This government document is issued by Department of Aging for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:p5rt2izphxk&q=https://www.aging.pa.gov/publications/aging-program-directives/Program%2520Area%252001%2520%2520AAA/APD%252015-01-09%2520-Chapter%2520IX%2520-%2520Assessment.pdf&sa=U&ved=2ahUKEwj31-SU76_8AhXqTaQEHZ2JDiA4PBAWegQIARAC&usg=AOvVaw0rGmCRFdmvz6t9jh4sfANB