№ lp_1_2_38786
File format: docx
Character count: 1899
File size: 37 KB
This is a self-report form used by assisted living facilities in Wisconsin for reporting incidents to the Division of Quality Assurance (DQA), detailing information about the incident, involved persons, and actions taken to ensure resident well-being.
Year:
2024
Region / City:
Wisconsin
Topic:
Assisted Living Facility Reporting
Document Type:
Form
Organization / Institution:
Department of Health Services, Division of Quality Assurance
Author:
Department of Health Services
Target Audience:
Assisted Living Facility Administrators
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
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The product description is provided for reference. Actual content and formatting may differ slightly.
Year:
2006-2007
Type of document:
Symptom checklist / assessment tool
Target audience:
Adults
Authors:
Adler et al., Kessler et al.
Purpose:
Screening for ADHD symptoms
Scope:
Clinical assessment
Scoring:
Part A (items 1-6), Part B (items 7-18)
Instructions:
Self-report, rate frequency of behaviors over past 6 months
Year:
2026
Type of document:
Self-assessment questionnaire
Intended audience:
Adults
Topic:
ADHD symptoms
Completion instructions:
Rate yourself on each criterion over the past 6 months and return to GP
Format:
Checklist
Title:
Self-Report Camouflaging of Autistic Traits Questionnaire
Type of document:
Questionnaire
Subject area:
Autism spectrum traits
Focus:
Social interaction and camouflaging behaviors
Response scale:
7-point Likert scale
Intended respondents:
Individuals reflecting on their own social experiences
Associated instrument:
Camouflaging of Autistic Traits Questionnaire (CAT-Q)
Related publication:
Development and Validation of the Camouflaging of Autistic Traits Questionnaire (CAT-Q)
Authors:
Hull, L.; Mandy, M.; Lai, M-C.; Baron-Cohen, S.; Allison, C.; Smith, P.; Petrides, K.V.
Year:
2018
Source:
Journal of Autism & Developmental Disorders
Format:
Self-report survey
Content type:
Statements with optional open-ended responses
Year:
2023
Region / City:
PMI Keystone Chapter
Topic:
Project Management Certifications
Document Type:
Instructional Guide
Organization:
PMI Keystone Chapter
Author:
PMI Keystone Chapter
Target Audience:
PMI certification holders
Period of Action:
Ongoing
Approval Date:
N/A
Modification Date:
N/A
Year:
2025
Region / City:
Québec
Topic:
Critical Infrastructure Protection
Document Type:
Self-Report Form
Organization:
Northeast Power Coordinating Council (NPCC)
Author:
NPCC
Target Audience:
Registered Entities in the Québec Reliability Standards Program
Effective Period:
2025-2026
Approval Date:
October 2025
Revision Date:
January 2026
Year:
2001
Region / City:
Not specified
Subject:
Impulsivity, Behavioral Psychology
Document Type:
Self-Report Measure
Author:
Whiteside, S. P., Lynam, D. R.
Target Audience:
Researchers, Psychologists
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Source:
Psychological Assessment, 19, 107–118
Description:
A self-report measure designed to assess five dimensions of impulsivity, including Negative Urgency, Positive Urgency, Perseverance, Premeditation, and Sensation Seeking.
Year:
2023
Type of document:
Supplemental Material
Authors:
Nola Chambers, Tosca-Marie Heunis, Sugnet Gardner-Lubbe, Jamie K Capal, Stacey Bissell, Anna W Byars, Sebastián Cukier, Peter E Davis, Jennifer Flinn, Tanjala T Gipson, J Chris Kingswood, Aubrey J Kumm, Eva Schoeters, Catherine Smith, Shoba Srivastava, Megumi Takei, Stephanie Vanclooster, Agnies M van Eeghen, Robert Waltereit, Darcy A Krueger, Mustafa Sahin, Liesbeth De Waele, Anna C Jansen, Petrus J de Vries
Field:
Neurodevelopmental Disorders
Focus:
Internal consistency and discriminant validity of TAND-SQ clusters
Population:
Individuals with Tuberous Sclerosis Complex (TSC)
Sample size:
92 (individuals), 66 (caregivers)
Data type:
Self-report checklist
Reference studies:
Alperin et al., 2021; de Vries et al., 2021; Leclezio et al., 2018; de Vries et al., 2020; Heunis et al., 2023
Year:
2012
Region / City:
International
Topic:
Adult Attention Deficit Hyperactivity Disorder
Document Type:
Self-report questionnaire
Organization:
World Health Organization
Author:
Ronald Kessler, PhD
Target Audience:
Adults, healthcare professionals
Based on:
Composite International Diagnostic Interview, 2001
Purpose:
Screening for adult ADHD symptoms
Instructions:
Complete and provide to healthcare professional
Year:
Not specified
Country:
United States
Region / City:
Logan, Utah; Cambridge, Massachusetts
Academic Field:
Psychology; Audiology
Research Topic:
Misophonia and hyperacusis co-occurrence and psychological correlates
Type of Document:
Academic research article
Authors:
