<p class=MsoNormal align=center style='text-align:center;line-height:150%'><b<!-- [et_pb_line_break_holder] -->style='mso-bidi-font-weight:normal'><span style='font-size:14.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] -->10.0pt;line-height:150%'>CAREGIVER CONTRIBUTIONS TO SELF-CARE OF HEART FAILURE<!-- [et_pb_line_break_holder] -->INDEX v.2<o:p></o:p></span></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal align=center style='text-align:center;line-height:150%'><i<!-- [et_pb_line_break_holder] -->style='mso-bidi-font-style:normal'>All answers are confidential.<o:p></o:p></i></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText><span style='mso-bidi-font-weight:bold'>We kindly ask you<!-- [et_pb_line_break_holder] -->to answer the following questions so that we know what you do for the person<!-- [et_pb_line_break_holder] -->with heart failure. There are not right or wrong answers. <b><o:p></o:p></b></span></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='line-height:150%'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] -->normal'><span style='font-size:14.0pt;mso-bidi-font-size:10.0pt;line-height:<!-- [et_pb_line_break_holder] -->150%'>SECTION A:<o:p></o:p></span></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText>How often do you <u>recommend</u> these things to the<!-- [et_pb_line_break_holder] -->person you care for?</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='tab-stops:163.05pt'>(Or, how often do you <u>do</u><!-- [et_pb_line_break_holder] -->these activities because the person you care for is not able to do them).</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal style='line-height:50%'><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] -->mso-bidi-font-size:10.0pt;line-height:50%'><o:p> </o:p></span></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> mso-border-insideh:2.25pt solid white;mso-border-insidev:2.25pt solid white'><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p> </o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-left-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;<!-- [et_pb_line_break_holder] --> mso-color-alt:windowtext'>Never </span></b><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-left-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6><o:p> </o:p></h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6><span style='color:black;mso-color-alt:windowtext'>Sometimes</span></h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-left-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><o:p> </o:p></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>Always </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:1'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#CCCCCC;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>1.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Try to avoid getting sick (e.g.,<!-- [et_pb_line_break_holder] --> wash your hands)? </span><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:2'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>2.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Get some exercise (e.g., take a<!-- [et_pb_line_break_holder] --> brisk walk, use the stairs)?</span><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in;tab-stops:10.5pt center 30.6pt'><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:windowtext'><span<!-- [et_pb_line_break_holder] --> style='mso-tab-count:2'>         </span>1</span><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] --> mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:3'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#CCCCCC;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>3.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Eat a low salt diet?</span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:4'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>4.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>See the health care provider for<!-- [et_pb_line_break_holder] --> routine health care?</span><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:5'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#CCCCCC;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>5.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Take prescribed medicines<!-- [et_pb_line_break_holder] --> without missing a dose?</span><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:6'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>6.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Order low salt items when eating<!-- [et_pb_line_break_holder] --> out?</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:7'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#CCCCCC;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>7.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Make sure to get a flu shot<!-- [et_pb_line_break_holder] --> annually?</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:8'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>8.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Ask for low salt foods when<!-- [et_pb_line_break_holder] --> visiting family and friends?</span><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:9'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#CCCCCC;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>9.<span style='font:7.0pt "Times New Roman"'>     <!-- [et_pb_line_break_holder] --> </span></span></span><![endif]><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt;color:black;mso-color-alt:windowtext'>Use a system or method to help<!-- [et_pb_line_break_holder] --> remember to take medicines?</span><span style='font-size:13.0pt;mso-bidi-font-size:<!-- [et_pb_line_break_holder] --> 10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid white 2.25pt;border-right:solid white 2.25pt;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#CCCCCC;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-bottom:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#CCCCCC;mso-shading:white;mso-pattern:gray-20 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:10;mso-yfti-lastrow:yes'><!-- [et_pb_line_break_holder] --> <td width=342 valign=top style='width:256.5pt;border:none;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;background:#F2F2F2;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>10.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>Ask your health care provider about medicines?