826 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091 Address}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid11232730 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091 Phone}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid6631826 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2021\clshdrawnil \cellx2089\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2318\clshdrawnil \cellx4447\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth4275\clshdrawnil \cellx8762\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1555\clshdrawnil \cellx10377\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7013091 \cell \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2021\clshdrawnil \cellx2089\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2318\clshdrawnil \cellx4447\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth4275\clshdrawnil \cellx8762\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1555\clshdrawnil \cellx10377\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7013091 \cell \cell \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow3\irowband3\lastrow \ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2021\clshdrawnil \cellx2089\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2318\clshdrawnil \cellx4447\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth4275\clshdrawnil \cellx8762\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth1555\clshdrawnil \cellx10377\row }\pard \ltrpar
\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16347479 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid7013091\charrsid16347479 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11600333\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth10289\clcbpatraw22 \cellx10377\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16347479\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\ul\insrsid16347479\charrsid16347479 Completing the plan}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\ul\cf6\insrsid16347479\charrsid16347479 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid7013091\charrsid16347479 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091\charrsid16347479 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11600333\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth10289\clcbpatraw22 \cellx10377\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts23\trgaph108\trrh361\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvmgf\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth7616\clshdrawnil \cellx7684\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2633\clshdrawnil \cellx10377\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 On completion of the plan, the GP }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid7013091 may}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  record (tick boxes below) that }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16347479 they have}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid7013091\charrsid214099 :
\par 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid16347479   D}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 iscussed the assessment with the patient
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid16347479   D}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 iscussed all aspects of the plan and the agreed date for review
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid16347479   O}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 ffered a copy of the plan to the patient and/or their carer (if agreed by patient)
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid214099 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid214099  Date plan completed}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid7013091\charrsid214099 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trrh361\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvmgf\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth7616\clshdrawnil \cellx7684\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2633\clshdrawnil \cellx10377\row \ltrrow}\trowd \irow2\irowband2\lastrow \ltrrow\ts23\trgaph108\trrh690\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth7616\clshdrawnil \cellx7684\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2633\clshdrawnil \cellx10377\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid214099 
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid7013091 \trowd \irow2\irowband2\lastrow \ltrrow\ts23\trgaph108\trrh690\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband
\tblind0\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth7616\clshdrawnil \cellx7684\clvertalt\clbrdrt\brdrinset\brdrw15 \clbrdrl
\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2633\clshdrawnil \cellx10377\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7013091 {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16122037\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth10319\clcbpatraw22 \cellx10449\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid16347479 Record of patient consent}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow0\irowband0\ltrrow
\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16122037\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth10319\clcbpatraw22 \cellx10449\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10319\clshdrawnil \cellx10449\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa240\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11075730\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099 I, ___________________________________________________}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid13379383 
[name of patient]}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid8856093 ,}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  agree to information about my}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11075730\charrsid214099  health being recorded in my medical file and being shared between the }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 GP }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099 
and other healt}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 hcare providers involved in my}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099 
 care, as nominated above, to assist in the management of my healthcare. I understand that I must inform my GP if I wish to change the nominated pe}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 ople involved in my}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099  care.
\par I understand that as part of my}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  c}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099 are under this Mental Health Treatment }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11075730 P}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099 lan, I should attend }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 the}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11075730\charrsid214099  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 general practice}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099  for a review appointment at least }{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 four}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099  weeks}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 ,}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11075730\charrsid214099  but }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 no later than}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11075730 six}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099  months}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 ,}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730\charrsid214099 
 after the plan has been developed.
