Child Disability Assessment Determination 2001
Sch 2Rating Method
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Schedule 2 Rating Method
(section 2.3)
STEP 1: Calculate the child’s chronological age:
| (a) child’s date of birth: | ____________________ | |
|---|---|---|
| (b) date of completion of the questionnaires: | ____________________(by claimant) | ____________________(by treating health professional) |
| (c) child’s chronological age: | _____years_____months(as at date of completion of claimant questionnaire) | _____years_____months(as at date of completion of professional questionnaire) |
STEP 2:
(b) the child’s functional age, based on the response marked in the functional domains numbered 1, 2, 3, 5, 6 and 7 in each questionnaire.
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td style="width:46.9pt; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span></span></p></td><td colspan="10" style="width:386pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>CHRONOLOGICAL AGE</span></p></td></tr><tr><td style="width:46.9pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>Functional age</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>Birth</span><br><span>to <6 months</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>6 months to <1 year</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>1 year to <2 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>2 years to <3 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>3 years to <4 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>4 years to <6 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>6 years to <9 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>9 years to <12 years</span></p></td><td style="width:28.9pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>12 years to <15 years</span></p></td><td style="width:28.9pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>15 years or older</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>Birth to <6 months (response a)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+7</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+8</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+9</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>6 months to <1 year (response b)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+6</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+7</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+8</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>1 year to <2</span><span> </span><span>years (response c)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+5</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+6</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+7</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>2 years to <3 years (response d)</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+5</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+6</span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><tbody><tr><td style="width:46.9pt; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span></span></p></td><td colspan="10" style="width:386pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>CHRONOLOGICAL AGE</span></p></td></tr><tr><td style="width:46.9pt; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>Functional age</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>Birth</span><br><span>to <6 months</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>6 months to <1 year</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>1 year to <2 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>2 years to <3 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>3 years to <4 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>4 years to <6 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>6 years to <9 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>9 years to <12 years</span></p></td><td style="width:28.9pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>12 years to <15 years</span></p></td><td style="width:28.9pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>15 years or older</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>3 years to <4 years (response e)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+5</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>4 years to <6 years (response f)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>6 years to <9 years (response g)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>9 years to <12 years (response h)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>12 years to <15 years (response i)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-8</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>15 years or older (response j)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-9</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-8</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-2</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>-1</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>No skills demon-strated (response k)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+8</span></p></td><td style="width:28.9pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+9</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>+10</span></p></td></tr><tr><td style="width:46.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>Age appropriate (response l)</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td><td style="width:28.9pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="font-size:8pt"><span>0</span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><thead><tr><td style="width:57.35pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; text-align:center; line-height:11pt"><span style="font-size:8pt"></span></p></td><td colspan="9" style="width:346.6pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">CHRONOLOGICAL AGE</span></p></td></tr><tr><td style="width:57.35pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">Functional age</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">Birth to <1 year</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">1 year to <2 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">2 years to <3 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">3 years to <4 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">4 years to <6 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">6 years to <9 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">9 years to <12 years</span></p></td><td style="width:29pt; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">12 years to <15 years</span></p></td><td style="width:29pt; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">15 years or older</span></p></td></tr></thead><tbody><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">Birth to <1</span><span style="font-size:8pt"> </span><span style="font-size:8pt">year (response a)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+7</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+8</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">1 year to <2</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response b)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+7</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">2 years to <3</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response c)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">3 years to <4</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response d)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">4 years to <6</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response e)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">6 years to <9</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response f)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">9 years to <12</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response g)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">12 years to <15</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response h)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">15 years or older</span><br><span style="font-size:8pt">(response i)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-8</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">No skills demonstrated (response j)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+8</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+9</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">Age appropriate (response k)</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; margin-bottom:0pt; border:0.75pt solid #000000; border-collapse:collapse"><thead><tr><td style="width:57.35pt; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt"></span></p></td><td colspan="9" style="width:346.6pt; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">CHRONOLOGICAL AGE</span></p></td></tr><tr><td style="width:57.35pt; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">Functional age</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">Birth</span><br><span style="font-size:8pt">to <6 months</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">6 months to <1 year</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">1 year to <2 years</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">2 years to <3 years</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">3 years to <4 years</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">4 years to <6 years</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">6 years to <9 years</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">9 years to <12 years</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="margin-top:3pt; margin-bottom:3pt; line-height:11pt"><span style="font-size:8pt">12 years or older</span></p></td></tr></thead><tbody><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">Birth to <6</span><span style="font-size:8pt"> </span><span style="font-size:8pt">months (response