| Quality Rating (Good, Fair, or Poor) |
| Rater #1 initials: |
| Rater #2 initials: |
| Additional Comments (If POOR, please state why): |
CD, cannot determine; NA, not applicable; NR, not reported.
| Quality Rating (Good, Fair, or Poor) |
| Rater #1 initials: |
| Rater #2 initials: |
| Additional Comments (If POOR, please state why): |
CD, cannot determine; NA, not applicable; NR, not reported.