\par I consent to the release of the following information to the following carer/support and emergency contact persons}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 .}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid14639418 
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid7013091 \trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10319\clshdrawnil \cellx10449\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trrh117\trleft8
\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil \cellx2340\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4070\clshdrawnil \cellx6450\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3939\clshdrawnil \cellx10449\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid214099 {\*\bkmkstart _Hlk40462220}Name\cell }\pard \ltrpar
\qc \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid214099 Assessment\cell Treatment Plan\cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid7013091\charrsid214099 \trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trrh117\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil \cellx2340\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4070\clshdrawnil \cellx6450\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth3939\clshdrawnil \cellx10449\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trrh116\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh
\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil \cellx2340\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3503\clshdrawnil \cellx5883\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth527\clshdrawnil \cellx6450\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3386\clshdrawnil \cellx9876\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth513\clshdrawnil \cellx10449\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid214099 {\*\bkmkend _Hlk40462220}\cell }\pard \ltrpar\qc \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091\charrsid214099 Yes\cell No\cell Yes\cell No\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091\charrsid214099 \trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trrh116\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb
\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil \cellx2340\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3503\clshdrawnil \cellx5883\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth527\clshdrawnil \cellx6450\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3386\clshdrawnil \cellx9876\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth513\clshdrawnil \cellx10449\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid10097516  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  W}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 ith the following limitations:

\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid10097516  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid10097516  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  W}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 ith the following limitations:

\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid10097516  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow4\irowband4\ltrrow\ts23\trgaph108\trrh116\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil \cellx2340\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3503\clshdrawnil \cellx5883\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth527\clshdrawnil \cellx6450\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3386\clshdrawnil \cellx9876\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth513\clshdrawnil \cellx10449\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  W}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 
ith the following limitations:
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730  W}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 
ith the following limitations:
\par \cell }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323500000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check25}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 
\par \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid7013091 \trowd \irow5\irowband5\ltrrow\ts23\trgaph108\trrh116\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth2230\clshdrawnil \cellx2340\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb
\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3503\clshdrawnil \cellx5883\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth527\clshdrawnil \cellx6450\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth3386\clshdrawnil \cellx9876\clvertalc\clbrdrt
\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth513\clshdrawnil \cellx10449\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt
\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5065\clshdrawnil \cellx5175\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5214\clshdrawnil \cellx10449\pard\plain \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par __________________________________________
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 Signature of patient}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid11075730 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 ________/________/________}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 Date}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid11075730 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow6\irowband6\ltrrow
\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11285029\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth5065\clshdrawnil \cellx5175\clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr
\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5214\clshdrawnil \cellx10449\row \ltrrow}\trowd \irow7\irowband7\ltrrow\ts23\trgaph108\trrh1256\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr
\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15752892\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10319\clshdrawnil \cellx10449\pard\plain \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 
\par I, ____________}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 ___________________________}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 _, have di}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 
scussed the plan and referral/s}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099  with the patient.
\par }\pard \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\tx2210\tx7160\tx12263\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid11075730 Full name of }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 GP}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid11075730 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow7\irowband7\ltrrow
\ts23\trgaph108\trrh1256\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15752892\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10319\clshdrawnil \cellx10449\row \ltrrow}\trowd \irow8\irowband8\ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt
\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3870664\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4894\clshdrawnil \cellx5004\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth5385\clshdrawnil \cellx10449\pard\plain \ltrpar\qr \li0\ri0\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1801956\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3222045\charrsid11075730 Mental Health Treatment Plan Included}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6565140\charrsid11075730 
:                                                }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15752892\charrsid11075730         }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid3222045\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid6565140\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid4151113\charrsid11075730 
\par }\pard \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid6178256 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 __________________________________________
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid11075730 Signature of GP}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\insrsid7013091\charrsid11075730 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid740118\charrsid11075730 