a)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+7</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+8</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">6 months to <1</span><span style="font-size:8pt"> </span><span style="font-size:8pt">year (response b)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+7</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">1 year to <2</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response c)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">2 years to <3</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response d)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">3 years to <4</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response e)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">4 years to <6</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response f)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">6 years to <9</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response g)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">9 years to <12</span><span style="font-size:8pt"> </span><span style="font-size:8pt">years (response h)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">12 years or older (response i)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-8</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">-1</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">No skills demonstrated (response j)</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+1</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+2</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+3</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+4</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+5</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+6</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+7</span></p></td><td style="width:29pt; border:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+8</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">+9</span></p></td></tr><tr><td style="width:57.35pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">Age appropriate (response k)</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-right:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td><td style="width:29pt; border-top:0.75pt solid #000000; border-left:0.75pt solid #000000; padding-right:4.97pt; padding-left:4.97pt; vertical-align:top"><p style="line-height:11pt"><span style="font-size:8pt">0</span></p></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; margin-bottom:0pt; border-collapse:collapse"><tbody><tr><td style="width:51.35pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 1</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Functional domain in claimant questionnaire</span></p></td><td style="width:31.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 2</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Score obtained from steps 2 to 5</span></p></td><td style="width:50.5pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 3</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Questionnaire weighting</span></p></td><td style="width:38.9pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 4</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Milestone weighting</span></p></td><td style="width:50.5pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 5</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Calculate the self care skills score</span></p></td><td style="width:31.85pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 6</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Raw score</span></p></td><td colspan="2" style="width:38.9pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 7</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Functional weighting</span></p></td><td colspan="2" style="width:31.85pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 8</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Total</span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>7</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:50.5pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/10</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:50.5pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td colspan="2" style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td colspan="2" style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>8</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:50.5pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/9</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:50.5pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td colspan="2" style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td colspan="2" style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>9</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:50.5pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span></span></p></td><td style="width:50.5pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td colspan="2" style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td colspan="2" style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>10</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:50.5pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td style="width:50.5pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td colspan="2" style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:0pt; font-size:10pt"><span>multiply by 2</span></p><p style="margin-top:0pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td colspan="2" style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td colspan="7" style="width:356.1pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>INTERIM CLAIMANT TOTAL SCORE</span></p></td><td colspan="2" style="width:31.85pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="vertical-align:top"></td></tr><tr style="height:0pt"><td style="width:62.05pt"></td><td style="width:42.5pt"></td><td style="width:61.2pt"></td><td style="width:49.6pt"></td><td style="width:61.2pt"></td><td style="width:42.55pt"></td><td style="width:47.7pt"></td><td style="width:1.9pt"></td><td style="width:40.65pt"></td><td style="width:1.9pt"></td></tr></tbody></table>
```
<table cellspacing="0" cellpadding="0" style="margin-top:0pt; margin-bottom:0pt; border-collapse:collapse"><thead><tr><td style="width:51.35pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 1</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Functional domain in professional questionnaire</span></p></td><td style="width:31.8pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 2</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Score obtained from steps 2 to 5</span></p></td><td style="width:53.1pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 3</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Questionnaire weighting</span></p></td><td style="width:38.9pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 4</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Milestone weighting</span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 5</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Calculate the self care skills score</span></p></td><td style="width:38.9pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 6</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Raw score</span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 7</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Functional weighting</span></p></td><td style="width:31.85pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-top:3pt; font-size:7pt"><span>Column 8</span></p><p style="margin-bottom:3pt; font-size:7pt"><span>Total</span></p></td></tr></thead><tbody><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>4</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/9</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>responses from 3, 4 and 5 and</span></p></td><td style="width:38.9pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>5</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/10</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>divide the figure by 3</span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>6</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/10</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>7</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/10</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>8</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>10/9</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>9</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span></span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td style="width:51.35pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>10</span></p></td><td style="width:31.8pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:53.1pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>divide by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span></span></p></td><td style="width:38.95pt; border-top:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top; background-color:#7f7f7f"><p style="font-size:10pt"><span></span></p></td><td style="width:38.9pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:38.95pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span>multiply by 2</span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td><td style="width:31.85pt; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="margin-bottom:12pt; font-size:10pt"><span></span></p><p style="margin-top:12pt; font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr><tr><td colspan="7" style="width:356.15pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span>INTERIM TREATING HEALTH PROFESSIONAL TOTAL SCORE</span></p></td><td style="width:31.85pt; border-top:0.75pt solid #000000; border-bottom:0.75pt solid #000000; padding-right:5.35pt; padding-left:5.35pt; vertical-align:top"><p style="font-size:10pt"><span style="width:28.35pt; font-family:'Lucida Console', monospace; text-decoration:underline; display:inline-block"></span></p></td></tr></tbody></table>
```