Daily Living Skills and Mentoring Program

Daily Living Skills and Mentoring Program

Daily Living Skills and Mentoring Program Timesheet and Expense Sheet Completion The Importance of Timesheets Accurate completion of Timesheets and Expenses are essential to prevent fraud. Timesheets are not only used to calculate your pay, they are used in our billing process to get reimbursed from the county for our services. Timesheets and Expenses MUST match the times and mileage reported on Progress Notes. Timesheets, Expenses (with receipts), and Progress Notes are due Monday by 10am after the Pay Period. Time Sheets Step 1 Fill in your Name NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun Mon Pay Period: Tues Wed Thur

Fri Sat Sun Mon Tues Wed Thur Fri Sat Type of Service: DLS Men Client Total = = = Type of Service: DLS Men Client Total = = Type of Service: DLS Men = Client Total = = = Office Total = = Employee Signature: Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. TOTAL: Fax to 715-720-7715 or scan and email to [email protected]

Form rev. 3.21.2012 Step 2 Fill in the Pay Period and Date boxes across the top of the time sheet A list of Pay Periods will be provided by your supervisor NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sat 29 Sun 30

Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Thur 4 Type of Service: Fri 5 DLS Sat 6 Men Client Total = = Type of Service: DLS Men = Client Total = = = Type of Service: DLS Men Client Total = = = Office Total = = Employee Signature: Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. TOTAL: Fax to 715-720-7715 or scan and email to [email protected] Form rev. 3.21.2012

Step 3 Write the clients full name Circle whether they are a DLS or Mentoring client NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sally Jones Sat 29 Sun 30

Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Thur 4 Type of Service: Fri 5 DLS Sat 6 Men Client Total = = = Jacob Smith Type of Service: DLS Men Client Total = = = Type of Service: DLS Men Client Total = = = Office Total = = Employee Signature: Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. TOTAL: Fax to 715-720-7715 or scan and email to [email protected]

Form rev. 3.21.2012 Step 4 Fill in the Correct Times Start time is the time on the clock that you meet or pick up your client End Time is the time on the clock that you leave or drop them off Direct Service hrs is the total number of hours you spent with your client - this cannot exceed their authorized number of hours of service as designated by their social worker. Times are rounded to the nearest 5 minutes and converted to 1/100ths of an hour. For example: You meet Sally on Mondays and Wednesdays from 4:15 to 6:30 each week. (2 hrs 15 minutes = 2.25 hrs) You meet Jacob on Thursdays from 3:25 to 7:45. (4 hrs 20 min = 4.33hrs) NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27

Fri 28 Sat 29 Sun 30 Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Sally Jones 4:15 6:30 2.25 Thur 4 Type of Service: 4:15 6:30 4:15 6:30 4:15 6:30 2.25 2.25 2.25 Fri 5 DLS Sat 6 Men Client Total = = = Jacob Smith Type of Service: 3:25 7:45 3:25 7:45

4.33 4.33 DLS Men Client Total = = = Type of Service: DLS Men Client Total = = = Office Total = = Employee Signature: Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. TOTAL: Fax to 715-720-7715 or scan and email to [email protected] Form rev. 3.21.2012 Step 5 Fill in the Correct Times Documentation Hrs is the time it takes to write your progress note. 5 minutes max for Mentoring = 0.08 hrs 15 minutes max for DLS = 0.25hrs Travel Hrs is the time you are in your car without your client This is the time it takes to make a round trip from your house to the clients OR from the DHS to the clients which ever is shorter. Sally lives in Chippewa Falls, so a round trip takes 25 minutes = 0.42 hrs. Jacob lives in Cadott, so a round trip takes 55 minutes = 0.92 hrs. NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time

Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sat 29 Sun 30 Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Sally Jones 4:15 6:30 2.25 0.25 0.42

Jacob Smith Thur 4 Type of Service: 4:15 6:30 4:15 6:30 4:15 6:30 2.25 0.25 0.42 2.25 0.25 0.42 2.25 0.25 0.42 Sat 6 Men Client Total = = = Type of Service: 3:25 7:45 3:25 7:45 4.33 4.33 0.08 0.92 0.08 0.92 Fri 5 DLS Type of Service: DLS Men Client Total = = =

