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Disclaimer: This tool is not intended to provide you or your loved one with a diagnosis. A diagnosis for this
condition may be made only after being evaluated by a health care provider. You should contact your health care
provider if your answers to the tool indicate the possibility that you have a memory issue or concern.
Note: We follow all Federal and State laws to protect your health information. Your health insurance rates will not
be affected if you use this assessment. Completing this assessment is completely voluntary.