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			<h4><cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>M2102<cfelse>M2100</cfif> Types & Sources of Assistance</h4>
			<div class="form-group">
				<div class="label-stable">
					<label>a. ADL assistance (transferring, bathing)</label>
					<div id="rdnADLd" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio" name="rdnADL" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100a_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area </label>
							<label>
							<input type="radio" name="rdnADL" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100a_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100a_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100a_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100a_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio" name="rdnADL" value="0 - No assistance needed in this area" <cfif AssForm.M2100a_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area  </label>
							<label>
							<input type="radio" name="rdnADL" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100a_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100a_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100a_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100a_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio" name="rdnADL" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100a_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>>  5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>b. IADL assistance (laundry, shopping)</label>
					<div id="rdnIADLd" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio" name="rdnIADL" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100b_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area </label>
							<label>
							<input type="radio" name="rdnIADL" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100b_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnIADL" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100b_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnIADL" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100b_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio"  name="rdnIADL" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100b_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio" name="rdnIADL" value="0 - No assistance needed in this area" <cfif AssForm.M2100b_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area  </label>
							<label>
							<input type="radio" name="rdnIADL" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100b_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnIADL" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100b_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnIADL" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100b_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio"  name="rdnIADL" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100b_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio"  name="rdnIADL" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100b_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>> 5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>c. Medication administration</label>
					<div id="rdnMedAdmind" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio" name="rdnMedAdmin" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100c_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area </label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100c_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100c_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100c_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100c_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio" name="rdnMedAdmin" value="0 - No assistance needed in this area" <cfif AssForm.M2100c_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area </label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100c_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100c_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100c_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100c_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio" name="rdnMedAdmin" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100c_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>> 5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>d. Medical treatment/procedures</label>
					<div id="rdnMedtreatmentd" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio"  name="rdnMedtreatment" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100d_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area </label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100d_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100d_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100d_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100d_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio"  name="rdnMedtreatment" value="0 - No assistance needed in this area" <cfif AssForm.M2100d_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area </label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100d_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100d_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100d_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100d_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio" name="rdnMedtreatment" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100d_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>> 5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>e. Equipment management</label>
					<div id="rdnEquipMgtd" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio" name="rdnEquipMgt" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100e_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area  </label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100e_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100e_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100e_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100e_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio" name="rdnEquipMgt" value="0 - No assistance needed in this area" <cfif AssForm.M2100e_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area  </label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100e_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100e_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100e_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100e_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio"  name="rdnEquipMgt" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100e_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>> 5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>f. Supervision and safety</label>
					<div id="rdnSupervisiond" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio" name="rdnSupervision" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100f_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area  </label>
							<label>
							<input type="radio" name="rdnSupervision" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100f_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100f_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100f_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100f_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio" name="rdnSupervision" value="0 - No assistance needed in this area" <cfif AssForm.M2100f_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area  </label>
							<label>
							<input type="radio" name="rdnSupervision" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100f_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100f_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100f_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100f_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio" name="rdnSupervision" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100f_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>> 5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>g. Advocacy</label>
					<div id="rdnAdvocacyd" class="radio-list">
						<cfif #AssForm.Assessment_Completed_M0090# gte '2015-01-01'>
							<label>
							<input type="radio" name="rdnAdvocacy" value="0 - No assistance needed–patient is independent or does not have needs in this area" <cfif AssForm.M2100g_Equip EQ "0 - No assistance needed–patient is independent or does not have needs in this area">checked</cfif>> 0 - No assistance needed–patient is independent or does not have needs in this area </label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="1 - Non-agency caregiver(s) currently provide assistance" <cfif AssForm.M2100g_Equip EQ "1 - Non-agency caregiver(s) currently provide assistance">checked</cfif>> 1 - Non-agency caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="2 - Non-agency caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100g_Equip EQ "2 - Non-agency caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Non-agency caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance" <cfif AssForm.M2100g_Equip EQ "3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance">checked</cfif>> 3 - Non-agency caregiver(s) are not likely to provide assistance OR it is unclear if they will provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="4 - Assistance needed, but no non-agency caregiver(s) available" <cfif AssForm.M2100g_Equip EQ "4 - Assistance needed, but no non-agency caregiver(s) available">checked</cfif>> 4 - Assistance needed, but no non-agency caregiver(s) available</label>
						<cfelse>
							<label>
							<input type="radio" name="rdnAdvocacy" value="0 - No assistance needed in this area" <cfif AssForm.M2100g_Equip EQ "0 - No assistance needed in this area">checked</cfif>> 0 - No assistance needed in this area </label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="1 - Caregiver(s) currently provide assistance" <cfif AssForm.M2100g_Equip EQ "1 - Caregiver(s) currently provide assistance">checked</cfif>> 1 - Caregiver(s) currently provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="2 - Caregiver(s) need training/ supportive services to provide assistance" <cfif AssForm.M2100g_Equip EQ "2 - Caregiver(s) need training/ supportive services to provide assistance">checked</cfif>> 2 - Caregiver(s) need training/ supportive services to provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="3 - Caregiver(s) not likely to provide assistance" <cfif AssForm.M2100g_Equip EQ "3 - Caregiver(s) not likely to provide assistance">checked</cfif>> 3 - Caregiver(s) not likely to provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="4 - Unclear if Caregiver(s) will provide assistance" <cfif AssForm.M2100g_Equip EQ "4 - Unclear if Caregiver(s) will provide assistance">checked</cfif>> 4 - Unclear if Caregiver(s) will provide assistance</label>
							<label>
							<input type="radio" name="rdnAdvocacy" value="5 - Assistance needed, but no Caregiver(s) available" <cfif AssForm.M2100g_Equip EQ "5 - Assistance needed, but no Caregiver(s) available">checked</cfif>> 5 - Assistance needed, but no Caregiver(s) available</label>
						</cfif>
					</div>
				</div>
			</div>
			<div class="form-group">
				<div class="label-stable">
					<label>M2110 - How Often does patient receive ADL or IADL assistance from any caregiver(S) (other than home health agency staff)?</label>
					<div id="rdnM2110d" class="radio-list">
						<label>
						<input type="radio" name="rdnM2110" value="1 - At least daily" <cfif AssForm.M2110_Assist_Freq EQ "1 - At least daily">checked</cfif>> 1 - At least daily </label>
						<label>
						<input type="radio" name="rdnM2110" value="2 - Three or more times per week" <cfif AssForm.M2110_Assist_Freq EQ "2 - Three or more times per week">checked</cfif>> 2 - Three or more times per week</label>
						<label>
						<input type="radio" name="rdnM2110" value="3 - One to two times per week" <cfif AssForm.M2110_Assist_Freq EQ "3 - One to two times per week">checked</cfif>> 3 - One to two times per week</label>
						<label>
						<input type="radio" name="rdnM2110" value="4 - Received, but less often than weekly" <cfif AssForm.M2110_Assist_Freq EQ "4 - Received, but less often than weekly">checked</cfif>> 4 - Received, but less often than weekly</label>
						<label>
						<input type="radio" name="rdnM2110" value="5 - No assistance received" <cfif AssForm.M2110_Assist_Freq EQ "5 - No assistance received">checked</cfif>> 5 - No assistance received</label>
						<label>
						<input type="radio" name="rdnM2110" value="UK - Unknown" <cfif AssForm.M2110_Assist_Freq EQ "UK - Unknown">checked</cfif>> UK - Unknown</label>
					</div>
				</div>
			</div>
			<div class="form-group">
				<label>Comments</label>
				<textarea class="form-control" name="txtComment" id="txtComment" onblur="CommentChangeBlur('formstep20')" rows="3"><cfoutput>#AssForm.Assessment_note#</cfoutput></textarea>
			</div>
			<h4>Patient's Own Words:</h4>
			  <div class="row">
			   <div class="col-md-4">
			     <div class="form-group">
				<label>Strengths</label>
				<textarea class="form-control" name="Strengths" id="Strengths" onblur="StrengthsChangeBlur('formstep20')" rows="3"><cfoutput>#AssForm.Strengths#</cfoutput></textarea>
				</div>
			</div>
			<div class="col-md-4">
			     <div class="form-group">
				<label>Goals</label>
				<textarea class="form-control" name="Goals" id="Goals" onblur="GoalsChangeBlur('formstep20')" rows="3"><cfoutput>#AssForm.Goals#</cfoutput></textarea>
				</div>
			</div>
			<div class="col-md-4">
			     <div class="form-group">
				<label>Care Preference</label>
				<textarea class="form-control" name="Care_Preference" id="Care_Preference" onblur="Care_PreferenceChangeBlur('formstep20')" rows="3"><cfoutput>#AssForm.Care_Preference#</cfoutput></textarea>
				</div>
			</div>
			  
