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you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No

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Page 1: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 2: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 3: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 4: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 5: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 6: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 7: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No
Page 8: you take, or have you taken, Phen-Fen or Redux? Are you on a special diet? Do you use tobacco? Do you use controlled substances? Yes Yes Yes Yes Yes Yes Yes Yes No No NO NO NO No No

Assessment Practising Certificate (APC) - Dyslexia Action · Assessment Practising Certificate (APC) NO NO NO NO YES YES YES YES YES YES Do you have an SpLD Teaching/Assessment

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a close family member had lung cancer, tubercolusis or emphysema? Yes No If yes, who? If you are a woman, have you passed menopause (change of life)? Yes If yes, at what age? No No

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docs/Ibstock...  · Web viewyes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no

docs/Ibstock...  · Web viewyes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no. yes / no

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