%PDF-1.4 % 24 0 obj <> endobj 30 0 obj <> endobj 170 0 obj <>stream /Artifact <>BDC q 1 i 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n 0 0 0 1 K 0 J 0 j .5 w 10 M [] 0 d /GS2 gs 33.25 192.75 545.5 -145.5 re 306 396.015 m S EMC /P <>BDC BT /TT2 1 Tf 7 0 0 7 36 35.7499 Tm 0 0 0 1 k 0 Tc .0278 Tw [(RUSH1928 \(07-15-24\))]TJ ET EMC /P <>BDC BT 7 0 0 7 109.1681 35.7499 Tm 0 Tw ( )Tj 35.2846 0 TD ( )Tj ET EMC /P <>BDC BT 7 0 0 7 533.1396 35.7499 Tm .0278 Tw [(P)73.7(AGE 1 OF 2)]TJ ET EMC /Artifact <>BDC 1.5 w q 1 0 0 1 288 756 cm 0 0 m 0 -120 l S Q EMC /Artifact <>BDC q 1 0 0 1 36 636 cm 0 0 m 540 0 l S Q EMC /P <>BDC BT 9 0 0 9 36 698.25 Tm [(P)73.7(A)73.7(TIENT)17.6( NAME)]TJ ET EMC /P <>BDC BT 9 0 0 9 105.8174 698.25 Tm 0 Tw (__________________________________)Tj ET EMC /P <>BDC BT 9 0 0 9 276 698.25 Tm ( )Tj ET EMC /P <>BDC BT 9 0 0 9 36 674.25 Tm .0278 Tw [(DA)73.7(TE OF BIR)17.6(TH)]TJ ET EMC /P <>BDC BT 9 0 0 9 105.8174 674.25 Tm 0 Tw (__________________________________)Tj ET EMC /P <>BDC BT 9 0 0 9 276 674.25 Tm ( )Tj ET EMC /P <>BDC BT 9 0 0 9 36 650.25 Tm .0278 Tw [(MEDICAL)36.6( RECORD #)]TJ ET EMC /P <>BDC BT 9 0 0 9 125.8389 650.25 Tm 0 Tw (______________________________)Tj ET EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 327.9442 726 Tm .0278 Tw [(AUTHORIZA)73.7(TION FOR RELEASE OF )]TJ ET EMC /P <>BDC BT 12 0 0 12 539.7231 726 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 12 0 0 12 337.7758 712.9999 Tm .0278 Tw [(P)73.7(A)73.7(TIENT HEAL)73.7(TH INFORMA)73.7(TION)]TJ ET EMC /Figure <>BDC Q 0 0 0 1 k /GS1 gs 3 i q 1 0 0 1 353.844 684.905 cm 0 0 m 0 7.1562 l .9532 7.1562 l .9532 4.2187 l 4.6407 4.2187 l 4.6407 7.1562 l 5.5938 7.1562 l 5.5938 0 l 4.6407 0 l 4.6407 3.375 l .9532 3.375 l .9532 0 l 0 0 l f Q q 1 0 0 1 364.462 686.592 cm 0 0 m .9023 -.125 l .7592 -.6548 .4941 -1.0654 .1064 -1.3584 c -.2813 -1.6504 -.7759 -1.7969 -1.378 -1.7969 c -2.1368 -1.7969 -2.7388 -1.564 -3.1832 -1.0977 c -3.6275 -.6318 -3.8497 .0215 -3.8497 .8623 c -3.8497 1.7324 -3.6251 2.4082 -3.1758 2.8887 c -2.7266 3.3691 -2.1436 3.6094 -1.4273 3.6094 c -.7339 3.6094 -.167 3.374 .2724 2.9043 c .7119 2.4346 .9316 1.7734 .9316 .9209 c .9316 .8691 .9297 .791 .9267 .6875 c -2.9434 .6875 l -2.9107 .1167 -2.7491 -.3203 -2.4586 -.6232 c -2.168 -.9268 -1.8057 -1.0781 -1.3711 -1.0781 c -1.0479 -1.0781 -.7725 -.9922 -.544 -.8213 c -.3155 -.6494 -.1338 -.376 0 0 c h -2.8965 1.4062 m .0097 1.4062 l -.0293 1.8408 -.1407 2.167 -.3233 2.3848 c -.6045 2.7217 -.9688 2.8906 -1.4165 2.8906 c -1.8218 2.8906 -2.1622 2.7557 -2.4385 2.4863 c -2.7144 2.2173 -2.8672 1.8574 -2.8965 1.4062 c f Q q 1 0 0 1 369.877 685.561 cm 0 0 m -.3159 -.2802 -.626 -.4775 -.9307 -.5927 c -1.2353 -.708 -1.5615 -.7656 -1.9106 -.7656 c -2.4868 -.7656 -2.9297 -.6269 -3.2393 -.3486 c -3.5488 -.0703 -3.7031 .2852 -3.7031 .7178 c -3.7031 .9717 -3.6445 1.2032 -3.5278 1.4131 c -3.4111 1.6231 -3.2578 1.7911 -3.0684 1.918 c -2.8789 2.045 -2.666 2.1412 -2.4287 2.2061 c -2.2539 2.252 -1.9902 2.2959 -1.6377 2.3379 c -.9199 2.4229 -.3911 2.5235 -.0518 2.6407 c -.0488 2.7593 -.0469 2.8345 -.0469 2.8667 c -.0469 3.2198 -.1309 3.4683 -.2978 3.6128 c -.5244 3.8086 -.8613 3.9063 -1.3076 3.9063 c -1.7246 3.9063 -2.0322 3.834 -2.2314 3.6895 c -2.4297 3.545 -2.5767 3.2891 -2.6719 2.9219 c -3.5469 3.0469 l -3.4687 3.4141 -3.3398 3.7105 -3.1602 3.9366 c -2.9805 4.162 -2.7207 4.336 -2.3809 4.4579 c -2.0415 4.5796 -1.6479 4.6407 -1.2007 4.6407 c -.7568 4.6407 -.3955 4.5884 -.1182 4.4844 c .1592 4.3799 .3633 4.2491 .4941 4.0913 c .6245 3.9336 .7158 3.7344 .7686 3.4937 c .7979 3.3438 .8125 3.0743 .8125 2.6851 c .8125 1.5171 l .8125 .7027 .8301 .1866 .8662 -.0307 c .9014 -.248 .9727 -.457 1.0781 -.6562 c .1719 -.6562 l .0825 -.4692 .0254 -.2504 0 0 c h -.0469 1.9532 m -.3716 1.8228 -.8584 1.712 -1.5078 1.6211 c -1.876 1.5689 -2.1362 1.5103 -2.2886 1.4454 c -2.4409 1.3799 -2.5586 1.2852 -2.6416 1.1597 c -2.7246 1.0342 -2.7656 .8951 -2.7656 .7422 c -2.7656 .5078 -2.6758 .3125 -2.4951 .1563 c -2.3154 0 -2.0513 -.0781 -1.7041 -.0781 c -1.3603 -.0781 -1.0542 -.0048 -.7861 .1426 c -.5186 .2901 -.3213 .4922 -.1958 .75 c -.0996 .9488 -.0518 1.2422 -.0518 1.6304 c -.0469 1.9532 l f Q 372.017 684.905 .875 7.1562 re f q 1 0 0 1 376.176 685.699 cm 0 0 m .125 -.7763 l -.123 -.8291 -.3452 -.8554 -.541 -.8554 c -.8613 -.8554 -1.1093 -.8047 -1.2856 -.7041 c -1.4619 -.6035 -1.5859 -.4712 -1.6582 -.3071 c -1.7295 -.143 -1.7656 .2022 -1.7656 .7285 c -1.7656 3.7071 l -2.4218 3.7071 l -2.4218 4.3946 l -1.7656 4.3946 l -1.7656 5.6786 l -.8906 6.2061 l -.8906 4.3946 l 0 4.3946 l 0 3.7071 l -.8906 3.7071 l -.8906 .6875 l -.8906 .4375 -.875 .2774 -.8437 .2061 c -.8125 .1348 -.7617 .0782 -.6914 .0362 c -.6211 -.0063 -.52 -.0273 -.3886 -.0273 c -.2905 -.0273 -.1611 -.0185 0 0 c f Q q 1 0 0 1 377.032 684.905 cm 0 0 m 0 7.1562 l .875 7.1562 l .875 4.5903 l 1.2851 5.0615 1.8022 5.2969 2.4272 5.2969 c 2.811 5.2969 3.1445 5.2212 3.4277 5.0703 c 3.7109 4.9189 3.9135 4.71 4.0356 4.4432 c 4.1577 4.1766 4.2187 3.79 4.2187 3.2822 c 4.2187 0 l 3.3437 0 l 3.3437 3.2871 l 3.3437 3.7266 3.248 4.0459 3.0576 4.2461 c 2.8672 4.4463 2.5971 4.5469 2.2485 4.5469 c 1.9878 4.5469 1.7422 4.4795 1.5127 4.3442 c 1.2832 4.209 1.1191 4.0259 1.0215 3.7949 c .9238 3.5635 .875 3.2441 .875 2.8379 c .875 0 l 0 0 l f Q 385.653 684.905 .95309 7.1562 re f q 1 0 0 1 388.15 684.905 cm 0 0 m 0 5.1875 l .7813 5.1875 l .7813 4.4502 l 1.1636 5.0146 1.7159 5.2969 2.4385 5.2969 c 2.7525 5.2969 3.0411 5.2407 3.3042 5.1289 c 3.5674 5.0166 3.7642 4.8691 3.8951 4.6875 c 4.0259 4.5049 4.1172 4.289 4.17 4.0386 c 4.2022 3.876 4.2188 3.5913 4.2188 3.1849 c 4.2188 0 l 3.3438 0 l 3.3438 3.1473 l 3.3438 3.5049 3.3096 3.7715 3.2408 3.9492 c 3.1719 4.126 3.0498 4.2676 2.875 4.373 c 2.7002 4.4785 2.4947 4.5312 2.2588 4.5312 c 1.8829 4.5312 1.5577 4.4126 1.2847 4.1758 c 1.0118 3.9385 .875 3.4883 .875 2.8262 c .875 0 l 0 0 l f Q q 1 0 0 1 393.931 684.905 cm 0 0 m 0 4.5 l -.7812 4.5 l -.7812 5.1875 l 0 5.1875 l 0 5.7392 l 0 6.0869 .0308 6.3457 .0928 6.5146 c .1777 6.7427 .3267 6.9272 .5401 7.0687 c .7534 7.2104 1.0523 7.2811 1.4365 7.2811 c 1.6836 7.2811 1.957 7.2518 2.2569 7.1924 c 2.125 6.4199 l 1.9424 6.452 1.77 6.4687 1.6074 6.4687 c 1.3403 6.4687 1.1514 6.4121 1.041 6.2988 c .9302 6.1854 .875 5.9736 .875 5.6631 c .875 5.1875 l 1.8906 5.1875 l 1.8906 4.5 l .875 4.5 l .875 0 l 0 0 l f Q q 1 0 0 1 396.162 687.498 cm 0 0 m 0 .958 .2666 1.6671 .8007 2.1285 c 1.247 2.5118 1.7905 2.7032 2.4321 2.7032 c 3.145 2.7032 3.7275 2.4698 4.1806 2.0039 c 4.6328 1.5381 4.8593 .8947 4.8593 .0734 c 4.8593 -.5927 4.7592 -1.1161 4.559 -1.4979 c 4.3588 -1.8794 4.0673 -2.1757 3.6845 -2.3867 c 3.3022 -2.5975 2.8847 -2.703 2.4321 -2.703 c 1.706 -2.703 1.1191 -2.4706 .6713 -2.0067 c .2236 -1.5419 0 -.8734 0 0 c h .9062 -.0052 m .9062 -.667 1.0507 -1.162 1.3398 -1.4911 c 1.6289 -1.8203 1.9931 -1.9843 2.4321 -1.9843 c 2.8676 -1.9843 3.2299 -1.8192 3.5195 -1.4882 c 3.8086 -1.1581 3.9531 -.6537 3.9531 .0236 c 3.9531 .6621 3.8076 1.1461 3.5166 1.4751 c 3.2255 1.8043 2.8642 1.9689 2.4321 1.9689 c 1.9931 1.9689 1.6289 1.8047 1.3398 1.4777 c 1.0507 1.1505 .9062 .6559 .9062 -.0052 c f Q q 1 0 0 1 402.052 684.905 cm 0 0 m 0 5.1875 l .7813 5.1875 l .7813 4.3955 l .9819 4.7627 1.167 5.0044 1.3369 5.1211 c 1.5068 5.2383 1.6943 5.2969 1.8984 5.2969 c 2.1929 5.2969 2.4922 5.2046 2.7969 5.0205 c 2.4873 4.2119 l 2.2759 4.3309 2.0645 4.3906 1.8535 4.3906 c 1.6641 4.3906 1.4942 4.333 1.3438 4.2173 c 1.1934 4.1016 1.0859 3.9414 1.021 3.7368 c .9238 3.4248 .875 3.083 .875 2.7124 c .875 0 l 0 0 l f Q q 1 0 0 1 405.382 684.905 cm 0 0 m 0 5.1875 l .7812 5.1875 l .7812 4.4482 l .9438 4.7031 1.1601 4.9087 1.4307 5.064 c 1.7002 5.2192 2.0078 5.2969 2.3525 5.2969 c 2.7363 5.2969 3.0517 5.2168 3.2969 5.0566 c 3.543 4.8965 3.7158 4.6728 3.8169 4.3848 c 4.2285 4.9932 4.7641 5.2969 5.4238 5.2969 c 5.9404 5.2969 6.3369 5.1543 6.6147 4.8701 c 6.8926 4.5854 7.0312 4.1473 7.0312 3.5557 c 7.0312 0 l 6.1562 0 l 6.1562 3.2598 l 6.1562 3.6102 6.1274 3.8628 6.0703 4.0171 c 6.0132 4.1714 5.9092 4.2959 5.7588 4.3895 c 5.6084 4.4844 5.4316 4.5312 5.2285 4.5312 c 4.8623 4.5312 4.5586 4.41 4.3164 4.168 c 4.0742 3.9258 3.9531 3.539 3.9531 3.0058 c 3.9531 0 l 3.0781 0 l 3.0781 3.3618 l 3.0781 3.7515 3.0063 4.0439 2.8633 4.2388 c 2.7197 4.4336 2.4853 4.5312 2.1601 4.5312 c 1.9121 4.5312 1.6836 4.4658 1.4736 4.3359 c 1.2637 4.206 1.1113 4.0161 1.0166 3.7661 c .9219 3.5161 .875 3.1553 .875 2.6846 c .875 0 l 0 0 l f Q q 1 0 0 1 417.118 685.561 cm 0 0 m -.3159 -.2802 -.626 -.4775 -.9306 -.5927 c -1.2353 -.708 -1.5615 -.7656 -1.9106 -.7656 c -2.4868 -.7656 -2.9297 -.6269 -3.2392 -.3486 c -3.5488 -.0703 -3.7031 .2852 -3.7031 .7178 c -3.7031 .9717 -3.6445 1.2032 -3.5278 1.4131 c -3.4111 1.6231 -3.2578 1.7911 -3.0683 1.918 c -2.8789 2.045 -2.666 2.1412 -2.4287 2.2061 c -2.2539 2.252 -1.9902 2.2959 -1.6377 2.3379 c -.9199 2.4229 -.3911 