a) Prior to the accident, did the applicant have any disease, condition or injury that could affect his/her response to treatment for the injuries identified in Part 7
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a) If Yes to "a" above, did the applicant undergo investigation or receive treatment for this disease, condition or injury in the past year?
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a) Since the accident, has the applicant developed any other disease, condition or injury not related to the automobile accident that could affect his/her response to treatment for the injuries identified in Part 7?
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OCF-18: Part 8 Activity Limitations
a) Does the applicant's impairment(s) from the injuries identified in Part 7 affect his/her ability to carry out:
If Yes to either of the questions above, briefly describe the activities limited by the impairment and their impacts on the applicant's ability to function.
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c) If the applicant is unable to carry out pre-accident employment activity, is the employer able to provide suitable modified employment to the applicant?
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OCF-18: Part 8 Activity Limitations
a) Goals
Identify the goal(s) in regard to the applicant's impairment(s), symptom(s) or pathology that this Treatment Plan seeks to achieve:
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a) Goals
Select the functional goal(s) that this Treatment Plan seeks to achieve:
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b) Evaluation
How will progress on the goal(s) in a) (i) and a) (ii) be evaluated:
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b) Evaluation
If this is a subsequent Treatment and Assessment Plan, what was the applicant's improvement at the end of the previous plan based on your evaluation method?
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c) Barriers to Recovery
Have you identified any other barriers to recovery? If yes, please explain:
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c) Barriers to Recovery
Do you have any recommendations and/or strategies to overcome these barriers? If yes, please explain:
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d) Concurrent Treatment
Are you aware if any concurrent treatment, that is not included in this Treatment Plan, will be provided by any other provider/facility?