Mercedes G. Woolley; Karen Muñoz; Guadalupe G. San Miguel; Anderson Clements; Julie M. Petersen; Michael P. Twohig
Author Affiliations:
Department of Psychology, Utah State University; Department of Communicative Disorders and Deaf Education, Utah State University; Department of Psychology, Harvard University
Institution:
Utah State University; Harvard University
Target Population:
Adults seeking treatment for misophonia
Sample Size:
60 participants
Methodology:
Self-report questionnaires and loudness discomfort level (LDL) audiological testing
Key Variables:
Hyperacusis indicators, misophonia severity, emotional and behavioral reactivity, depression, anxiety, stress
Conflict of Interest:
No relevant conflicts of interest reported
Contact Institution Address:
Department of Psychology, Utah State University, 2810 Old Main Hill, Logan, UT 84321, USA
Year:
Not specified
Region / city:
Not specified
Topic:
Disease severity, self-reported indices, statistical analysis
Document type:
Research analysis
Organization / institution:
Not specified
Author:
Not specified
Target audience:
Researchers, medical professionals
Period of validity:
Not specified
Approval date:
Not specified
Date of changes:
Not specified
Year:
2023
Type of document:
Questionnaire / Research material
Subject:
Informal second language learning, learner engagement
Institution:
University of York, IRIS Database
Author:
H.L. Arndt
Target audience:
Second language learners
Data collection method:
Self-report survey
Measures:
Affective, cognitive, linguistic, and behavioural engagement
Scale:
Frequency of activities and engagement levels
Data analysis:
Descriptive statistics, skewness, kurtosis
Publication DOI:
10.48316/xFCKb-IxdcC
Language:
English
Year:
2025
Region / City:
Augusta, ME
Subject:
Assisted Housing, Licensing, Assisted Living Facilities
Document Type:
Rule
Organization / Institution:
Department of Health and Human Services
Author:
Not specified
Target Audience:
Assisted living facility operators, staff, and regulatory bodies
Effective Date:
September 18, 2025
Amendment Date:
Not specified
Period of Application:
Ongoing from September 18, 2025
Approval Date:
Not specified
Changes Date:
Not specified
Section:
Part A
Enforcement:
Inspections, sanctions, compliance
Resident Rights:
Rights and protections for facility residents
Medication Handling:
Guidelines for medication administration
Staffing:
Training and qualifications for facility staff
Food and Infection Control:
Standards for food handling, storage, and infection prevention
Facility Standards:
Compliance with health and safety codes
Scope of Licenses:
Types of licenses and their scope
Year:
2026
Region / City:
Washington State
Document Type:
License application instructions and checklist
Responsible Authority:
Washington State Department of Social and Health Services (DSHS)
Target Audience:
Prospective assisted living facility operators
Required Identifiers:
Federal Employer Identification Number (EIN), Unified Business Identifier (UBI)
Related Legal Documents:
Certificate of Incorporation / Certificate of Formation
Fees:
$383 per bed
Submission Methods:
US Postal Mail, Federal Express, UPS
Inspection Type:
Initial License, Change of Ownership
Note:
Year
Topic:
Fertility treatment pricing
Document Type:
Price List
Organization / Institution:
Ninewells Hospital
Target Audience:
Patients seeking self-funded fertility treatment
Year:
2022
Region / city:
Massachusetts
Topic:
Assisted Living
Document Type:
Guide
Organization:
Executive Office of Aging & Independence
Author:
Executive Office of Aging & Independence
Target Audience:
Consumers considering assisted living
Period of Validity:
Not specified
Approval Date:
Not specified
Date of Changes:
Not specified
Note:
Year
Authority / Organization:
Virginia Department of Social Services
Year:
2021
Region / city:
Victoria, Australia
Subject:
Voluntary assisted dying
Document type:
Policy guidance
Organization / institution:
Department of Health and Human Services, Victoria
Author:
Department of Health and Human Services
Target audience:
Health service staff
Period of validity:
Ongoing
Approval date:
2021
Date of amendments:
Not applicable
Note:
Contextual description
Year:
2021
Region / City:
United States
Theme:
Health plan enrollee experience survey
Document Type:
Survey script
Organization / Institution:
QHP Issuer
Author:
Not specified
Target Audience:
QHP enrollees
Period of Action:
July through December 2020
Approval Date:
Not specified
Modification Date:
Not specified
Note:
Year
Topic:
Emergency Environmental Control
Document Type:
Sample Format for Plan Submission
Organization / Institution:
AHCA (Agency for Health Care Administration)
Author:
AHCA
Target Audience:
Assisted Living Facility Administrators