2.5235 -.0517 2.6407 c -.0488 2.7593 -.0469 2.8345 -.0469 2.8667 c -.0469 3.2198 -.1308 3.4683 -.2978 3.6128 c -.5244 3.8086 -.8613 3.9063 -1.3076 3.9063 c -1.7246 3.9063 -2.0322 3.834 -2.2314 3.6895 c -2.4297 3.545 -2.5766 3.2891 -2.6719 2.9219 c -3.5469 3.0469 l -3.4687 3.4141 -3.3398 3.7105 -3.1601 3.9366 c -2.9805 4.162 -2.7207 4.336 -2.3808 4.4579 c -2.0415 4.5796 -1.6479 4.6407 -1.2007 4.6407 c -.7568 4.6407 -.3955 4.5884 -.1182 4.4844 c .1592 4.3799 .3633 4.2491 .4942 4.0913 c .6245 3.9336 .7158 3.7344 .7686 3.4937 c .7979 3.3438 .8125 3.0743 .8125 2.6851 c .8125 1.5171 l .8125 .7027 .8301 .1866 .8662 -.0307 c .9014 -.248 .9727 -.457 1.0781 -.6562 c .1719 -.6562 l .0825 -.4692 .0254 -.2504 0 0 c h -.0469 1.9532 m -.3716 1.8228 -.8584 1.712 -1.5078 1.6211 c -1.876 1.5689 -2.1362 1.5103 -2.2886 1.4454 c -2.4409 1.3799 -2.5586 1.2852 -2.6416 1.1597 c -2.7246 1.0342 -2.7656 .8951 -2.7656 .7422 c -2.7656 .5078 -2.6758 .3125 -2.4951 .1563 c -2.3154 0 -2.0513 -.0781 -1.7041 -.0781 c -1.3603 -.0781 -1.0542 -.0048 -.7861 .1426 c -.5185 .2901 -.3213 .4922 -.1958 .75 c -.0996 .9488 -.0517 1.2422 -.0517 1.6304 c -.0469 1.9532 l f Q q 1 0 0 1 421.195 685.699 cm 0 0 m .125 -.7763 l -.1231 -.8291 -.3452 -.8554 -.541 -.8554 c -.8614 -.8554 -1.1094 -.8047 -1.2857 -.7041 c -1.462 -.6035 -1.586 -.4712 -1.6582 -.3071 c -1.7295 -.143 -1.7657 .2022 -1.7657 .7285 c -1.7657 3.7071 l -2.4219 3.7071 l -2.4219 4.3946 l -1.7657 4.3946 l -1.7657 5.6786 l -.8907 6.2061 l -.8907 4.3946 l 0 4.3946 l 0 3.7071 l -.8907 3.7071 l -.8907 .6875 l -.8907 .4375 -.875 .2774 -.8438 .2061 c -.8125 .1348 -.7618 .0782 -.6914 .0362 c -.6211 -.0063 -.5201 -.0273 -.3887 -.0273 c -.2906 -.0273 -.1612 -.0185 0 0 c f Q q 1 0 0 1 422.067 691.061 cm 0 0 m .875 0 -.875 1.0001 re 0 0 m h 0 -6.1561 m 0 -.9686 l .875 -.9686 l .875 -6.1561 l 0 -6.1561 l f Q q 1 0 0 1 423.945 687.498 cm 0 0 m 0 .958 .2666 1.6671 .8007 2.1285 c 1.247 2.5118 1.791 2.7032 2.4316 2.7032 c 3.1445 2.7032 3.7275 2.4698 4.1806 2.0039 c 4.6328 1.5381 4.8593 .8947 4.8593 .0734 c 4.8593 -.5927 4.7597 -1.1161 4.5586 -1.4979 c 4.3593 -1.8794 4.0673 -2.1757 3.6845 -2.3867 c 3.3027 -2.5975 2.8847 -2.703 2.4316 -2.703 c 1.706 -2.703 1.1191 -2.4706 .6718 -2.0067 c .2236 -1.5419 0 -.8734 0 0 c h .9062 -.0052 m .9062 -.667 1.0507 -1.162 1.3398 -1.4911 c 1.6289 -1.8203 1.9931 -1.9843 2.4316 -1.9843 c 2.8672 -1.9843 3.2304 -1.8192 3.5195 -1.4882 c 3.8086 -1.1581 3.9531 -.6537 3.9531 .0236 c 3.9531 .6621 3.8076 1.1461 3.5166 1.4751 c 3.2256 1.8043 2.8642 1.9689 2.4316 1.9689 c 1.9931 1.9689 1.6289 1.8047 1.3398 1.4777 c 1.0507 1.1505 .9062 .6559 .9062 -.0052 c f Q q 1 0 0 1 429.835 684.905 cm 0 0 m 0 5.1875 l .7813 5.1875 l .7813 4.4502 l 1.1631 5.0146 1.7158 5.2969 2.4385 5.2969 c 2.7529 5.2969 3.041 5.2407 3.3037 5.1289 c 3.5674 5.0166 3.7647 4.8691 3.8955 4.6875 c 4.0264 4.5049 4.1172 4.289 4.1699 4.0386 c 4.2022 3.876 4.2188 3.5913 4.2188 3.1849 c 4.2188 0 l 3.3438 0 l 3.3438 3.1473 l 3.3438 3.5049 3.3096 3.7715 3.2412 3.9492 c 3.1719 4.126 3.0498 4.2676 2.875 4.373 c 2.7002 4.4785 2.4951 4.5312 2.2588 4.5312 c 1.8828 4.5312 1.5576 4.4126 1.2842 4.1758 c 1.0117 3.9385 .875 3.4883 .875 2.8262 c .875 0 l 0 0 l f Q q 1 0 0 1 353 696.404 cm 0 0 m 2.7354 7.1563 l 3.7847 7.1563 l 6.6963 0 l 5.6172 0 l 4.793 2.1719 l 1.7793 2.1719 l 1.0078 0 l 0 0 l h 2.062 2.9375 m 4.4912 2.9375 l 3.7534 4.9214 l 3.5191 5.521 3.3462 6.0161 3.2344 6.4063 c 3.1426 5.9502 3.0122 5.4966 2.8443 5.0444 c 2.062 2.9375 l f Q q 1 0 0 1 363.764 696.404 cm 0 0 m 0 .7627 l -.4043 .1812 -.9531 -.1094 -1.6475 -.1094 c -1.9541 -.1094 -2.2397 -.0508 -2.5054 .0659 c -2.771 .1831 -2.9683 .3306 -3.0967 .5073 c -3.2256 .6851 -3.3159 .9019 -3.3682 1.1587 c -3.4043 1.3311 -3.4219 1.604 -3.4219 1.978 c -3.4219 5.1875 l -2.5469 5.1875 l -2.5469 2.311 l -2.5469 1.8521 -2.5293 1.5425 -2.4932 1.3833 c -2.4375 1.1519 -2.3203 .9702 -2.1406 .8384 c -1.9609 .7065 -1.7393 .6406 -1.4746 .6406 c -1.21 .6406 -.9619 .708 -.7304 .8433 c -.4985 .978 -.3345 1.1621 -.2383 1.395 c -.1421 1.6279 -.0937 1.9653 -.0937 2.4087 c -.0937 5.1875 l .7813 5.1875 l .7813 0 l 0 0 l f Q q 1 0 0 1 367.841 697.198 cm 0 0 m .125 -.7764 l -.1231 -.8286 -.3452 -.855 -.541 -.855 c -.8614 -.855 -1.1094 -.8047 -1.2857 -.7041 c -1.4619 -.6035 -1.586 -.4707 -1.6582 -.3066 c -1.7295 -.1426 -1.7657 .2026 -1.7657 .7295 c -1.7657 3.7075 l -2.4219 3.7075 l -2.4219 4.395 l -1.7657 4.395 l -1.7657 5.6792 l -.8907 6.2065 l -.8907 4.395 l 0 4.395 l 0 3.7075 l -.8907 3.7075 l -.8907 .688 l -.8907 .4385 -.875 .2778 -.8438 .2065 c -.8125 .1353 -.7617 .0781 -.6914 .0361 c -.6211 -.0059 -.5201 -.0269 -.3887 -.0269 c -.2906 -.0269 -.1612 -.0176 0 0 c f Q q 1 0 0 1 368.697 696.404 cm 0 0 m 0 7.1563 l .875 7.1563 l .875 4.5903 l 1.2852 5.061 1.8023 5.2969 2.4273 5.2969 c 2.8111 5.2969 3.1445 5.2212 3.4277 5.0698 c 3.711 4.9185 3.9136 4.71 4.0357 4.4434 c 4.1577 4.1768 4.2188 3.7896 4.2188 3.2827 c 4.2188 0 l 3.3438 0 l 3.3438 3.2866 l 3.3438 3.7261 3.2481 4.0464 3.0576 4.2466 c 2.8672 4.4468 2.5972 4.5469 2.2485 4.5469 c 1.9878 4.5469 1.7422 4.479 1.5127 4.3442 c 1.2832 4.209 1.1192 4.0259 1.0215 3.7944 c .9238 3.5635 .875 3.2446 .875 2.8374 c .875 0 l 0 0 l f Q q 1 0 0 1 373.931 698.998 cm 0 0 m 0 .9575 .2666 1.6675 .8008 2.1284 c 1.2471 2.5112 1.7905 2.7031 2.4321 2.7031 c 3.145 2.7031 3.7276 2.4702 4.1807 2.0044 c 4.6328 1.5381 4.8594 .894 4.8594 .0728 c 4.8594 -.5923 4.7593 -1.1162 4.5591 -1.4976 c 4.3589 -1.8794 4.0674 -2.1758 3.6846 -2.3867 c 3.3023 -2.5972 2.8848 -2.7031 2.4321 -2.7031 c 1.7061 -2.7031 1.1192 -2.4712 .6714 -2.0063 c .2236 -1.5425 0 -.8735 0 0 c h .9063 -.0054 m .9063 -.6665 1.0508 -1.1616 1.3399 -1.4907 c 1.6289 -1.8198 1.9932 -1.9844 2.4321 -1.9844 c 2.8677 -1.9844 3.23 -1.8188 3.5195 -1.4888 c 3.8086 -1.1577 3.9531 -.6538 3.9531 .0239 c 3.9531 .6626 3.8076 1.146 3.5166 1.4751 c 3.2256 1.8042 2.8643 1.9688 2.4321 1.9688 c 1.9932 1.9688 1.6289 1.8052 1.3399 1.4775 c 1.0508 1.1499 .9063 .6558 .9063 -.0054 c f Q q 1 0 0 1 379.82 696.404 cm 0 0 m 0 5.1875 l .7812 5.1875 l .7812 4.3955 l .9819 4.7622 1.167 5.0044 1.3369 5.1216 c 1.5068 5.2383 1.6943 5.2969 1.8984 5.2969 c 2.1928 5.2969 2.4922 5.2046 2.7968 5.02 c 2.4873 4.2124 l 2.2758 4.3311 2.0644 4.3906 1.8535 4.3906 c 1.664 4.3906 1.4941 4.3325 1.3437 4.2173 c 1.1933 4.1021 1.0859 3.9419 1.021 3.7368 c .9238 3.4243 .875 3.083 .875 2.7124 c .875 0 l 0 0 l f Q q 1 0 0 1 383.166 702.561 cm 0 0 m .875 0 -.875 1 re 0 0 m h 0 -6.1562 m 0 -.9687 l .875 -.9687 l .875 -6.1562 l 0 -6.1562 l f Q q 1 0 0 1 384.903 696.404 cm 0 0 m 0 .7065 l 3.2861 4.5 l 2.9145 4.479 2.5864 4.4688 2.3017 4.4688 c .2031 4.4688 l .2031 5.1875 l 4.4375 5.1875 l 4.4375 4.603 l 1.6259 1.3135 l 1.08 .7031 l 1.4746 .7344 1.8447 .75 2.1909 .75 c 4.5937 .75 l 4.5937 0 l 0 0 l f Q q 1 0 0 1 393.778 697.061 cm 0 0 m -.3159 -.2798 -.626 -.4775 -.9307 -.5928 c -1.2354 -.708 -1.5616 -.7656 -1.9107 -.7656 c -2.4868 -.7656 -2.9297 -.6265 -3.2393 -.3481 c -3.5489 -.0703 -3.7032 .2852 -3.7032 .7183 c -3.7032 .9717 -3.6446 1.2036 -3.5279 1.4136 c -3.4112 1.623 -3.2578 1.7915 -3.0684 1.9185 c -2.8789 2.0454 -2.666 2.1411 -2.4287 2.2065 c -2.2539 2.2515 -1.9903 2.2954 -1.6377 2.3384 c -.92 2.4224 -.3911 2.5234 -.0518 2.6406 c -.0489 2.7593 -.0469 2.8345 -.0469 2.8667 c -.0469 3.2197 -.1309 3.4683 -.2979 3.6128 c -.5244 3.8081 -.8614 3.9063 -1.3076 3.9063 c -1.7246 3.9063 -2.0323 3.834 -2.2315 3.6895 c -2.4297 3.5449 -2.5767 3.2891 -2.6719 2.9219 c -3.5469 3.0469 l -3.4688 3.4141 -3.3399 3.7104 -3.1602 3.936 c -2.9805 4.1621 -2.7207 4.3359 -2.3809 4.4575 c -2.0415 4.5796 -1.648 4.6406 -1.2007 4.6406 c -.7569 4.6406 -.3955 4.5884 -.1182 4.4844 c .1592 4.3804 .3632 4.249 .4941 4.0913 c .6245 3.9336 .7158 3.7344 .7685 3.4937 c .7978 3.3438 .8125 3.0742 .8125 2.6851 c .8125 1.5171 l .8125 .7026 .83 .187 .8662 -.0308 c .9013 -.2485 .9726 -.4565 1.0781 -.6562 c .1718 -.6562 l .0825 -.4692 .0254 -.2505 0 0 c h -.0469 1.9531 m -.3716 1.8228 -.8584 1.7124 -1.5078 1.6211 c -1.876 1.5688 -2.1363 1.5103 -2.2886 1.4453 c -2.4409 1.3804 -2.5586 1.2847 -2.6416 1.1597 c -2.7246 1.0342 -2.7657 .895 -2.7657 .7422 c -2.7657 .5078 -2.6758 .3125 -2.4951 .1563 c -2.3155 0 -2.0513 -.0781 -1.7041 -.0781 c -1.3604 -.0781 -1.0542 -.0044 -.7862 .1426 c -.5186 .2896 -.3213 .4922 -.1958 .75 c -.0996 .9487 -.0518 1.2422 -.0518 1.6304 c -.0469 1.9531 l f Q q 1 0 0 1 397.855 697.198 cm 0 0 m .125 -.7764 l -.123 -.8286 -.3452 -.855 -.541 -.855 c -.8613 -.855 -1.1094 -.8047 -1.2856 -.7041 c -1.4619 -.6035 -1.5859 -.4707 -1.6582 -.3066 c -1.7295 -.1426 -1.7656 .2026 -1.7656 .7295 c -1.7656 3.7075 l -2.4219 3.7075 l -2.4219 4.395 l -1.7656 4.395 l -1.7656 5.6792 l -.8906 6.2065 l -.8906 4.395 l 0 4.395 l 0 3.7075 l -.8906 3.7075 l -.8906 .688 l -.8906 .4385 -.875 .2778 -.8437 .2065 c -.8125 .1353 -.7617 .0781 -.6914 .0361 c -.6211 -.0059 -.52 -.0269 -.3887 -.0269 c -.2905 -.0269 -.1611 -.0176 0 0 c f