DLS Men Client Total = = = Office Total = = Employee Signature: Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. TOTAL: Fax to 715-720-7715 or scan and email to [email protected] Form rev. 3.21.2012 Step 6 Fill in the Correct Times Training time Used for trainings during Orientation or new trainings that come up Note on your timesheet what it was for Supervision time Used for staff meetings where we review cases and progress. NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time

Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sat 29 Sun 30 Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Sally Jones 4:15 6:30 2.25 0.25 0.42 Jacob Smith Thur 4 Type of Service: 4:15 6:30 4:15 6:30 4:15 6:30 2.25 0.25

0.42 2.25 0.25 0.42 2.25 0.25 0.42 Sat 6 Men Client Total = = = Type of Service: 3:25 7:45 3:25 7:45 4.33 4.33 0.08 0.92 0.08 0.92 Fri 5 DLS Type of Service: DLS Men Client Total = = = DLS Men Client Total = = = 10:00 12:00 10:00 11:00 1.00 2.00

Employee Signature: A PA HI Office Total = ng ini a Tr Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. = TOTAL: Fax to 715-720-7715 or scan and email to [email protected] Form rev. 3.21.2012 Step 7 Add up the totals horizontally across the page for each client for Direct Service, Documentation, and Travel time. Add up the total of office time for Training and Supervision NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training

Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sat 29 Sun 30 Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Sally Jones 4:15 6:30 2.25 0.25 0.42 Jacob Smith Thur 4 Type of Service: 4:15 6:30 4:15 6:30 4:15 6:30 2.25 0.25 0.42

2.25 0.25 0.42 2.25 0.25 0.42 Sat 6 Men Client Total = = = Type of Service: 3:25 7:45 3:25 7:45 4.33 4.33 0.08 0.92 0.08 0.92 Fri 5 DLS Type of Service: DLS 9.00 1.00 1.68 Men Client Total = = = DLS 8.66 0.16 1.84 Men Client Total = = = 10:00 12:00

10:00 11:00 1.00 2.00 Employee Signature: IPA HI n ini a r T Office Total = g Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. = 1.00 2.00 TOTAL: Fax to 715-720-7715 or scan and email to [email protected] Form rev. 3.21.2012 Step 8 Total the column on the right of the page and put the total number of hours in the box. Note: This is the number of hours you will be paid for, and that amount will be Direct Deposited into the account you designated. NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE: DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs

Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sat 29 Sun 30 Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Sally Jones 4:15 6:30 2.25 0.25 0.42 Jacob Smith Thur 4 Type of Service: 4:15

6:30 4:15 6:30 4:15 6:30 2.25 0.25 0.42 2.25 0.25 0.42 2.25 0.25 0.42 Sat 6 Men Client Total = = = Type of Service: 3:25 7:45 3:25 7:45 4.33 4.33 0.08 0.92 0.08 0.92 Fri 5 DLS Type of Service: DLS 9.00 1.00 1.68 Men Client Total = = = DLS

8.66 0.16 1.84 Men Client Total = = = 10:00 12:00 10:00 11:00 1.00 2.00 Employee Signature: IPA HI n ini a r T Office Total = g Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. = TOTAL: Fax to 715-720-7715 or scan and email to [email protected] 1.00 2.00 25.34 Form rev. 3.21.2012 Step 8 Hand sign your timesheet. Fancy fonts are not acceptable. Scanned, cut, and pasted signatures are not acceptable. NORTHWEST COUNSELING AND GUIDANCE CLINIC TIMESHEET CHIPPEWA DAILY LIVING SKILLS AND MENTORING PROGRAM EMPLOYEE:

DAY DATE CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs CLIENT NAME: Start Time End Time Direct Service hrs Documentation hrs Travel hrs Start Time End Time Supervision Training Chris Smith Sun 23 Mon 24 Pay Period: Tues 25 Wed 26 Thur 27 Fri 28 Sat 29 Sun 30 Sept 23 to Oct 6, 2012 Mon 1 Tues 2 Wed 3 Sally Jones

