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/policy-procedure-manual/Documents/Chapter%2520III_Assessment/NAT%2520Instructions%252010.1.21.pdf&sa=U&ved=2ahUKEwjViKvX6K_8AhVniP0HHfU7BMQ4FBAWegQIBxAB&usg=AOvVaw0r7XhRO6t2H7fJ9r1WDWoS