| RPT |
|Functional Assessment Staging
| Gender: <.Patient_Gender.>
|
|
| PLACEHOLDER FOR DEPRECATED FAST-ORIGINAL
|
|
|Copyright (c) 1984 by Barry Reisberg, M.D., Reproduced with permission.
|
|Information contained in this note is based on a self-report assessment and is
not sufficient to use alone for diagnostic purposes. Assessment results
|
should be verified for accuracy and used in conjunction with other diagnostic activities and procedures.
| Date Given: <.Date_Given.>
| Clinician: <.Staff_Ordered_By.>
| Location: <.Location.>
|
| Veteran: <.Patient_Name_Last_First.>
| SSN: <.Patient_SSN.>
| DOB: <.Patient_Date_Of_Birth.> (<.Patient_Age.>)
|