			  
			</div>
			
		<div class="row">
		  <div class="col-md-4">
			     <div class="form-group">
				<label>Risk Factor</label>
				<textarea class="form-control" name="Risk_Factor" id="Risk_Factor" onblur="Risk_FactorChangeBlur('formstep20')" rows="3"><cfoutput>#AssForm.Risk_Factor#</cfoutput></textarea>
				</div>
			</div>
			<div class="col-md-4">
			     <div class="form-group">
				<label>Interventions</label>
				<textarea class="form-control" name="Interventions" id="Interventions" onblur="InterventionsChangeBlur('formstep20')" rows="3"><cfoutput>#AssForm.Interventions#</cfoutput></textarea>
				</div>
			</div>
			
			<div class="col-md-4" style="padding:4%;">
			<div class="form-group">
				<label>Add Vital <img name="imgbtnaddvital" id="imgbtnaddvital" src="../../images/icon_add.png" style="cursor:pointer" onclick="ColdFusion.Window.show('Vitaldiv')"/></label>
				<input type="hidden" name="AssTrackID" id="AssTrackID" value="<cfoutput>#AssForm.Assessment_Tracker_ID#</cfoutput>">
			</div>
			</div>
			</div>
			
			<!---<div class="form-group">
				<label>Add Vital <img name="imgbtnaddvital" id="imgbtnaddvital" src="../../images/icon_add.png" style="cursor:pointer" onclick="ColdFusion.Window.show('Vitaldiv')"/></label>
			</div>--->
		</div>
		</div>
		
		<div class="form-actions">
			<input class="btn blue" type="button" value="Previous" onClick="$('#StartOfCare20').hide(); $('#StartOfCare19').show(); $('.pagination li').removeClass('active'); $('.nav_StartOfCare19').addClass('active'); $('html, body').animate({scrollTop: '0px'}, 300);">
			<input class="btn green" type="button" name="BtnStep3" value="Next" onClick="UpdateSoc('20');" >
			<button type="button" id="imgclose" class="btn default" onclick="StepClose('20');">Cancel</button>
		</div>
	</form>
</div>