</span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:none;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-right:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;<!-- [et_pb_line_break_holder] --> background:#F2F2F2;mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=102 valign=top style='width:76.5pt;border:none;mso-border-top-alt:<!-- [et_pb_line_break_holder] --> solid white 2.25pt;mso-border-left-alt:solid white 2.25pt;background:#F2F2F2;<!-- [et_pb_line_break_holder] --> mso-shading:white;mso-pattern:gray-5 black;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b>SECTION B:<o:p></o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText>Listed below are changes that people with heart failure commonly<!-- [et_pb_line_break_holder] --><u>monitor</u>. How often do you <u>recommend</u> to the person you care for to<!-- [et_pb_line_break_holder] -->do the following things? Or, you <u>do</u> the following things because the<!-- [et_pb_line_break_holder] -->person you care for is not able to do them.</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><span style='font-size:13.0pt'><o:p> </o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;<!-- [et_pb_line_break_holder] --> mso-color-alt:windowtext'>Never </span></b><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6><o:p> </o:p></h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <h6><span style='color:black;mso-color-alt:windowtext'>Sometimes</span></h6><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><o:p> </o:p></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoHeading7 align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>Always </span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:1'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>11.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Monitor weight daily?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>1<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>2<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>3<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>4<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>5<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:2'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>12.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;color:black;mso-color-alt:windowtext'>Pay attention<!-- [et_pb_line_break_holder] --> to changes in how he/she feels?</span><span style='font-size:13.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:3'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>13.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-weight:bold'>Look for medicine<!-- [et_pb_line_break_holder] --> side-effects?</span><span style='font-size:13.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>1<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>2<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>3<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>4<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>5<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:4'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 0in;margin-left:.25in;margin-bottom:.0001pt;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 22.5pt 27.0pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>14.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;color:black;mso-color-alt:windowtext'>Notice whether he/she<!-- [et_pb_line_break_holder] --> tires more than usual doing normal activities?</span><span style='font-size:<!-- [et_pb_line_break_holder] --> 13.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:5;height:23.8pt'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>15.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Ask the health care provider how he/she is doing?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>1<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>2<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>3<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>4<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>5<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:6;height:23.8pt'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>16.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;color:black;mso-color-alt:windowtext'>Monitor closely<!-- [et_pb_line_break_holder] --> for symptoms?</span><span style='font-size:13.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:7;height:23.8pt'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>17.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Check ankles for swelling?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>1<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>2<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>3<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>4<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>5<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:8;height:23.8pt'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>18.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;color:black;mso-color-alt:windowtext'>Check for<!-- [et_pb_line_break_holder] --> shortness of breath with activity such as bathing and dressing?</span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>1</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>2</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>3</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>4</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>5</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:9;mso-yfti-lastrow:yes;height:23.8pt'><!-- [et_pb_line_break_holder] --> <td width=330 valign=top style='width:247.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:0in;margin-right:0in;margin-bottom:3.0pt;<!-- [et_pb_line_break_holder] --> margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;tab-stops:list .25in'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'><span style='mso-list:Ignore'>19.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Keep a record of symptoms?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=84 valign=top style='width:63.0pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>1<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=42 valign=top style='width:31.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>2<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>3<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=66 valign=top style='width:49.