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Get Beacon Health Options (Formerly ValueOptions ORF 2) 2008-2024

Disturbance (Depression or Mania) 0 1 2 3 na Anxiety 0 1 2 3 na Psychosis/Hallucinations/Delusions 0 1 2 3 na Thinking/Cognition/Memory/Concentration Problems 0 1 2 3 na Impulsive/Reckless/Aggressive Behavior 0 1 2 3 na Activities of Daily Living Problems 0 1 2 3 na Weight Change Associated with a Behavioral Diagnosis 0 1 2 3 na Gain Loss Select One: na of _________ pounds in last three months na Height = ________ft. ______ inches na Current weight = _____ lbs. Medical/Physical Condition 0 1 2 3.

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