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Rt-term memory loss: Yes No (If there is no evidence of short-term memory loss, the assessor may go to 4.b, and skip 2 and 3.) And 2. One or more of the following conditions: (Check all that apply.) Is not oriented to place or time. Has limited ability to make him or herself understood through speech, writing, sign language or any other method the individual uses to communicate. Requires hands-on assistance with eating or drinking. (If there is no evidence of one of these conditions, the assesso.

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