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>4<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt;<!-- [et_pb_line_break_holder] --> height:23.8pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>5<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5 style='margin-top:6.0pt;tab-stops:22.5pt'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] -->normal'><span style='mso-bidi-font-size:13.0pt'><o:p> </o:p></span></b></h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5 style='margin-top:6.0pt;tab-stops:22.5pt'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] -->normal'><span style='mso-bidi-font-size:13.0pt'><o:p> </o:p></span></b></h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5 style='margin-top:6.0pt;tab-stops:22.5pt'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] -->normal'><span style='mso-bidi-font-size:13.0pt'>The last time the person you<!-- [et_pb_line_break_holder] -->care for </span>had symptoms…</b> </h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right'>(circle <b<!-- [et_pb_line_break_holder] -->style='mso-bidi-font-weight:normal'>one</b> number)</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='border-collapse:collapse;border:none;mso-border-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-padding-alt:0in 5.4pt 0in 5.4pt;mso-border-insideh:.5pt solid windowtext;<!-- [et_pb_line_break_holder] --> mso-border-insidev:.5pt solid windowtext'><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'><!-- [et_pb_line_break_holder] --> <td width=217 valign=top style='width:162.9pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><b style='mso-bidi-font-weight:normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Has not had symptoms</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=108 valign=top style='width:81.0pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>I did not</span></b><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'> <b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'>recognize the symptom</b></span><b style='mso-bidi-font-weight:normal'><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Not Quickly</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Somewhat Quickly</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=30 valign=top style='width:22.5pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-left:none;mso-border-left-alt:solid windowtext .5pt;mso-border-alt:<!-- [et_pb_line_break_holder] --> solid windowtext .5pt;background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Very Quickly</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:1'><!-- [et_pb_line_break_holder] --> <td width=217 valign=top style='width:162.9pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in'><![if !supportLists]><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] --> mso-bidi-font-size:10.0pt'><span style='mso-list:Ignore'>20.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>How quickly did you <u>recognize</u><!-- [et_pb_line_break_holder] --> that he/she had symptoms?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>N/A<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=108 valign=top style='width:81.0pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>0<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=30 valign=top style='width:22.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:2;mso-yfti-lastrow:yes'><!-- [et_pb_line_break_holder] --> <td width=217 valign=top style='width:162.9pt;border:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> border-top:none;mso-border-top-alt:solid windowtext .5pt;mso-border-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> background:#E6E6DD;mso-shading:white;mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in'><![if !supportLists]><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] --> mso-bidi-font-size:10.0pt'><span style='mso-list:Ignore'>21.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>How quickly did you <u>know</u> that the symptom was due to heart<!-- [et_pb_line_break_holder] --> failure?</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>N/A</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=108 valign=top style='width:81.0pt;border-top:none;border-left:<!-- [et_pb_line_break_holder] --> none;border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>0</span><span style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=36 valign=top style='width:27.0pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=30 valign=top style='width:22.5pt;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border-top:none;border-left:none;<!-- [et_pb_line_break_holder] --> border-bottom:solid windowtext 1.0pt;border-right:solid windowtext 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-top-alt:solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;<!-- [et_pb_line_break_holder] --> mso-border-alt:solid windowtext .5pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='margin-bottom:6.0pt'><b>SECTION C:<o:p></o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText>Listed below are behaviors that people with heart failure use<!-- [et_pb_line_break_holder] -->to control their symptoms. When the person you care for has symptoms, how likely<!-- [et_pb_line_break_holder] -->are you to <u>recommend</u> that he/she use one of these? Or, you <u>do</u><!-- [et_pb_line_break_holder] -->these because the person you care is not able to do them? </p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right;line-height:50%'><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText align=right style='text-align:right'>(circle <b<!-- [et_pb_line_break_holder] -->style='mso-bidi-font-weight:normal'>one</b> number for each treatment)</p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes;height:36.4pt'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoFooter style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in;tab-stops:.3in 26.1pt'><o:p> </o:p></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Not Likely</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Somewhat Likely</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt;height:36.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Very Likely</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:1'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in'><![if !supportLists]><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] --> mso-bidi-font-size:10.0pt'><span style='mso-list:Ignore'>22.<span<!