4:15 6:30 2.25 0.25 0.42 Jacob Smith Thur 4 Type of Service: 4:15 6:30 4:15 6:30 4:15 6:30 2.25 0.25 0.42 2.25 0.25 0.42 2.25 0.25 0.42 Sat 6 Men Client Total = = = Type of Service: 3:25 7:45 3:25 7:45 4.33 4.33 0.08 0.92 0.08 0.92 Fri 5 DLS Type of Service: DLS

9.00 1.00 1.68 Men Client Total = = = DLS 8.66 0.16 1.84 Men Client Total = = = 10:00 12:00 10:00 11:00 1.00 2.00 Employee Signature: IPA HI n ini a r T Office Total = g Supervisor Signature: Timesheets, Expenses, and Progress Notes DUE by 10am on Monday after pay period. = TOTAL: Fax to 715-720-7715 or scan and email to [email protected] 1.00 2.00 25.34

Form rev. 3.21.2012 Expense Sheets Step 1 Fill in your Name Fill in the Pay Period A list of Pay Periods will be provided by your supervisor Employee: Program: Chippewa County Daily Living Skills & Mentoring Pay Period: Sept 23 to Oct 6, CASH REIMBURSEMENT Chris Smith CATEGORY MILEAGE $.37/MILE GENERAL OFFICE SUPPLIES/EQUIPMENT Therapeutic/ Experiential materials Client Reward OTHER(PLEASE EXPLAIN) Total 2012 Description MILEAGE Date Program Travel/Business Purpose Total Miles Total Miles x.37 enter under --MILEAGE - $.37/MILE section above Employee Signature Reimbursable Miles Step 2 Enter each trip you made on the Mileage section at the bottom. Mileage is calculated as the shorter of (your house to client and back) OR (DHS to client and back) + anywhere you go while your client is with you, so: (your house client your house = 15.7miles) OR (DHS client DHS = 4.7 miles) + (Clients house to mall and back = 33.7miles) = Your mileage would be 4.7 + 33.7 = 38.4 miles Employee: Program: Chippewa County Daily Living Skills & Mentoring Pay Period: Sept 23 to Oct 6,

CASH REIMBURSEMENT Chris Smith CATEGORY MILEAGE $.37/MILE GENERAL OFFICE SUPPLIES/EQUIPMENT Therapeutic/ Experiential materials Client Reward OTHER(PLEASE EXPLAIN) Total 2012 Description MILEAGE Date Program 9-24-12 9-26-12 DLS DLS 9-27-12 Men 10-1-12 DLS 10-3-12 DLS 10-4-12 Men Travel/Business Purpose DHS SJs in Chippewa DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + a trip to the Mall in Eau Claire DHS SJs in Chippewa + trip to Dairy Queen in Chippewa for reward DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + went bowling at Ojibwa in Chippewa Total Miles Total Miles x.37 enter under --MILEAGE - $.37/MILE section

above Employee Signature Reimbursable Miles 4.7 4.7 27.4 38.9 4.7 3.6 4.7 27.4 29.5 Step 3 Add up the total number of miles and enter it in the box. Take that number and multiply it by $0.37. Employee: Program: Chippewa County Daily Living Skills & Mentoring Pay Period: Sept 23 to Oct 6, CASH REIMBURSEMENT Chris Smith CATEGORY MILEAGE $.37/MILE GENERAL OFFICE SUPPLIES/EQUIPMENT Therapeutic/ Experiential materials Client Reward OTHER(PLEASE EXPLAIN) Total 2012 Description MILEAGE Date Program 9-24-12 9-26-12 DLS DLS 9-27-12 Men 10-1-12 DLS 10-3-12

DLS 10-4-12 Men Travel/Business Purpose DHS SJs in Chippewa DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + a trip to the Mall in Eau Claire DHS SJs in Chippewa + trip to Dairy Queen in Chippewa for reward DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + went bowling at Ojibwa in Chippewa Total Miles Total Miles x.37 enter under --MILEAGE - $.37/MILE section above Employee Signature Reimbursable Miles 4.7 4.7 27.4 38.9 4.7 3.6 4.7 27.4 29.5 145.6 $53.87 Step 4 Transfer the dollar amount from the bottom up to the top section of the sheet under the section labeled Mileage $.37/mile. Employee: Program: Chippewa County Daily Living Skills & Mentoring Pay Period: Sept 23 to Oct 6, CASH REIMBURSEMENT Chris Smith CATEGORY MILEAGE $.37/MILE GENERAL OFFICE SUPPLIES/EQUIPMENT Therapeutic/ Experiential materials Client