Q q 1 0 0 1 398.728 702.561 cm 0 0 m .875 0 -.875 1 re 0 0 m h 0 -6.1562 m 0 -.9687 l .875 -.9687 l .875 -6.1562 l 0 -6.1562 l f Q q 1 0 0 1 400.605 698.998 cm 0 0 m 0 .9575 .2666 1.6675 .8008 2.1284 c 1.2471 2.5112 1.7905 2.7031 2.4321 2.7031 c 3.145 2.7031 3.7276 2.4702 4.1807 2.0044 c 4.6328 1.5381 4.8594 .894 4.8594 .0728 c 4.8594 -.5923 4.7593 -1.1162 4.5591 -1.4976 c 4.3589 -1.8794 4.0674 -2.1758 3.6846 -2.3867 c 3.3023 -2.5972 2.8848 -2.7031 2.4321 -2.7031 c 1.7061 -2.7031 1.1192 -2.4712 .6714 -2.0063 c .2237 -1.5425 0 -.8735 0 0 c h .9063 -.0054 m .9063 -.6665 1.0508 -1.1616 1.3399 -1.4907 c 1.6289 -1.8198 1.9932 -1.9844 2.4321 -1.9844 c 2.8677 -1.9844 3.23 -1.8188 3.5195 -1.4888 c 3.8086 -1.1577 3.9531 -.6538 3.9531 .0239 c 3.9531 .6626 3.8076 1.146 3.5166 1.4751 c 3.2256 1.8042 2.8643 1.9688 2.4321 1.9688 c 1.9932 1.9688 1.6289 1.8052 1.3399 1.4775 c 1.0508 1.1499 .9063 .6558 .9063 -.0054 c f Q q 1 0 0 1 406.495 696.404 cm 0 0 m 0 5.1875 l .7812 5.1875 l .7812 4.4502 l 1.1635 5.0146 1.7158 5.2969 2.4384 5.2969 c 2.7524 5.2969 3.041 5.2407 3.3042 5.1284 c 3.5674 5.0161 3.7641 4.8696 3.895 4.687 c 4.0258 4.5054 4.1172 4.2886 4.1699 4.0386 c 4.2021 3.876 4.2187 3.5913 4.2187 3.1851 c 4.2187 0 l 3.3437 0 l 3.3437 3.1475 l 3.3437 3.5044 3.3095 3.772 3.2407 3.9487 c 3.1718 4.126 3.0498 4.2671 2.875 4.3726 c 2.7002 4.478 2.4946 4.5313 2.2588 4.5313 c 1.8828 4.5313 1.5576 4.4126 1.2846 4.1753 c 1.0117 3.938 .875 3.4888 .875 2.8257 c .875 0 l 0 0 l f Q q 1 0 0 1 415.054 696.404 cm 0 0 m 0 4.5 l -.7813 4.5 l -.7813 5.1875 l 0 5.1875 l 0 5.7388 l 0 6.0874 .0307 6.3457 .0927 6.5151 c .1777 6.7427 .3266 6.9272 .54 7.0688 c .7534 7.2104 1.0522 7.2813 1.4365 7.2813 c 1.6836 7.2813 1.957 7.2515 2.2568 7.1929 c 2.125 6.4204 l 1.9423 6.4526 1.77 6.4688 1.6074 6.4688 c 1.3403 6.4688 1.1513 6.4121 1.041 6.2988 c .9301 6.1855 .875 5.9736 .875 5.6631 c .875 5.1875 l 1.8906 5.1875 l 1.8906 4.5 l .875 4.5 l .875 0 l 0 0 l f Q q 1 0 0 1 417.285 698.998 cm 0 0 m 0 .9575 .2666 1.6675 .8008 2.1284 c 1.2471 2.5112 1.7905 2.7031 2.4321 2.7031 c 3.145 2.7031 3.7275 2.4702 4.1807 2.0044 c 4.6328 1.5381 4.8594 .894 4.8594 .0728 c 4.8594 -.5923 4.7593 -1.1162 4.5591 -1.4976 c 4.3589 -1.8794 4.0674 -2.1758 3.6846 -2.3867 c 3.3022 -2.5972 2.8848 -2.7031 2.4321 -2.7031 c 1.7061 -2.7031 1.1192 -2.4712 .6714 -2.0063 c .2236 -1.5425 0 -.8735 0 0 c h .9063 -.0054 m .9063 -.6665 1.0508 -1.1616 1.3398 -1.4907 c 1.6289 -1.8198 1.9932 -1.9844 2.4321 -1.9844 c 2.8677 -1.9844 3.23 -1.8188 3.5195 -1.4888 c 3.8086 -1.1577 3.9531 -.6538 3.9531 .0239 c 3.9531 .6626 3.8076 1.146 3.5166 1.4751 c 3.2256 1.8042 2.8643 1.9688 2.4321 1.9688 c 1.9932 1.9688 1.6289 1.8052 1.3398 1.4775 c 1.0508 1.1499 .9063 .6558 .9063 -.0054 c f Q q 1 0 0 1 423.175 696.404 cm 0 0 m 0 5.1875 l .7812 5.1875 l .7812 4.3955 l .9814 4.7622 1.1669 5.0044 1.3369 5.1216 c 1.5068 5.2383 1.6943 5.2969 1.8984 5.2969 c 2.1923 5.2969 2.4921 5.2046 2.7968 5.02 c 2.4873 4.2124 l 2.2763 4.3311 2.0644 4.3906 1.8535 4.3906 c 1.664 4.3906 1.4941 4.3325 1.3437 4.2173 c 1.1933 4.1021 1.0859 3.9419 1.0205 3.7368 c .9238 3.4243 .875 3.083 .875 2.7124 c .875 0 l 0 0 l f Q q 1 0 0 1 429.439 696.404 cm 0 0 m 0 7.1563 l 3.1602 7.1563 l 3.793 7.1563 4.2734 7.0918 4.6035 6.9634 c 4.9316 6.8345 5.1953 6.6069 5.3926 6.2808 c 5.5889 5.9551 5.6875 5.5952 5.6875 5.2007 c 5.6875 4.6919 5.5244 4.2632 5.1982 3.9146 c 4.8731 3.5659 4.3691 3.3442 3.6885 3.25 c 3.9385 3.1304 4.1279 3.0122 4.2578 2.896 c 4.5342 2.644 4.7939 2.3267 5.0391 1.9438 c 6.2686 0 l 5.0869 0 l 4.1484 1.4858 l 3.8731 1.9146 3.6475 2.2427 3.4707 2.4702 c 3.293 2.6978 3.1338 2.8569 2.9932 2.9478 c 2.8535 3.0386 2.71 3.1021 2.5654 3.1377 c 2.459 3.1606 2.2842 3.1719 2.042 3.1719 c .9531 3.1719 l .9531 0 l 0 0 l h .9531 4 m 2.9717 4 l 3.4004 4 3.7344 4.0444 3.9736 4.1338 c 4.2119 4.2231 4.3926 4.3657 4.5176 4.562 c 4.6406 4.7583 4.7031 4.9712 4.7031 5.2017 c 4.7031 5.5386 4.582 5.8159 4.3418 6.0337 c 4.1006 6.2505 3.7197 6.3594 3.1992 6.3594 c .9531 6.3594 l .9531 4 l f Q q 1 0 0 1 440.058 698.092 cm 0 0 m .9023 -.125 l .7588 -.6548 .4941 -1.0659 .1064 -1.3579 c -.2813 -1.6509 -.7764 -1.7969 -1.378 -1.7969 c -2.1367 -1.7969 -2.7393 -1.564 -3.1827 -1.0981 c -3.628 -.6323 -3.8496 .0215 -3.8496 .8623 c -3.8496 1.7324 -3.625 2.4077 -3.1758 2.8882 c -2.7266 3.3687 -2.1436 3.6094 -1.4268 3.6094 c -.7334 3.6094 -.167 3.3745 .2724 2.9043 c .7119 2.4341 .9316 1.7729 .9316 .9209 c .9316 .8687 .9297 .791 .9267 .6875 c -2.9434 .6875 l -2.9112 .1167 -2.7491 -.3198 -2.458 -.6235 c -2.168 -.9263 -1.8057 -1.0781 -1.3711 -1.0781 c -1.0479 -1.0781 -.7725 -.9927 -.544 -.8208 c -.3155 -.6499 -.1338 -.376 0 0 c h -2.8965 1.4063 m .0097 1.4063 l -.0293 1.8408 -.1407 2.167 -.3233 2.3843 c -.6045 2.7222 -.9688 2.8906 -1.417 2.8906 c -1.8213 2.8906 -2.1621 2.7559 -2.4385 2.4868 c -2.7139 2.2173 -2.8672 1.8569 -2.8965 1.4063 c f Q 442.051 696.404 .875 7.1562 re f q 1 0 0 1 447.841 698.092 cm 0 0 m .9023 -.125 l .7588 -.6548 .4941 -1.0659 .1064 -1.3579 c -.2813 -1.6509 -.7764 -1.7969 -1.378 -1.7969 c -2.1367 -1.7969 -2.7393 -1.564 -3.1827 -1.0981 c -3.628 -.6323 -3.8496 .0215 -3.8496 .8623 c -3.8496 1.7324 -3.625 2.4077 -3.1758 2.8882 c -2.7266 3.3687 -2.1436 3.6094 -1.4268 3.6094 c -.7334 3.6094 -.167 3.3745 .2724 2.9043 c .7119 2.4341 .9316 1.7729 .9316 .9209 c .9316 .8687 .9297 .791 .9267 .6875 c -2.9434 .6875 l -2.9112 .1167 -2.7491 -.3198 -2.458 -.6235 c -2.168 -.9263 -1.8057 -1.0781 -1.3711 -1.0781 c -1.0479 -1.0781 -.7725 -.9927 -.544 -.8208 c -.3155 -.6499 -.1338 -.376 0 0 c h -2.8965 1.4063 m .0097 1.4063 l -.0293 1.8408 -.1407 2.167 -.3233 2.3843 c -.6045 2.7222 -.9688 2.8906 -1.417 2.8906 c -1.8213 2.8906 -2.1621 2.7559 -2.4385 2.4868 c -2.7139 2.2173 -2.8672 1.8569 -2.8965 1.4063 c f Q q 1 0 0 1 453.256 697.061 cm 0 0 m -.3165 -.2798 -.6261 -.4775 -.9308 -.5928 c -1.2354 -.708 -1.5616 -.7656 -1.9102 -.7656 c -2.4864 -.7656 -2.9298 -.6265 -3.2394 -.3481 c -3.5489 -.0703 -3.7032 .2852 -3.7032 .7183 c -3.7032 .9717 -3.6446 1.2036 -3.5274 1.4136 c -3.4112 1.623 -3.2579 1.7915 -3.0684 1.9185 c -2.879 2.0454 -2.6661 2.1411 -2.4288 2.2065 c -2.254 2.2515 -1.9903 2.2954 -1.6378 2.3384 c -.92 2.4224 -.3907 2.5234 -.051 2.6406 c -.048 2.7593 -.047 2.8345 -.047 2.8667 c -.047 3.2197 -.13 3.4683 -.2979 3.6128 c -.5245 3.8081 -.8614 3.9063 -1.3077 3.9063 c -1.7247 3.9063 -2.0323 3.834 -2.2315 3.6895 c -2.4298 3.5449 -2.5763 3.2891 -2.672 2.9219 c -3.547 3.0469 l -3.4688 3.4141 -3.3399 3.7104 -3.1602 3.936 c -2.9806 4.1621 -2.7208 4.3359 -2.381 4.4575 c -2.0411 4.5796 -1.6485 4.6406 -1.2013 4.6406 c -.7569 4.6406 -.3956 4.5884 -.118 4.4844 c .16 4.3804 .364 4.249 .494 4.0913 c .625 3.9336 .716 3.7344 .769 3.4937 c .798 3.3438 .813 3.0742 .813 2.6851 c .813 1.5171 l .813 .7026 .83 .187 .867 -.0308 c .902 -.2485 .973 -.4565 1.078 -.6562 c .172 -.6562 l .082 -.4692 .026 -.2505 0 0 c h -.047 1.9531 m -.3712 1.8228 -.8585 1.7124 -1.5079 1.6211 c -1.8761 1.5688 -2.1368 1.5103 -2.2892 1.4453 c -2.4415 1.3804 -2.5587 1.2847 -2.6417 1.1597 c -2.7247 1.0342 -2.7657 .895 -2.7657 .7422 c -2.7657 .5078 -2.6759 .3125 -2.4952 .1563 c -2.3155 0 -2.0509 -.0781 -1.7042 -.0781 c -1.3604 -.0781 -1.0548 -.0044 -.7862 .1426 c -.5186 .2896 -.3214 .4922 -.195 .75 c -.099 .9487 -.051 1.2422 -.051 1.6304 c -.047 1.9531 l f Q q 1 0 0 1 455.084 697.967 cm 0 0 m .875 .125 l .922 -.2231 1.058 -.4897 1.28 -.6753 c 1.5 -.8608 1.81 -.9531 2.208 -.9531 c 2.608 -.9531 2.906 -.8711 3.099 -.7065 c 3.293 -.5425 3.39 -.3496 3.39 -.1284 c 3.39 .0698 3.303 .2261 3.129 .3403 c 3.007 .418 2.708 .5171 2.231 .6377 c 1.587 .7998 1.143 .9399 .895 1.0591 c .647 1.1772 .459 1.3413 .332 1.5503 c .204 1.7603 .14 1.9912 .14 2.2446 c .14 2.4751 .193 2.688 .298 2.8843 c .404 3.0806 .547 3.2441 .729 3.374 c .866 3.4746 1.051 3.5601 1.287 3.6294 c 1.522 3.6997 1.774 3.7344 2.043 3.7344 c 2.45 3.7344 2.805 3.6758 3.112 3.5591 c 3.418 3.4419 3.645 3.2832 3.792 3.0835 c 3.937 2.8833 4.038 2.6157 4.093 2.2813 c 3.234 2.1563 l 3.195 2.4263 3.083 2.6372 2.895 2.7886 c 2.708 2.9399 2.445 3.0156 2.104 3.0156 c 1.702 3.0156 1.414 2.9487 1.242 2.8154 c 1.07 2.6821 .984 2.5259 .984 2.3472 c .984 2.2329 1.02 2.1304 1.091 2.0396 c 1.163 1.9448 1.274 1.8667 1.427 1.8052 c 1.514 1.7725 1.773 1.6978 2.202 1.5806 c 2.822 1.415 3.255 1.2798 3.502 1.1743 c 3.75 1.0688 3.944 .915 4.084 .7139 c 4.226 .5127 4.296 .2627 4.296 -.0356 c 4.296 -.3281 4.211 -.603 4.041 -.8613 c 3.87 -1.1196 3.624 -1.3188 3.302 -1.4604 c 2.981 -1.6011 2.618 -1.6719 2.211 -1.6719 c 1.539 -1.6719 1.027 -1.5317 .674 -1.2505 c .322 -.9692 .097 -.5522 0 0 c f Q q 1 0 0 1 463.964 698.092 cm 0 0 m .903 -.125 l .759 -.6548 .495 -1.0659 .107 -1.3579 c -.281 -1.6509 -.776 -1.7969 -1.378 -1.7969 c -2.136 -1.7969 -2.739 -1.564 -3.182 -1.0981 c -3.628 -.6323 -3.849 .0215 -3.849 .8623 c -3.849 1.7324 -3.625 2.4077 -3.175 2.8882 c -2.726 3.3687 -2.143 3.6094 -1.426 3.6094 c -.733 