     }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1536563\charrsid11075730  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1536563\charrsid11075730  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid1536563\charrsid11075730 No}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid740118\charrsid11075730   }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11084623\charrsid11075730       }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid740118\charrsid11075730  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1839459\charrsid11075730  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1839459\charrsid11075730  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid479490\charrsid11075730 Yes}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid9206775\charrsid11075730  }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid15547766\charrsid11075730 (}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid15956021\charrsid11075730 if yes}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid4007519\charrsid11075730 , please select below}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11558976\charrsid11075730 )}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid6178256\charrsid11075730 
\par }\pard \ltrpar\ql \li0\ri0\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid479490\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid740118\charrsid11075730              }{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\caps\f1\fs20\insrsid3870664\charrsid11075730      }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid11084623\charrsid11075730       }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid479490\charrsid11075730 MBS }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid11075730\charrsid11075730 item n}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5261227\charrsid11075730 umber}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid479490\charrsid11075730 :
}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730   }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid9897985\charrsid11075730 
\par }\pard \ltrpar\ql \li0\ri0\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2061493\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid1536563\charrsid11075730           }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid3870664\charrsid11075730      }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1536563\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid11084623\charrsid11075730       }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid1536563\charrsid11075730  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  FORMCHECKBOX }{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\insrsid479490\charrsid11075730 2700    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\insrsid479490\charrsid11075730 2701    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\insrsid479490\charrsid11075730 2715  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\insrsid479490\charrsid11075730 2717 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid479490\charrsid11075730    }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid14419266\charrsid11075730 
\par }\pard \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid214099 ________/________/________}{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid11075730 Date}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\insrsid7013091\charrsid11075730 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow8\irowband8\ltrrow
\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3870664\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrnone \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4894\clshdrawnil \cellx5004\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrnone \clbrdrr\brdrinset\brdrw15 
\cltxlrtb\clftsWidth3\clwWidth5385\clshdrawnil \cellx10449\row \ltrrow}\trowd \irow9\irowband9\lastrow \ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15750316\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4894\clshdrawnil \cellx5004\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5385\clshdrawnil \cellx10449\pard\plain \ltrpar\ql \li0\ri0\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid15609352\yts23 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid3870664 \cell }\pard \ltrpar
\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid3870664 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3870664 
\trowd \irow9\irowband9\lastrow \ltrrow\ts23\trgaph108\trrh376\trleft8\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15750316\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth4894\clshdrawnil \cellx5004\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrnone \clbrdrb\brdrinset\brdrw15 \clbrdrr
\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5385\clshdrawnil \cellx10449\row }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091 
\par \ltrrow}\trowd \irow0\irowband-1\lastrow \ltrrow\ts15\trgaph128\trrh360\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy1184\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7013091\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat20\cltxlrtb\clftsWidth3\clwWidth9864\clcbpatraw20 \cellx9952\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1184\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13842070\tscfirstrow\yts15 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid13842070\charrsid13379383 R}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid13842070 e}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\cf19\insrsid13842070\charrsid13379383 quest for services
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\pvpg\phmrg\posxc\posy1184\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7013091\tscfirstrow\yts15 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\cf8\insrsid7013091\charrsid11805927 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091\charrsid11805927 \trowd \irow0\irowband-1\lastrow \ltrrow\ts15\trgaph128\trrh360\trleft8\trkeep\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 
\trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\tpvpg\tphmrg\tposxc\tposy1184\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth9944\trftsWidthB3\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7013091\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15\brdrcf21 
\clcbpat20\cltxlrtb\clftsWidth3\clwWidth9864\clcbpatraw20 \cellx9952\row \ltrrow}\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trrh117\trleft284\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 
\trbrdrh\brdrinset\brdrw15 \trbrdrv\brdrinset\brdrw15 
\trftsWidth1\trftsWidthB3\trwWidthB216\trftsWidthA3\trwWidthA192\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9882\clshdrawnil \cellx10206
\pard\plain \ltrpar\qc \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2905631\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2905631 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 Date: }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\lang3081\langfe2052\langfenp2052\insrsid12131637\charrsid3294131 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid12131637\charrsid3294131 
\par }\pard\plain \ltrpar\s29\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 To}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637 :}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 
\par [}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12006798 Attn}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 ]
\par [}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12006798 Address}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 ]
\par [}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12006798 Post code}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 ]
\par 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\fs20\insrsid12131637\charrsid3294131 
\par Subject:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637\charrsid3294131 \hich\af1\dbch\af31505\loch\f1  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637\charrsid3294131 \hich\af1\dbch\af31505\loch\f1 L}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 etter}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637\charrsid3294131 \hich\af1\dbch\af31505\loch\f1  of }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637 \hich\af1\dbch\af31505\loch\f1 
r}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637\charrsid3294131 \hich\af1\dbch\af31505\loch\f1 equest for }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637 \hich\af1\dbch\af31505\loch\f1 s}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\lang2057\langfe2052\dbch\af31505\langfenp2052\insrsid12131637\charrsid3294131 \hich\af1\dbch\af31505\loch\f1 
ervices
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 
\par 
\par }\pard\plain \ltrpar\qj \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 Dear Dr
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid12131637\charrsid3294131 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 I am referring [patient\rquote s name] for 
\par 
\par I am referring [patient\rquote s name] [date of birth] for [number of sessions] sessions.
\par 
\par I have been [patient\rquote s name]\rquote s primary care physician for the past [number of years] years.
