2012 / 2013 INFLUENZA VACCINE CONSENT FORM & ADMINISTATION RECORD Section 1: Information to Receive Vaccine (please print) * Complete both sides of form. * NAME (Last) BIRTHDATE: DAYTIME PHONE NUMBER: Parent Name: Section 2: Self Screening Checklist: (All questions below pertain to the person named in Section 1.) * Injectable and intranasal forms of 2012 / 201
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Francisconakajima.com.brSTUDENT´S NAME: _________________________________________________ 1. COMPLETE THE FOLLOWING SENTENCES USING THE WORDS LISTED. MODIFY WHEN a) Who do you generally _____________________ your kids with when you travel on business? b) I generally leave home at 7:20 _____________________ that I can get to work on time.
c) Every time I need help, I _____________________ my best friends.
d) As a marketing specialist, I can say that you can _____________________ your profits if you e) That plane is flying _____________________ the clouds.
f) I _____________________ I can get my driver’s license pretty soon.
g) I want the captain to turn off the fasten-seat-belt sign so that I can be in a ____________________ h) I’m buying a new car because of the great promotion I got. I could never afford one ___________ .
_____________________ Bernardo trained a lot for the judo competition, he lost his last fight.
Hugo wants to have another trip _____________________ Europe next year. He loved the first k) “Sorry, sir. But this credit card is _____________________ .” Coke® is a (n) _____________________ company. We can find it all over the world.
m) Mr. Sardella is a (n) _____________________ . That’s why he can’t walk fast now.
n) I got Dad's car without his permission and I crashed. Now I am __________________ .
o) “Do you remember that if we don’t ___________________ , the contract _____________________ p) Do you generally eat your food _____________________? After all, you only have 10 minutes for q) Yesterday I went to a jiu jitsu competition. _____________________, we all went to a restaurant to r) The internet is certainly _____________________ the world.
s) “Tina, there’s a _____________________ on the doorstep for you here. Is it a present from your t) Bianca went to that famous restaurant over by the _____________________ last night. She ate only 10 lasagnas because she wants to lose some _____________________ .
u) Claudio is surely a (n) _____________________ guy. He is always helping people. Last week, he gave Bea US$10,000,00 for a trip to Hawaii.
v) The _____________________ asked Hugo to show his boarding pass.
w) Poli needs 4 hours _____________________ to do a CCAA lesson. She checks every small detail.
a) SONY®’s _____________________ is in Japan. All the important decisions are taken there.
b) Some big companies such as Apple offers a (n) _____________________ at their plants so that the employees can exercise when they want. Some of them _____________________ at least c) “_____________________ do you eat EMPADAS, Poli?” “Every time they have them at the d) I usually _____________________ my co-workers when they go out to lunch.
e) Most women generally carry _____________________ and _____________________ in the bags.
Based on this _____________________ , I can definitely tell you that BraZil is the perfect market for your products, Mr. Hugo Valentim.
g) Do you think a newspaper gets more _____________________ from selling papers or from h) “Please, I would like to have a proposal with a ballpark figure of your _____________________ .
I just love Italian _____________________ . I love lasagna, ravioli – pasta, in general.
Kibon® produces a _____________________ variety of delicious ice cream.
A beauty salon is the perfect place for some women to _____________________ . They talk Peter is going to _____________________ his project for his boss's approval. It's a good and interesting project. I think his boss is going to love it.
m) Some women prefer to have _____________________ hair, not straight.
n) One of the _____________________ to get a passport is to have another official document.
o) Bernardo is late again! I _____________________ he woke up late for class again! a) Your bedroom is dirty. ____________ you clean it anymore? b) Bob came alone yesterday. ________________ his girlfriend come too? c) ______________ you feel better if you take an aspirin? d) ______________ the children arrive here an hour ago? e) ______________ he at Jessica's birthday party yesterday? f) ______________ she going to N.York with us? h)______________ it be better if Tom washed the car? i) ______________ she feel better if she went to see a doctor? j) ______________ he go to the beach if it is a sunny day? k) ______________ the children arrive here an hour ago? l) _____________ we almost have it all when we were in love? 3. FILL IN THE SENTENCES USING SOMEONE, ANYONE, NO ONE: a) Look! There is _____________________ at the door. I'll check who it is.
b) Is _____________________ here American? c) There is _____________________ in that room. It's empty.
d) Would you like _____________________ to help you carry the luggage, sir? e) If _____________________ needs a body guard, talk to Claudio. He's the strongest and best trained man in this group. Do you know that he's a black belt in karate? f) _____________________ in this group has a BMW, except Bianca.
g) Is _____________________ in that group your student, Mr. Sardella? h) I can't see _____________________ in that room. It's too dark.
a) If I have the time, I _______________ a serious talk with John tonight. (have) b) We ______________ do our exercises yesterday. We ___________ very busy. (not; can)(be) c) If Peter were here, Susan _____________________ that way. (not; behave) d) BraZil is certainly an ideal market for our products, so we ________________________ to sell our e) When I was a small kid, I _______________________ fast. (be able to; run) f) Mom ______________ to talk to you right now. Why ________________ her? (need)(you; not; call) g) We ___________________________ the USA next year. What about you? (probably; visit) h) ___________________________, Mrs. Oliver? (I; may; go out) He ________________________ to remember how his accident happened. (not; like) Mike _____________________________ with you next week. (be able to; travel) k) _________ you __________ dinner at that nice restaurant? No. We ______________________ there but it ______________ a lot yesterday. We just ____________ home. (have) (go) (rain) (stay) Sue ______________________ very fast when she was younger. (be able to; type) m) When ________________ Linda? We ______ probably ________ there tomorrow. (visit) (go) n) My maid _______________ a delicious roast beef yesterday. (make) o) Sorry, but I ________________________ you to the airport tomorrow morning. Call a cab, right? p) Last Monday __________ my mother-in-law’s birthday. (be) q) ______________________ English with me next Saturday: (you; be able to; study) r) Do you think it ______________ tomorrow? (may; rain) s) I'm tired and it's late at night. I ___________________ finish this report today. (may; finish; not) t) I ____________________ like yoga. It's too slow! (may; not; like) 5. USE THE SIMPLE PAST TENSE OR THE PRESENT PERFECT TENSE: a) Daniel _____________________ all around Europe. (travel) b) Who _____________________ to at the party yesterday? (talk/you) c) Carol _____________________ a lot of things the last time she went shopping. (buy) e) Susie and Olly _____________________ a lot of films when they were on vacation. (watch) f) All the teachers _____________________ to postpone the final exams. (decide) g) How long _____________________ at CCAA? (study/you) h) Bob _____________________ his new car two weeks ago. (buy) How long _____________________ at your last job? (you/work) Bob _____________________ Julie since they were 10 years old. (know) k) Last month, Mom _____________________ a letter to me. I think she was very busy. (not/write) Natasha _____________________ in the States for a year. (live)
NATIONAL INFLAMMATORY ARTHRITIS REGISTRY SECTION 1 : PATIENT DETAILS & DEMOGRAPHICSa source data provider (SDP) by the Registry manager and / or the steering committee for the purpose of reporting to central data coordinator. admission OR the date Source Data Provider (SDP) was informed/ notify of this admissionrheumatologist based on patient's recollection or medical recordSECTION 1 : PA