Peer & Self Evaluation Form
Place the respondent’s score on each question in the column to the left of the question and total down. High School Education Less than High School Education 27-30 Normal 25-30 21-26 MNCD* 20-24 1-20 Dementia 1-19 *Mild Neurocognitive Disorder DISTRIBUTION. The SLUMS form shall be scanned into the respondent’s electronic record. ................
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