3.6094 -.167 3.3745 .273 2.9043 c .712 2.4341 .932 1.7729 .932 .9209 c .932 .8687 .93 .791 .927 .6875 c -2.943 .6875 l -2.911 .1167 -2.749 -.3198 -2.458 -.6235 c -2.168 -.9263 -1.805 -1.0781 -1.371 -1.0781 c -1.047 -1.0781 -.772 -.9927 -.544 -.8208 c -.315 -.6499 -.133 -.376 0 0 c h -2.896 1.4063 m .01 1.4063 l -.029 1.8408 -.14 2.167 -.323 2.3843 c -.604 2.7222 -.968 2.8906 -1.417 2.8906 c -1.821 2.8906 -2.162 2.7559 -2.438 2.4868 c -2.714 2.2173 -2.867 1.8569 -2.896 1.4063 c f Q q 1 0 0 1 468.423 698.998 cm 0 0 m 0 .9575 .267 1.6675 .801 2.1284 c 1.247 2.5112 1.79 2.7031 2.433 2.7031 c 3.146 2.7031 3.728 2.4702 4.181 2.0044 c 4.633 1.5381 4.86 .894 4.86 .0728 c 4.86 -.5923 4.759 -1.1162 4.56 -1.4976 c 4.359 -1.8794 4.068 -2.1758 3.685 -2.3867 c 3.302 -2.5972 2.885 -2.7031 2.433 -2.7031 c 1.706 -2.7031 1.119 -2.4712 .671 -2.0063 c .224 -1.5425 0 -.8735 0 0 c h .907 -.0054 m .907 -.6665 1.051 -1.1616 1.34 -1.4907 c 1.629 -1.8198 1.994 -1.9844 2.433 -1.9844 c 2.869 -1.9844 3.23 -1.8188 3.52 -1.4888 c 3.809 -1.1577 3.953 -.6538 3.953 .0239 c 3.953 .6626 3.808 1.146 3.517 1.4751 c 3.226 1.8042 2.865 1.9688 2.433 1.9688 c 1.994 1.9688 1.629 1.8052 1.34 1.4775 c 1.051 1.1499 .907 .6558 .907 -.0054 c f Q q 1 0 0 1 474.532 696.404 cm 0 0 m 0 4.5 l -.782 4.5 l -.782 5.1875 l 0 5.1875 l 0 5.7388 l 0 6.0874 .031 6.3457 .093 6.5151 c .177 6.7427 .326 6.9272 .54 7.0688 c .754 7.2104 1.052 7.2813 1.436 7.2813 c 1.683 7.2813 1.957 7.2515 2.257 7.1929 c 2.125 6.4204 l 1.942 6.4526 1.769 6.4688 1.607 6.4688 c 1.34 6.4688 1.151 6.4121 1.041 6.2988 c .929 6.1855 .875 5.9736 .875 5.6631 c .875 5.1875 l 1.89 5.1875 l 1.89 4.5 l .875 4.5 l .875 0 l 0 0 l f Q q 1 0 0 1 479.979 696.404 cm 0 0 m 0 7.1563 l 2.703 7.1563 l 3.178 7.1563 3.541 7.1333 3.793 7.0879 c 4.145 7.0293 4.439 6.9175 4.677 6.7534 c 4.915 6.5884 5.106 6.3584 5.251 6.062 c 5.397 5.7656 5.469 5.4399 5.469 5.085 c 5.469 4.4761 5.275 3.9604 4.888 3.5386 c 4.5 3.1167 3.801 2.9063 2.789 2.9063 c .953 2.9063 l .953 0 l 0 0 l h .953 3.75 m 2.799 3.75 l 3.409 3.75 3.843 3.8638 4.1 4.0923 c 4.355 4.3203 4.484 4.6416 4.484 5.0557 c 4.484 5.3555 4.408 5.6123 4.258 5.8257 c 4.107 6.0396 3.908 6.1802 3.661 6.249 c 3.502 6.2915 3.208 6.3125 2.779 6.3125 c .953 6.3125 l .953 3.75 l f Q q 1 0 0 1 489.946 697.061 cm 0 0 m -.317 -.2798 -.626 -.4775 -.931 -.5928 c -1.236 -.708 -1.562 -.7656 -1.91 -.7656 c -2.487 -.7656 -2.93 -.6265 -3.239 -.3481 c -3.549 -.0703 -3.703 .2852 -3.703 .7183 c -3.703 .9717 -3.645 1.2036 -3.528 1.4136 c -3.411 1.623 -3.258 1.7915 -3.069 1.9185 c -2.879 2.0454 -2.666 2.1411 -2.429 2.2065 c -2.254 2.2515 -1.99 2.2954 -1.638 2.3384 c -.92 2.4224 -.391 2.5234 -.052 2.6406 c -.049 2.7593 -.047 2.8345 -.047 2.8667 c -.047 3.2197 -.131 3.4683 -.298 3.6128 c -.525 3.8081 -.862 3.9063 -1.308 3.9063 c -1.725 3.9063 -2.032 3.834 -2.232 3.6895 c -2.43 3.5449 -2.576 3.2891 -2.672 2.9219 c -3.547 3.0469 l -3.469 3.4141 -3.34 3.7104 -3.16 3.936 c -2.981 4.1621 -2.721 4.3359 -2.381 4.4575 c -2.041 4.5796 -1.649 4.6406 -1.201 4.6406 c -.757 4.6406 -.396 4.5884 -.118 4.4844 c .159 4.3804 .363 4.249 .494 4.0913 c .625 3.9336 .716 3.7344 .768 3.4937 c .798 3.3438 .812 3.0742 .812 2.6851 c .812 1.5171 l .812 .7026 .83 .187 .866 -.0308 c .901 -.2485 .972 -.4565 1.078 -.6562 c .172 -.6562 l .082 -.4692 .025 -.2505 0 0 c h -.047 1.9531 m -.371 1.8228 -.859 1.7124 -1.508 1.6211 c -1.876 1.5688 -2.137 1.5103 -2.289 1.4453 c -2.442 1.3804 -2.559 1.2847 -2.642 1.1597 c -2.725 1.0342 -2.766 .895 -2.766 .7422 c -2.766 .5078 -2.676 .3125 -2.495 .1563 c -2.316 0 -2.051 -.0781 -1.704 -.0781 c -1.361 -.0781 -1.055 -.0044 -.786 .1426 c -.519 .2896 -.321 .4922 -.196 .75 c -.1 .9487 -.052 1.2422 -.052 1.6304 c -.047 1.9531 l f Q q 1 0 0 1 494.023 697.198 cm 0 0 m .125 -.7764 l -.123 -.8286 -.345 -.855 -.541 -.855 c -.861 -.855 -1.1089 -.8047 -1.2859 -.7041 c -1.462 -.6035 -1.586 -.4707 -1.658 -.3066 c -1.73 -.1426 -1.766 .2026 -1.766 .7295 c -1.766 3.7075 l -2.422 3.7075 l -2.422 4.395 l -1.766 4.395 l -1.766 5.6792 l -.891 6.2065 l -.891 4.395 l 0 4.395 l 0 3.7075 l -.891 3.7075 l -.891 .688 l -.891 .4385 -.875 .2778 -.844 .2065 c -.813 .1353 -.762 .0781 -.691 .0361 c -.621 -.0059 -.521 -.0269 -.389 -.0269 c -.29 -.0269 -.1609 -.0176 0 0 c f Q q 1 0 0 1 495.77 702.561 cm 0 0 m -.875 0 .875 1 re 0 0 m h 0 -6.1562 m 0 -.9687 l -.875 -.9687 l -.875 -6.1562 l 0 -6.1562 l f Q q 1 0 0 1 500.654 698.092 cm 0 0 m .902 -.125 l .759 -.6548 .494 -1.0659 .106 -1.3579 c -.281 -1.6509 -.777 -1.7969 -1.378 -1.7969 c -2.137 -1.7969 -2.739 -1.564 -3.183 -1.0981 c -3.628 -.6323 -3.85 .0215 -3.85 .8623 c -3.85 1.7324 -3.625 2.4077 -3.176 2.8882 c -2.727 3.3687 -2.144 3.6094 -1.427 3.6094 c -.734 3.6094 -.167 3.3745 .272 2.9043 c .712 2.4341 .931 1.7729 .931 .9209 c .931 .8687 .93 .791 .927 .6875 c -2.944 .6875 l -2.911 .1167 -2.749 -.3198 -2.458 -.6235 c -2.168 -.9263 -1.806 -1.0781 -1.371 -1.0781 c -1.048 -1.0781 -.773 -.9927 -.544 -.8208 c -.316 -.6499 -.134 -.376 0 0 c h -2.897 1.4063 m .01 1.4063 l -.029 1.8408 -.141 2.167 -.323 2.3843 c -.605 2.7222 -.969 2.8906 -1.417 2.8906 c -1.821 2.8906 -2.162 2.7559 -2.439 2.4868 c -2.714 2.2173 -2.867 1.8569 -2.897 1.4063 c f Q q 1 0 0 1 502.663 696.404 cm 0 0 m 0 5.1875 l .781 5.1875 l .781 4.4502 l 1.164 5.0146 1.715 5.2969 2.438 5.2969 c 2.752 5.2969 3.041 5.2407 3.304 5.1284 c 3.567 5.0161 3.763 4.8696 3.894 4.687 c 4.025 4.5054 4.117 4.2886 4.17 4.0386 c 4.202 3.876 4.218 3.5913 4.218 3.1851 c 4.218 0 l 3.343 0 l 3.343 3.1475 l 3.343 3.5044 3.309 3.772 3.24 3.9487 c 3.171 4.126 3.049 4.2671 2.875 4.3726 c 2.7 4.478 2.494 4.5313 2.258 4.5313 c 1.882 4.5313 1.557 4.4126 1.285 4.1753 c 1.011 3.938 .875 3.4888 .875 2.8257 c .875 0 l 0 0 l f Q q 353 703.686 157 -65.686 re W n q 1 0 0 1 510.146 697.198 cm 0 0 m .125 -.7764 l -.123 -.8286 -.345 -.855 -.541 -.855 c -.861 -.855 -1.109 -.8047 -1.286 -.7041 c -1.462 -.6035 -1.586 -.4707 -1.658 -.3066 c -1.729 -.1426 -1.766 .2026 -1.766 .7295 c -1.766 3.7075 l -2.422 3.7075 l -2.422 4.395 l -1.766 4.395 l -1.766 5.6792 l -.891 6.2065 l -.891 4.395 l 0 4.395 l 0 3.7075 l -.891 3.7075 l -.891 .688 l -.891 .4385 -.875 .2778 -.844 .2065 c -.812 .1353 -.762 .0781 -.691 .0361 c -.621 -.0059 -.52 -.0269 -.389 -.0269 c -.29 -.0269 -.161 -.0176 0 0 c f Q Q q 353.052 680.48 m 353.052 638 l 480.493 638 l 480.493 680.48 l W n q 127.47 0 0 42.51 353.037 637.985 cm /Im1 Do Q EMC /P <>BDC Q q 1 i 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n /GS2 gs BT /TT4 1 Tf 8.5 0 0 8.5 36 620.625 Tm 0 Tc 0 Tw (INSTRUCTIONS:)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 102.5807 620.625 Tm .0278 Tw [( )17.6(This authorization is made by you for the release of your healthcare information, as indicated. Please address questions)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 559.324 620.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 609.625 Tm .0278 Tw [(about this form to: ֱ and Rush Oak Park Hospital, )54.7(A)73.7(TTN: Health Information Management Of)17.6(fice, 161)73.7(1)]TJ 59.1397 0 TD [( W)17.6(est)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 560.4981 609.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 598.6249 Tm .0278 Tw [(Harrison Street, L1, Suite 001, Chicago, IL)36.6( 60612, )17.6(T)110.8(elephone: \(312\) 942-7262, Fax: \(312\) 942-2264 or to Rush Copley Medical Cen)]TJ 58.6196 0 TD 0 Tw [(ter)54.7(, )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 548.6815 598.6249 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 587.625 Tm .0278 Tw [(A)73.7(TTN: Health Information Management Of)17.6(fice, 2000 Ogden )54.7(A)17.6(venue, )54.7(Aurora, IL)36.6( 60504, )17.6(T)110.8(elephone: \(630\) 978-6786, Fax \(630\) 978-6858.)]TJ ET EMC /Figure <>BDC Q q 1 i 288 756 288 -15 re 549.662 587.625 m W* n 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n 0 g /GS3 gs q 1 0 0 1 426.823 743.992 cm 0 0 m 1.3412 -2.049 2.2539 -1.3598 2.2539 -1.8068 c 2.2539 -2.0303 1.2108 -2.0303 1.0431 -2.0303 c -.3167 -2.0303 -1.0431 -1.0804 -1.7509 -.0186 c -3.8185 3.2411 l -4.4891 4.2842 -4.2097 4.2283 -6.2959 4.2283 c -6.892 4.2283 -6.7802 3.8931 -6.7802 3.7068 c -6.7802 -.2235 l -6.7802 -1.8254 -4.843 -1.248 -4.843 -1.8813 c -4.843 -2.0676 -5.0107 -2.0303 -5.1597 -2.0303 c -5.3273 -2.0303 -5.7558 -1.9558 -7.3018 -1.9558 c -8.0096 -1.9558 -8.7175 -2.0303 -9.4253 -2.0303 c -9.5371 -2.0303 -9.6116 -1.9372 -9.6116 -1.8254 c -9.6116 -1.3598 -8.2518 -1.6205 -8.2518 -.2049 c -8.2518 9.2763 l -8.2518 11.064 -9.8537 10.301 -9.8537 10.934 c -9.8537 11.046 -9.7047 11.158 -9.4812 11.158 c -9.1459 11.158 -9.239 11.083 -8.289 11.083 c -7.2087 11.083 -6.1469 11.158 -5.1783 11.158 c -4.8803 11.158 -.7637 11.53 -.7637 7.9351 c -.7637 6.4822 -1.8068 5.2342 -3.1107 4.7127 c 0 0 l h -6.7802 5.1225 m -6.7802 4.7686 -5.6254 4.8616 -4.7499 4.8616 c -3.9489 4.8616 -2.1607 5.197 -2.1607 7.5067 c -2.1607 9.7792 -3.8931 10.543 -5.7185 