-- [et_pb_line_break_holder] --> style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>Further limit the salt he/she<!-- [et_pb_line_break_holder] --> eats that day? <o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:2'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 26.1pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>23.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>Reduce fluid intake?</span><span style='font-size:13.0pt;<!-- [et_pb_line_break_holder] --> mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:3'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 26.1pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>24.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>Take a medicine?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:4'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 26.1pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>25.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>Call the health care provider for guidance?</span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:5'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 26.1pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>26.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'>Ask a family member or<!-- [et_pb_line_break_holder] --> friend for advice?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:6'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 26.1pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>27.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt;color:black;mso-color-alt:<!-- [et_pb_line_break_holder] --> windowtext'>Try to figure out why he/she has symptoms?</span><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>1</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>2</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>3</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>4</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><span<!-- [et_pb_line_break_holder] --> style='color:black;mso-color-alt:windowtext'>5</span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:7;mso-yfti-lastrow:yes'><!-- [et_pb_line_break_holder] --> <td width=324 valign=top style='width:243.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in left 26.1pt'><![if !supportLists]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span style='mso-list:<!-- [et_pb_line_break_holder] --> Ignore'>28.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt;mso-bidi-font-size:10.0pt'><span<!-- [et_pb_line_break_holder] --> style='mso-spacerun:yes'> </span>Suggest that he/she limit activity until he/she<!-- [et_pb_line_break_holder] --> feels better?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=60 valign=top style='width:45.0pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=96 valign=top style='width:1.0in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=78 valign=top style='width:58.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5><b style='mso-bidi-font-weight:normal'><span style='font-size:14.0pt'><o:p> </o:p></span></b></h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><h5><span style='font-size:14.0pt'>Think of what you did the last time the<!-- [et_pb_line_break_holder] -->person you care for had symptoms… </span>(circle one number)</h5><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoNormal><o:p> </o:p></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><table class=MsoNormalTable border=0 cellspacing=0 cellpadding=0<!-- [et_pb_line_break_holder] --> style='border-collapse:collapse;mso-padding-alt:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'><!-- [et_pb_line_break_holder] --> <td width=270 valign=top style='width:202.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:0in'><o:p> </o:p></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>I did not do<!-- [et_pb_line_break_holder] --> anything</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Not Sure</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Somewhat Sure</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;border:none;border-bottom:solid black 1.0pt;<!-- [et_pb_line_break_holder] --> mso-border-bottom-alt:solid black .75pt;background:#E6E6DD;mso-shading:white;<!-- [et_pb_line_break_holder] --> mso-pattern:gray-25 olive;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'><b style='mso-bidi-font-weight:<!-- [et_pb_line_break_holder] --> normal'><span style='color:black;mso-color-alt:windowtext'>Very Sure</span><o:p></o:p></b></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --> <tr style='mso-yfti-irow:1;mso-yfti-lastrow:yes'><!-- [et_pb_line_break_holder] --> <td width=270 valign=top style='width:202.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal style='margin-top:3.0pt;margin-right:0in;margin-bottom:<!-- [et_pb_line_break_holder] --> 3.0pt;margin-left:.25in;text-indent:-.25in;mso-list:l1 level1 lfo2;<!-- [et_pb_line_break_holder] --> tab-stops:list .25in'><![if !supportLists]><span style='font-size:13.0pt'><span<!-- [et_pb_line_break_holder] --> style='mso-list:Ignore'>29.<span style='font:7.0pt "Times New Roman"'> </span></span></span><![endif]><span<!-- [et_pb_line_break_holder] --> style='font-size:13.0pt'>Did the treatment you used make him/her feel better?<o:p></o:p></span></p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>0</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=54 valign=top style='width:40.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>1</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>2</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=90 valign=top style='width:67.5pt;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>3</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=48 valign=top style='width:.5in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>4</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> <td width=72 valign=top style='width:.75in;padding:0in 5.4pt 0in 5.4pt'><!-- [et_pb_line_break_holder] --> <p class=MsoNormal align=center style='margin-top:3.0pt;margin-right:0in;<!-- [et_pb_line_break_holder] --> margin-bottom:3.0pt;margin-left:0in;text-align:center'>5</p><!-- [et_pb_line_break_holder] --> </td><!-- [et_pb_line_break_holder] --> </tr><!-- [et_pb_line_break_holder] --></table><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p><!-- [et_pb_line_break_holder] --><!-- [et_pb_line_break_holder] --><p class=MsoBodyText style='line-height:150%'><b><o:p> </o:p></b></p>