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YELLOW FLAG RISK FORM Name:___Primary Complaint:___1. Please indicate your usual level of pain during the past week. No Pain Worst pain possible 0 1 2 3 4 5 6 7 8 9 10 2. Does pain, numbness, tingling,

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Form optimal screening is used to assess and identify individuals or entities that may pose a risk in regulatory compliance and to ensure efficient review processes.

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