10.543 c -6.3891 10.543 -6.7802 10.58 -6.7802 9.8538 c -6.7802 5.1225 l f Q q 1 0 0 1 430.651 746.936 cm 0 0 m 0 -2.9803 1.8404 -4.3401 4.2292 -4.3401 c 7.556 -4.3401 8.3169 -2.0303 8.3169 .1677 c 8.3169 6.2029 l 8.3169 8.1028 6.6713 7.3205 6.6713 8.0283 c 6.6713 8.1215 6.7951 8.2146 6.8482 8.2146 c 7.5383 8.2146 8.2285 8.1401 8.9186 8.1401 c 9.2548 8.1401 9.5733 8.2146 9.8918 8.2146 c 9.9803 8.2146 10.122 8.1215 10.122 8.0096 c 10.122 7.4882 9.0778 7.8979 9.0778 6.1842 c 9.0778 .4098 l 9.0778 -.5029 9.2902 -5.1038 4.1408 -5.1038 c -.5132 -5.1038 -1.3979 -2.3656 -1.3979 .5029 c -1.3979 6.7803 l -1.3979 7.8793 -2.8313 7.4323 -2.8313 8.0283 c -2.8313 8.1587 -2.5305 8.2146 -2.442 8.2146 c -1.9819 8.2146 -1.5395 8.1401 -1.0617 8.1401 c -.4955 8.1401 .0708 8.2146 .6194 8.2146 c .7078 8.2146 1.1856 8.2518 1.1856 8.0283 c 1.1856 7.5068 0 8.0283 0 6.6871 c 0 0 l f Q q 1 0 0 1 441.35 745.259 cm 0 0 m -.0745 .3726 .0186 .5774 .2049 .5774 c .4656 .5774 .4656 .3539 .5588 -.0372 c .7823 -.894 1.9 -2.8313 4.4705 -2.8313 c 6.2401 -2.8313 7.9724 -1.8441 7.9724 .1117 c 7.9724 3.7068 .4098 1.6951 .4098 6.5568 c .4098 8.9224 2.4029 10.059 4.545 10.059 c 6.7989 10.059 7.4136 9.3881 7.6743 9.3881 c 7.842 9.3881 7.8792 9.5929 8.0655 9.5929 c 8.1773 9.5929 8.2704 9.5371 8.289 9.3322 c 8.5684 6.7988 l 8.587 6.6499 8.5498 6.5195 8.3636 6.5195 c 8.1586 6.5195 8.0283 6.9106 7.9724 7.0783 c 7.4136 8.6802 6.0538 9.4998 4.4146 9.4998 c 2.9431 9.4998 1.3784 8.792 1.3784 7.0783 c 1.3784 3.5764 8.941 5.6254 8.941 .4843 c 8.941 -1.0804 7.842 -3.4274 3.6136 -3.4274 c 2.2352 -3.4274 .5402 -2.7382 .4656 -2.4029 c 0 0 l f Q q 1 0 0 1 452.804 753.548 cm 0 0 m -.0186 1.3597 -1.6206 .9872 -1.6206 1.397 c -1.6206 1.5647 -1.4716 1.6019 -1.3225 1.6019 c -.6333 1.6019 .0373 1.5274 .7264 1.5274 c 1.3039 1.5274 1.8813 1.6019 2.4588 1.6019 c 2.7754 1.6019 2.8127 1.4901 2.8127 1.4156 c 2.8127 1.0431 1.4715 1.397 1.4715 0 c 1.4715 -4.0234 l 1.4715 -4.2842 1.4715 -4.3588 1.7509 -4.3588 c 8.5685 -4.3588 l 8.7547 -4.3588 8.7175 -3.8931 8.7175 -3.8186 c 8.7175 0 l 8.7175 1.2853 7.3204 .9686 7.3204 1.397 c 7.3204 1.5088 7.3577 1.6019 7.6371 1.6019 c 8.2518 1.6019 9.2204 1.5274 9.5743 1.5274 c 10.264 1.5274 10.543 1.6019 10.915 1.6019 c 11.4 1.6019 11.437 1.4156 11.437 1.3038 c 11.437 .9686 10.189 1.2853 10.189 0 c 10.189 -9.8724 l 10.189 -11.232 11.884 -10.897 11.884 -11.363 c 11.884 -11.418 11.81 -11.586 11.679 -11.586 c 11.176 -11.586 10.599 -11.512 9.9283 -11.512 c 8.7361 -11.512 8.2145 -11.586 7.8606 -11.586 c 7.693 -11.586 7.4136 -11.642 7.4136 -11.344 c 7.4136 -10.897 8.7175 -11.158 8.7175 -9.9841 c 8.7175 -5.5137 l 8.7175 -5.2156 8.792 -5.048 8.5685 -5.048 c 1.695 -5.048 l 1.4715 -5.048 1.4715 -5.1597 1.4715 -5.3646 c 1.4715 -10.003 l 1.4715 -11.269 3.2411 -10.86 3.2411 -11.437 c 3.2411 -11.53 3.1107 -11.586 2.9431 -11.586 c 2.7009 -11.586 1.3412 -11.512 .3539 -11.512 c -.9686 -11.512 -1.1735 -11.586 -1.248 -11.586 c -1.3971 -11.586 -1.4529 -11.493 -1.4529 -11.307 c -1.4529 -10.767 0 -11.381 0 -9.5371 c 0 0 l f Q q 1 0 0 1 412.773 747.444 cm 0 0 m -.4563 -3.5532 -3.2819 -6.2545 -6.6994 -6.2545 c -10.109 -6.2545 -12.929 -3.5313 -13.396 .0099 c -11.011 .0103 l -10.68 -3.1144 -8.8756 -5.5029 -6.6994 -5.5029 c -4.5295 -5.5029 -2.7091 -3.1084 -2.3704 .0027 c 0 0 l f Q q 1 0 0 1 412.769 749.529 cm 0 0 m -.4676 3.5396 -3.2872 6.2609 -6.6956 6.2609 c -10.105 6.2609 -12.926 3.5377 -13.392 -.0034 c -11.007 -.0021 l -10.675 3.1213 -8.8713 5.5094 -6.6956 5.5094 c -4.52 5.5094 -2.716 3.1223 -2.3842 -.0011 c 0 0 l f Q q 1 0 0 1 407.187 741.961 cm 0 0 m -.4808 4.2766 .1771 10.578 y -2.404 10.578 l -1.7461 4.2766 -2.2269 0 v -2.2269 .0001 -.8857 -.4555 0 0 c f Q EMC /Artifact <>BDC Q q 1 i 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n 0 0 0 1 K 0 J 0 j .5 w 10 M [] 0 d /GS2 gs 111.25 755.75 101.5 -17.5 re 549.662 587.625 m S EMC /P <>BDC BT /TT2 1 Tf 9 0 0 9 117.1985 744.3896 Tm 0 Tc .0278 Tw [(\(For Of)17.6(ficial Use Only\))]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 572.625 Tm [(P)73.7(A)73.7(TIENT INFORMA)73.7(TION:)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 135.8746 572.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 36 559.625 Tm .0278 Tw (Patient Name:)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 90.5894 559.625 Tm 0 Tw (______________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 232.4082 559.625 Tm .0278 Tw [( Maiden Name: _____________ Birthdate: ___)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 415.5247 559.625 Tm 0 Tw (_)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 421.6702 559.625 Tm (/___)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 438.2136 559.625 Tm (_)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 444.3592 559.625 Tm .0278 Tw [(/____ Phone #:_______________)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 576 559.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 7 0 0 7 36 551.625 Tm .0278 Tw [( Last Name, First Name, Middle Initial)]TJ ET EMC /P <>BDC BT 7 0 0 7 207.3529 551.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 538.625 Tm (Address:)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 71.6519 538.625 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 350.5623 538.625 Tm .0278 Tw [( City:___________________ State:____ Zip:__________ )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 580.7231 538.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 519.6249 Tm .0278 Tw [(MEDICAL)17.6( INFORMA)73.7(TION REQUESTED FROM: )]TJ ET EMC /P <>BDC BT 7.5 0 0 7.5 225.0487 519.6249 Tm (\(Check box or fill in information\))Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 341.5093 519.6249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 344.1071 519.6249 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 506.625 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 43.112 506.625 Tm .0278 Tw [( ֱ )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 178.4485 506.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 185.5605 506.625 Tm .0278 Tw [( Rush Oak Park Hospital )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 292.5582 506.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 299.6702 506.625 Tm .0278 Tw [( Copley Memorial Hospital)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 399.5812 506.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 493.625 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 43.112 493.625 Tm .0278 Tw [( Rush Copley Surgicenter )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 153.6628 493.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 160.7748 493.625 Tm .0278 Tw [( Rush Medical Group)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 241.3243 493.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 480.6249 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 43.112 480.6249 Tm .0278 Tw [( Individual or Organization)17.6(s Name: )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 181.9922 480.6249 Tm 0 Tw (____________________________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 465.6299 480.6249 Tm .0278 Tw [( Phone #:_______________)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 576 480.6249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 467.625 Tm (Address:)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 74.267 467.625 Tm (_____________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 249.1769 467.625 Tm .0278 Tw [( City:___________________ State:____ Zip:__________ F)54.7(AX #:_______________)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 576 467.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 450.6249 Tm .0278 Tw [(RELEASE REQUESTED MEDICAL)17.6( INFORMA)73.7(TION T)17.6(O: )]TJ ET EMC /P <>BDC BT 7.5 0 0 7.5 254.4248 450.6249 Tm (\(Requestor may be billed unless it is a medical office for continuation of care\))Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 533.8574 450.6249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 437.625 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 43.112 437.625 Tm .0278 Tw [( Check box if same as patient information above )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 229.0293 437.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 424.625 Tm .0278 Tw [(Individual or Organization)17.6(s Name: )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 172.5376 424.625 Tm 0 Tw (______________________________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 465.6299 424.625 Tm .0278 Tw [( Phone #:_______________)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 576 424.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 36 411.625 Tm (Address:)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 74.267 411.625 Tm (_____________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 249.1769 411.625 Tm .0278 Tw [( City:___________________ State:____ Zip:__________ F)54.7(AX #:_______________)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 576 411.