Reward OTHER(PLEASE EXPLAIN) Total $53.87 2012 Description MILEAGE Date Program 9-24-12 9-26-12 DLS DLS 9-27-12 Men 10-1-12 DLS 10-3-12 DLS 10-4-12 Men Travel/Business Purpose DHS SJs in Chippewa DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + a trip to the Mall in Eau Claire DHS SJs in Chippewa + trip to Dairy Queen in Chippewa for reward DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + went bowling at Ojibwa in Chippewa Total Miles Total Miles x.37 enter under --MILEAGE - $.37/MILE section above Employee Signature Reimbursable Miles 4.7 4.7 27.4 38.9

4.7 3.6 4.7 27.4 29.5 145.6 $53.87 Step 5 Include any other amounts to be reimbursed for. Any materials bought for DLS interventions go under Therapeutic/Experiential Material Rewards for reaching DLS goals and activities with mentors go under Client Reward You MUST submit receipts for your expenses to be reimbursed for them. Employee: Program: Chippewa County Daily Living Skills & Mentoring Pay Period: Sept 23 to Oct 6, CASH REIMBURSEMENT Chris Smith CATEGORY MILEAGE $.37/MILE GENERAL OFFICE SUPPLIES/EQUIPMENT Therapeutic/ Experiential materials Client Reward OTHER(PLEASE EXPLAIN) Total $53.87 7.59 2.99 9.89 2012 Description Chore chart materials for SJ DQ reward for SJ Bowling for JS MILEAGE Date Program 9-24-12 9-26-12 DLS DLS 9-27-12

Men 10-1-12 DLS 10-3-12 DLS 10-4-12 Men Travel/Business Purpose DHS SJs in Chippewa DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + a trip to the Mall in Eau Claire DHS SJs in Chippewa + trip to Dairy Queen in Chippewa for reward DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + went bowling at Ojibwa in Chippewa Total Miles Total Miles x.37 enter under --MILEAGE - $.37/MILE section above Employee Signature Reimbursable Miles 4.7 4.7 27.4 38.9 4.7 3.6 4.7 27.4 29.5 145.6 $53.87 Step 6 Total the amount to be reimbursed. Hand sign your timesheet. Fancy fonts are not acceptable Scanned, cut, and pasted signatures are not acceptable. Note: This expense check will be mailed to your home. Employee: Program: Chippewa County Daily Living Skills & Mentoring

Pay Period: Sept 23 to Oct 6, CASH REIMBURSEMENT Chris Smith CATEGORY MILEAGE $.37/MILE GENERAL OFFICE SUPPLIES/EQUIPMENT Therapeutic/ Experiential materials Client Reward OTHER(PLEASE EXPLAIN) Total $53.87 7.59 2.99 9.89 2012 Description Chore chart materials for SJ DQ reward for SJ Bowling for JS $74.34 MILEAGE Date Program 9-24-12 9-26-12 DLS DLS 9-27-12 Men 10-1-12 DLS 10-3-12 DLS 10-4-12 Men Travel/Business Purpose DHS SJs in Chippewa DHS SJs in Chippewa Home in Chippewa

JSs in Cadott and back + a trip to the Mall in Eau Claire DHS SJs in Chippewa + trip to Dairy Queen in Chippewa for reward DHS SJs in Chippewa Home in Chippewa JSs in Cadott and back + went bowling at Ojibwa in Chippewa Total Miles Total Miles x.37 enter under --MILEAGE - $.37/MILE section above Employee Signature Reimbursable Miles 4.7 4.7 27.4 38.9 4.7 3.6 4.7 27.4 29.5 145.6 $53.87 Step 6 Time Sheets, Expenses (with receipts), and Progress Notes are due by Monday at 10am after the Pay Period. Late timesheets are still expected as soon as possible so the progress notes can be forwarded to the County, but timesheets and expenses will not be processed until the next pay period.

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