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CDNLGAFO160226Dispensing Chart Notes: Custom Molded Gauntlet PATIENT INFORMATION: Mr./Ms. ___ICN:___DOB:___ /___ /___DX: CHECK ALL THAT APPLY Corresponds to Biomechanical Examination Form Adult Acquired
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Gather all the necessary information for filling out the self-reported form.
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Carefully read and follow the instructions provided on the form.
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Start by providing your personal information such as name, address, contact details, etc.
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Proceed to fill out the social and activity section by listing your daily routines, hobbies, social interactions, etc.
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Who needs self-reported social and activity?

01
Individuals participating in research studies or surveys that require information on social and activity habits.
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Patients undergoing medical treatment that necessitates tracking of social and activity patterns.
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Students collecting data for academic projects related to social and activity behaviors.
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Self-reported social and activity refers to reporting personal social activities and physical activities that an individual engages in.
Individuals who participate in social and physical activities are required to file self-reported social and activity.
Self-reported social and activity can be filled out by providing details of the social and physical activities conducted during a specific period.
The purpose of self-reported social and activity is to track and monitor an individual's social and physical activities.
Information such as type of activity, duration, frequency, and any other relevant details must be reported on self-reported social and activity.
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