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 394.625 Tm (PURPOSE:)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 80.3967 394.625 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 36 381.625 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 43.5565 381.625 Tm .0278 Tw [( Continuation of Care )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 137.5804 381.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 145.137 381.625 Tm .0278 Tw [( For Personal Records )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 243.8674 381.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 251.4239 381.625 Tm .0278 Tw [( Insurance )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 304.339 381.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 311.8955 381.625 Tm .0278 Tw [( Legal )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 348.2796 381.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 355.8361 381.625 Tm .0278 Tw [( Other \(specify\): )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 419.9993 381.625 Tm 0 Tw (_________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 576 381.625 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 364.625 Tm .0278 Tw [(PREFERRED FORMA)73.7(T)110.8(:)]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 128.6363 364.625 Tm .0278 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 133.8318 364.625 Tm 0 Tc ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 141.3883 364.625 Tm .0278 Tw [( Paper)]TJ ET EMC /P <>BDC BT /TT6 1 Tf 8.5 0 0 8.5 166.668 364.625 Tm 0 Tw (*)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 170.918 364.625 Tm .0278 Tc ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 176.1135 364.625 Tm 0 Tc ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 183.6699 364.625 Tm .0278 Tw [( CD)]TJ ET EMC /P <>BDC BT /TT6 1 Tf 8.5 0 0 8.5 198.5446 364.625 Tm 0 Tw (*)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 202.7946 364.625 Tm .0278 Tc ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 207.99 364.625 Tm 0 Tc ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 215.5466 364.625 Tm .0278 Tw [( Fax to Number:__________________ )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 367.4779 364.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 375.0345 364.625 Tm .0278 Tw [( Secure Email address:)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 467.2723 364.625 Tm 0 Tw (_______________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 576.0818 364.625 Tm ( )Tj ET EMC /P <>BDC BT /TT6 1 Tf 8.5 0 0 8.5 133.75 351.625 Tm (*)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 138 351.625 Tm .0278 Tw [(If you choose Paper or CD: )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 252.0948 351.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 259.6513 351.625 Tm .0278 Tw [( Call Patient for Pick-up )]TJ ET EMC /P <>BDC BT /F1 1 Tf 8.5 0 0 8.5 359.8012 351.625 Tm 0 Tw ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 367.3577 351.625 Tm .0278 Tw [( Mail to Patient )54.7(Address )54.7(Above)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 483.8364 351.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 332.625 Tm .0278 Tw [(DA)73.7(TES: From____ /____ /____ T)73.7(o)0( ____ /____ /____)]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 252.0936 332.625 Tm [(. \(See Ef)17.6(fective paragraph on Page 2\))]TJ ET EMC /Artifact <>BDC 33.25 308.25 545.5 -95.5 re 404.319 332.625 m S EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 298.625 Tm (TYPE OF VISIT)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 96.4538 298.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 285.6249 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 45 285.6249 Tm (Inpatient )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 80.2074 285.6249 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 272.625 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 45 272.625 Tm .0278 Tw (Emergency Room )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 115.8588 272.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 259.6249 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 45 259.6249 Tm (Other )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 71.9993 259.6249 Tm (_________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 228.1061 259.6249 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 71.9993 246.6249 Tm (_________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 576 246.6249 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 71.9993 233.625 Tm (_________________________________)Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 251 292.625 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8.5 0 0 8.5 260 292.625 Tm (Outpatien)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 296.8596 292.625 Tm (t)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 300.1666 292.625 Tm (/)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 303.0009 292.625 Tm (Clinic: )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 330.2769 292.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 335 292.625 Tm [(Dr)54.7(./Dept. )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 371.7264 292.625 Tm (___________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 575.0001 292.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 252.345 277.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 335 277.625 Tm (Location )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 371.4901 277.625 Tm (___________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 574.7638 277.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 577.3616 277.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 252.345 262.6249 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 335 262.6249 Tm [(Dr)54.7(./Dept. )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 371.7264 262.6249 Tm (___________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 575.0001 262.6249 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 252.345 247.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 335 247.625 Tm (Location )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 371.4901 247.625 Tm (___________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 574.7638 247.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 577.3616 247.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 252.345 232.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 335 232.625 Tm [(Dr)54.7(./Dept. )]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 371.7264 232.625 Tm (___________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 575.0001 232.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 252.345 217.625 Tm ( )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 335 217.625 Tm (Location )Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 371.4901 217.625 Tm (___________________________________________)Tj ET EMC /P <>BDC BT 8.5 0 0 8.5 574.7638 217.625 Tm ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 36 183.9999 Tm .0278 Tw [(STEP)17.6( 1 OF 3)]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 84.0965 183.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 168 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 45 168 Tm .0278 Tw (Abstract Only )Tj ET EMC /P <>BDC BT 8 0 0 8 95.6829 168 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 158 Tm .0278 Tw [(\(Discharge Summary)73.7(, History)]TJ ET EMC /P <>BDC BT 8 0 0 8 149.3196 158 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 147.9999 Tm .0278 Tw [(& Physical, Of)17.6(fice/Progress)]TJ ET EMC /P <>BDC BT 8 0 0 8 142.2258 147.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 138 Tm .0278 Tw (Notes, Operative Reports,)Tj ET EMC /P <>BDC BT 8 0 0 8 137.929 138 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 128 Tm (ED)Tj /TT1 1 Tf 1.3892 0 TD <0001>Tj /TT2 1 Tf .2778 0 TD .0278 Tw (Notes, Pathology)Tj ET EMC /P <>BDC BT 8 0 0 8 119.484 128 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 117.9999 Tm .0278 Tw (Reports, Consults, EKGs,)Tj ET EMC /P <>BDC BT 8 0 0 8 136.5891 117.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 108 Tm .0278 Tw (Radiology Reports,)Tj ET EMC /P <>BDC BT 8 0 0 8 113.2574 108 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 97.9999 Tm .0278 Tw (Laboratory Reports\))Tj ET EMC /P <>BDC BT 8 0 0 8 116.3668 97.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 82.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 45 82.9999 Tm .0278 Tw (Entire Medical Record)Tj ET EMC /P <>BDC BT 8 0 0 8 124.1438 82.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 36 67.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 45 67.9999 Tm .0278 Tw (Other; Or in addition to)Tj ET EMC /P <>BDC BT 8 0 0 8 126.8188 67.