\par 
\par In summary, the following assessment and treatment planning has been undertaken: [  ]
\par 
\par 
\par Mental Health Treatment Plan attached:  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 
650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 Yes  }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid12131637\charrsid3294131  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname 
Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 No
\par 
\par Specific treatment requests}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637 :}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131  [  ]
\par 
\par 
\par If you have any questions, please feel free to contact me directly. I will be available on phone [T+00000000] and email [email@email.com] in case of any query.}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637 
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 
\par Looking forward to your reply}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637 .}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 
\par 
\par }\pard\plain \ltrpar\s29\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 Yours sincerely,
\par 
\par 
\par 
\par [Signature]}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 \tab \tab \tab \tab 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\expnd0\expndtw-1\insrsid12131637\charrsid3294131 [Physician\rquote }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 s }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\fs20\expnd0\expndtw-1\insrsid12131637 n}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\expnd0\expndtw-1\insrsid12131637\charrsid3294131 ame}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\expnd0\expndtw-1\insrsid12131637  and title}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \fs20\expnd0\expndtw-1\insrsid12131637\charrsid3294131 ]}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \fs20\insrsid12131637\charrsid3294131 
\par 
\par \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid3294131 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\insrsid12131637\charrsid3294131 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \caps\f1\fs20\insrsid12131637\charrsid12006798 [}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid12131637\charrsid12006798 Provider number}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\insrsid12131637\charrsid12006798 ]
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2905631\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\caps\f1\fs20\cf6\insrsid14422781\charrsid14422781 
\par }\pard \ltrpar\qc \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2905631\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid2905631\charrsid14422781 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2905631\charrsid14422781 
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2905631 
\par }\pard \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid7289837\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2905631 
\par }\pard \ltrpar\qc \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2905631\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2905631 
\par 
\par 
\par }\pard \ltrpar\ql \li0\ri0\sb120\sa120\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12131637\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid2905631\charrsid214099 \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid2905631\charrsid214099 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trrh117\trleft284\trbrdrt\brdrinset\brdrw15 \trbrdrl\brdrinset\brdrw15 \trbrdrb\brdrinset\brdrw15 \trbrdrr\brdrinset\brdrw15 \trbrdrh\brdrinset\brdrw15 \trbrdrv
\brdrinset\brdrw15 \trftsWidth1\trftsWidthB3\trwWidthB216\trftsWidthA3\trwWidthA192\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3
\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrinset\brdrw15 \clbrdrl\brdrinset\brdrw15 \clbrdrb\brdrinset\brdrw15 \clbrdrr\brdrinset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth9882\clshdrawnil \cellx10206
\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trrh363\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \clcbpat20\cltxlrtb\clftsWidth3\clwWidth10370\clcbpatraw20 \cellx10458\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091 \page }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid7013091\charrsid7803740 REVIEW\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trrh363\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl
\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \clcbpat20\cltxlrtb\clftsWidth3\clwWidth10370\clcbpatraw20 \cellx10458\row \ltrrow}\trowd \irow2\irowband2\ltrrow
\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10370\clshdrawnil \cellx10458\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16076831\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid16076831 MBS item number}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 :}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 {\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740  }{\rtlch\fcs1 
\af1\afs20 \ltrch\fcs0 \caps\f1\fs20\insrsid7013091\charrsid7803740 2712    }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid4798275 
{\*\datafield 650000001400000007436865636b323600000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check26}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery708\footery708\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid680115\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740  }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\caps\f1\fs20\insrsid7013091\charrsid7803740 2719}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow2\irowband2\ltrrow
\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth10370\clshdrawnil \cellx10458\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trleft8\trbrdrt
\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4949\clshdrawnil \cellx5017\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb
\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5381\clshdrawnil \cellx10458\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 
\af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 Planned date for review with GP
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831 (Initial review four weeks to six}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740  months after completion of plan)}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\b\f1\fs20\insrsid7013091\charrsid7803740 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr
\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4949\clshdrawnil \cellx5017\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb
\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5381\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 
\rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid7013091\charrsid14703373 Actual date of review with GP\cell }{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow4\irowband4\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr
