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Quent deficiencies of concentration, persistence or pace resulting in failure to complete tasks in a timely manner in work, home of school setting. 2. The individual has met criteria for ratings of 50 or less on the Global Assessment of Functioning Scale (Axis V of DSM-IV) due to a designated mental illness over the past 12 months on a continuous or intermittent basis. Yes Yes No Yes Yes Yes No No No Yes No Yes Yes Yes No No No Date: From To: Score: D. Reliance on Psychiatric Treatm.

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