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 45 58 Tm .0278 Tw (Abstract, select in Step 2)Tj ET EMC /P <>BDC BT /TT4 1 Tf 8.5 0 0 8.5 36 196.625 Tm [(REQUESTED MEDICAL)17.6( INFORMA)73.7(TION:)]TJ ET EMC /P <>BDC BT 8.5 0 0 8.5 36 312.6249 Tm [(LOCA)73.7(TION OF RECORDS BEING REQUESTED:)]TJ ET EMC /Artifact <>BDC q 1 0 0 1 159 193 cm 0 0 m 0 -146 l S Q EMC /Artifact <>BDC q 1 0 0 1 387 193 cm 0 0 m 0 -146 l S Q EMC /P <>BDC BT 8 0 0 8 162 183.9999 Tm [(STEP)17.6( 2 OF 3 \(IF NEEDED\))]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 260.7637 183.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 168 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 168 Tm .0102 Tw [(Cardiac T)110.8(esting )-17.6(Result)]TJ ET EMC /P <>BDC BT 8 0 0 8 251.3391 168 Tm 0 Tw (s)Tj ET EMC /P <>BDC BT 8 0 0 8 255.7839 168 Tm (/)Tj ET EMC /P <>BDC BT 8 0 0 8 258.0066 168 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 171 158 Tm (EKG)Tj ET EMC /P <>BDC BT 8 0 0 8 187.8944 158 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 147.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 147.9999 Tm (Consultations)Tj ET EMC /P <>BDC BT 8 0 0 8 219.4727 147.9999 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 138 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 138 Tm .0278 Tw (Discharge Summary)Tj ET EMC /P <>BDC BT 8 0 0 8 243.6871 138 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 128 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 128 Tm .0278 Tw (Emergency Record)Tj ET EMC /P <>BDC BT 8 0 0 8 239.6949 128 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 117.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 117.9999 Tm (EM)Tj ET EMC /P <>BDC BT 8 0 0 8 183 117.9999 Tm .0556 Tc (G/)Tj ET EMC /P <>BDC BT 8 0 0 8 192.3351 117.9999 Tm 0 Tc .0278 Tw (EEG Reports)Tj ET EMC /P <>BDC BT 8 0 0 8 239.6863 117.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 108 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 108 Tm .0278 Tw (History & Physical)Tj ET EMC /P <>BDC BT 8 0 0 8 235.9055 108 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 97.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 97.9999 Tm .0278 Tw (Immunization Records)Tj ET EMC /P <>BDC BT 8 0 0 8 250.8083 97.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 87.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 171 87.9999 Tm .0278 Tw (Lab Reports)Tj ET EMC /P <>BDC BT 8 0 0 8 214.8043 87.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162 78 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 169.112 78 Tm .0278 Tw [( Mammography)]TJ ET EMC /P <>BDC BT 8 0 0 8 224.9085 78 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 162.1094 67.9999 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 171 67.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 178.112 67.9999 Tm .0278 Tw [( Films)]TJ ET EMC /P <>BDC BT 8 0 0 8 199.6624 67.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 162.04 58 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 171 58 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 178.112 58 Tm .0278 Tw [( Reports)]TJ ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 390 183.9999 Tm [(STEP)17.6( 3 OF 3 \(IF NEEDED\))]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 488.7636 183.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 429.26 168 Tm .0278 Tw [(ADDITIONAL)17.6( INFORMA)73.7(TION )]TJ ET EMC /P <>BDC BT 8 0 0 8 539.1849 168 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 445.7327 158 Tm .0278 Tw [(T)17.6(O)0( BE RELEASED)]TJ ET EMC /P <>BDC BT /TT6 1 Tf 8 0 0 8 516.2672 158 Tm 0 Tw (*)Tj ET EMC /P <>BDC BT /TT4 1 Tf 8 0 0 8 520.2673 158 Tm ( )Tj ET EMC /P <>BDC BT 6.5 0 0 6.5 394.7909 147.9999 Tm .0278 Tw [(P)73.7(A)73.7(TIENT INITIAL)17.6( )36.6(AND DA)73.7(TE REQUIRED FOR EACH ITEM)]TJ ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 571.2091 147.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 390 134 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 399 134 Tm .0102 Tw [(Genetic T)110.8(esting)]TJ ET EMC /P <>BDC BT 8 0 0 8 456.1093 134 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 465 134 Tm .0278 Tw (Initial:_______ Date:________ )Tj ET EMC /P <>BDC BT 8 0 0 8 576.6477 134 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 390 119 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 399 119 Tm (Dru)Tj ET EMC /P <>BDC BT 8 0 0 8 411.8906 119 Tm (g)Tj ET EMC /P <>BDC BT 8 0 0 8 416.7846 119 Tm (/Alcohol)Tj ET EMC /P <>BDC BT 8 0 0 8 447.2188 119 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 465 119 Tm .0278 Tw (Initial:_______ Date:________ )Tj ET EMC /P <>BDC BT 8 0 0 8 576.6477 119 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 390 103.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 399 103.9999 Tm (HIV)Tj ET EMC /P <>BDC BT 8 0 0 8 413.879 103.9999 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 465 103.9999 Tm .0278 Tw (Initial:_______ Date:________)Tj ET EMC /P <>BDC BT 8 0 0 8 574.2027 103.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 390 88.9999 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 399 88.9999 Tm .0278 Tw (Mental Health/)Tj ET EMC /P <>BDC BT 8 0 0 8 450.8044 88.9999 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 399 78.9999 Tm (Developmental)Tj ET EMC /P <>BDC BT 8 0 0 8 452.3633 78.9999 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 399 69 Tm (Disability)Tj ET EMC /P <>BDC BT 8 0 0 8 431.6602 69 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 465 69 Tm .0278 Tw (Initial:_______ Date:________ )Tj ET EMC /P <>BDC BT 8 0 0 8 576.6477 69 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT6 1 Tf 8 0 0 8 390 54 Tm (*)Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 394 54 Tm .0278 Tw (Witness signature required on page 2.)Tj ET EMC /P <>BDC BT 8 0 0 8 530.3027 54 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 276 183.8159 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276 167.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 285 167.8159 Tm .0278 Tw (Operative Reports)Tj ET EMC /P <>BDC BT 8 0 0 8 350.1403 167.8159 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 276 157.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 285 157.8159 Tm .0278 Tw (Pathology Reports)Tj ET EMC /P <>BDC BT 8 0 0 8 351.0387 157.8159 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 276 147.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 285 147.8159 Tm .0278 Tw [(Physician Of)17.6(fice Record)]TJ ET EMC /P <>BDC BT 8 0 0 8 370.6711 147.8159 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 276 137.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 285 137.8159 Tm .0278 Tw (Progress Notes)Tj ET EMC /P <>BDC BT 8 0 0 8 340.3551 137.8159 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 276 127.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 285 127.8159 Tm (Radiology)Tj ET EMC /P <>BDC BT 8 0 0 8 320.5781 127.8159 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276.1094 117.8159 Tm ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 285 117.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 292.112 117.8159 Tm .0278 Tw [( Images)]TJ ET EMC /P <>BDC BT 8 0 0 8 320.7914 117.8159 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /F1 1 Tf 8 0 0 8 276.0399 107.8159 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 285 107.8159 Tm ()Tj ET EMC /P <>BDC BT /TT2 1 Tf 8 0 0 8 292.112 107.8159 Tm .0278 Tw [( Reports)]TJ ET EMC /P <>BDC BT 8 0 0 8 322.5687 107.8159 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276 96.8159 Tm (______________________)Tj ET EMC /P <>BDC BT 8 0 0 8 373.8828 96.8159 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276 85.816 Tm (______________________)Tj ET EMC /P <>BDC BT 8 0 0 8 373.8828 85.816 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276 74.8159 Tm (______________________)Tj ET EMC /P <>BDC BT 8 0 0 8 373.8828 74.8159 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276 63.8159 Tm (______________________)Tj ET EMC /P <>BDC BT 8 0 0 8 373.8828 63.8159 Tm ( )Tj ET EMC /P <>BDC BT 8 0 0 8 276 52.816 Tm (______________________)Tj ET EMC /Artifact <>BDC q 1 0 0 1 33 181 cm 0 0 m 546 0 l S Q EMC Q endstream endobj 171 0 obj <>/XObject<>/ExtGState<>>> endobj 267 0 obj <> endobj 281 0 obj <>stream /Artifact <>BDC q 1 i 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n 0 0 0 1 K 0 J 0 j 1.5 w 10 M [] 0 d /GS2 gs q 1 0 0 1 288 756 cm 0 0 m 0 -120 l S Q EMC /Artifact <>BDC q 1 0 0 1 36 636 cm 0 0 m 540 0 l S Q EMC /P <>BDC BT /TT4 1 Tf 12 0 0 12 327.9442 726 Tm 0 0 0 1 k 0 Tc .0278 Tw [(AUTHORIZA)73.7(TION FOR RELEASE OF )]TJ ET EMC /P <>BDC BT 12 0 0 12 539.7231 726 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 12 0 0 12 337.776 712.9999 Tm .0278 Tw [(P)73.7(A)73.7(TIENT HEAL)73.7(TH INFORMA)73.7(TION)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 36 619.875 Tm [(PLEASE READ THE FOLLOWING ST)73.7(A)73.7(TEMENTS CAREFULL)91.8(Y)73.7(:)]TJ ET EMC /P <>BDC BT /TT2 1 Tf 9.5 0 0 9.5 314.5917 619.875 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 603.625 Tm .0326 Tw [(This authorization is voluntary)73.7(. Rush will not condition your treatment on giving this authorization. However)54.7(, Rush may conditi)]TJ 55.7295 0 TD 0 Tw (on)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576.0002 603.