\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4949\clshdrawnil \cellx5017\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb
\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5381\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16076831\yts23 
\rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid16076831\charrsid16076831 Assessment/outcome tool results on review
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid16076831\charrsid11299109 (except where clinically inappropriate)}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid16076831\charrsid6250655 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 
\par \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow5\irowband5\ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 
\trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4949\clshdrawnil \cellx5017\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb
\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5381\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 
\rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid9572134 Comments
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740 Consider:
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid7013091\charrsid9572134 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls5\adjustright\rin0\lin360\pararsid11285029\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\ul\insrsid7013091\charrsid9572134 Progress on goals and actions
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid16076831 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831 Identified actions have}
{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740  been }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831 initiated and followed through (}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740 
e.g. referrals, appointments, attendance}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831 )}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid7013091\charrsid5257806 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\ul\insrsid7013091\charrsid5257806 Checking, reinforcing and expanding education
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid7013091\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid7013091\charrsid7803740 Communication}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831  between the GP and patient}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091\charrsid7803740 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid7013091\charrsid7803740 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Where appropriate, communication received from referred practitioners}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid7013091\charrsid5257806 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\ul\insrsid7013091\charrsid5257806 Modification of treatment plan if required
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 \cell }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 \trowd \irow6\irowband6\ltrrow
\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4949\clshdrawnil \cellx5017\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb
\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5381\clshdrawnil \cellx10458\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 
\rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\insrsid7013091\charrsid16076831 Intervention/relapse prevention plan}{\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid16076831  (if appropriate)
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16076831\yts23 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831 Consider:}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 
\f1\fs20\insrsid16076831\charrsid2962803 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid16076831\charrsid16076831 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li360\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls8\adjustright\rin0\lin360\pararsid16076831\yts23\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831\charrsid16076831 Warning signs from past experiences
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid16076831\charrsid16076831 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Arrangements to intervene in case of relapse or crisis
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid16076831\charrsid16076831 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Other support services currently in place}{\rtlch\fcs1 
\ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid7013091 
\par {\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f3\fs20\lang3081\langfe3081\langfenp3081\insrsid16076831 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831 
Any past effective strategies}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid16076831\charrsid16076831 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11285029\yts23 
\rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \fs22\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid7803740 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang3081\langfe3081\cgrid\langnp3081\langfenp3081 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid7013091 
\trowd \irow7\irowband7\lastrow \ltrrow\ts23\trgaph108\trleft8\trbrdrt\brdroutset\brdrw15 \trbrdrl\brdroutset\brdrw15 \trbrdrb\brdroutset\brdrw15 \trbrdrr\brdroutset\brdrw15 \trbrdrh\brdroutset\brdrw15 \trbrdrv\brdroutset\brdrw15 
\trftsWidth1\trftsWidthB3\trautofit1\trspdl20\trspdt20\trspdb20\trspdr20\trspdfl3\trspdft3\trspdfb3\trspdfr3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2905631\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth4949\clshdrawnil \cellx5017\clvertalt\clbrdrt\brdroutset\brdrw15 \clbrdrl\brdroutset\brdrw15 \clbrdrb
\brdroutset\brdrw15 \clbrdrr\brdroutset\brdrw15 \cltxlrtb\clftsWidth3\clwWidth5381\clshdrawnil \cellx10458\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7013091 {\rtlch\fcs1 \af1\afs20 
\ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid12871205 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16453115 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid7013091\charrsid12871205 
\par }{\*\themedata 504b030414000600080000002100e9de0fbfff0000001c020000130000005b436f6e74656e745f54797065735d2e786d6cac91cb4ec3301045f748fc83e52d4a
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0c895fcf6720192de6bf3b9e89ecdbd6596cbcdd8eb28e7c365ecc4ec1ff1460f53fe813d3cc7f5b7f020000ffff0300504b030414000600080000002100a5d6
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4b0d592c9c070d8a65cd2e88b7f07c2ca71ba8da481cc52c6ce1c715e6e97818c9b48d13df49c873517d23d59085adb5dd20d6b52bd521ef2cdd5eb9246a3d8b
4757e8d3f729e245eb2b260a0238fd010000ffff0300504b03041400060008000000210096b5ade296060000501b0000160000007468656d652f7468656d652f
7468656d65312e786d6cec594f6fdb3614bf0fd87720746f6327761a07758ad8b19b2d4d1bc46e871e698996d850a240d2497d1bdae38001c3ba618715d86d87
615b8116d8a5fb34d93a6c1dd0afb0475292c5585e9236d88aad3e2412f9e3fbff1e1fa9abd7eec70c1d1221294fda5efd72cd4324f1794093b0eddd1ef62fad
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