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 593.3749 Tm .0278 Tw (the provision of research-related treatment on the provision of an authorization.)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 370.8011 593.3749 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 577.125 Tm -.0009 Tw (I understand that I may change my mind and revoke this authorization at any time by giving written notice of my revocation to t)Tj 55.7297 0 TD 0 Tw (he)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576.0001 577.125 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 566.8749 Tm .0812 Tw [(contact of)17.6(fice listed above. I understand that revocation of this authorization will not af)17.6(fect action Rush took in reliance on)]TJ 54.9267 0 TD [( this)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9999 566.8749 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 556.625 Tm .0278 Tw (authorization before Rush received my written notice of revocation.)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 319.0343 556.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 540.3749 Tm .1964 Tw (I authorize the use and/or disclosure of my Protected Health Information \(PHI\) as described above. I understand that this)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576.0005 540.3749 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 530.1249 Tm .1047 Tw (authorization is voluntary and made to confirm my decision so Rush may use an)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 385.2939 530.1249 Tm 0 Tw (d)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 391.6341 530.1249 Tm .1047 Tw (/or disclose my PHI for a specific purpose. )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 579.6345 530.1249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 519.875 Tm -.0304 Tw (I understand that if the persons or organizations I authorized above to receive an)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 371.2943 519.875 Tm 0 Tw (d)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 377.6344 519.875 Tm -.0304 Tw (/or use the PHI described above are not subject)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9998 519.875 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 509.625 Tm .0281 Tw (to federal health information privacy laws, they may further disclose the PHI and it may no longer be protected by federal heal)Tj 56.0078 0 TD 0 Tw (th)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9998 509.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 499.3749 Tm .1048 Tw (information privacy laws. I understand that I have a right to inspect and copy the information to be disclosed pursuant to this)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576.0007 499.3749 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 489.125 Tm .0278 Tw [(authorization and that I may obtain a copy of the information by contacting the of)17.6(fice listed above.)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 448.278 489.125 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 472.875 Tm .0385 Tw (I have had full opportunity to read and consider the contents of this authorization, and I confirm that the contents are consis)Tj 55.1739 0 TD 0 Tw (tent)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576.0001 472.875 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 462.6249 Tm .0812 Tw (with my direction to Rush. I understand that, by signing this form, I am confirming my authorization that Rush may use and/or)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9994 462.6249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 452.375 Tm .0278 Tw (disclose to the persons and/or organizations named in this form the PHI described in this form.)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 436.5195 452.375 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT4 1 Tf 9.5 0 0 9.5 36 436.125 Tm .0806 Tw [(EFFECTIVE: This authorization request does not apply to any treatment dates beyond the date of signature. )17.6(Y)73.7(ou may)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9998 436.125 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 425.875 Tm .1144 Tw (choose to provide an event \(related to you or the purpose of the us)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 352.5791 425.875 Tm 0 Tw (e)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 358.3908 425.875 Tm .1144 Tw (/disclosure\) upon which your authorization will)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576.0005 425.875 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 415.625 Tm .0697 Tw (expire, unless mental health records are requested. Otherwise, this authorization will expire ninety \(90\) calendar days)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9998 415.625 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 405.375 Tm .0278 Tw (after the date of signature.)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 156.3532 405.375 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 37.0883 389.125 Tm (______________________________________________________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576 389.125 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 37.0883 372.875 Tm (______________________________________________________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 576 372.875 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 356.6249 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 346.375 Tm [(P)73.7(A)73.7(TIEN)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 69.4356 346.375 Tm (T)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 75.7669 346.375 Tm (/)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 79.4628 346.375 Tm .0278 Tw [(PERSONAL)17.6( REPRESENT)73.7(A)73.7(TIVES SIGNA)73.7(TURE:)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 289.9139 346.375 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT /TT2 1 Tf 9.5 0 0 9.5 36 336.125 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 325.875 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36.2766 315.6249 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 349.6877 315.6249 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 384 315.6249 Tm (Date:)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 407.9138 315.6249 Tm (_________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 540 315.6249 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 305.375 Tm .0278 Tw (Signature of Patient or Personal Representative )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 241.4255 305.375 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 295.125 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 284.8749 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36.2766 274.625 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 349.6877 274.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 384 274.625 Tm .0278 Tw (Phone #:)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 423.7642 274.625 Tm 0 Tw (______________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 540 274.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 264.375 Tm .0278 Tw [(If signed by other than patient: PRINT)17.6( Representative Name)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 291.411 264.375 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 254.1249 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 243.875 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36.2766 233.625 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 348 233.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 223.3749 Tm .0278 Tw (If signed by other than patient: State Relationship to Patient )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 291.6096 223.3749 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 213.125 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 202.875 Tm ( )Tj ET EMC /P <>BDC BT /TT6 1 Tf 9.5 0 0 9.5 36 192.6249 Tm (*)Tj ET EMC /P <>BDC BT /TT2 1 Tf 9.5 0 0 9.5 40.7263 192.6249 Tm -.0028 Tc -.0354 Tw (\(Signature of a witness who has verified the patien)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 248.9769 192.6249 Tm 0 Tc 0 Tw (t)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 252.6465 192.6249 Tm (/)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 255.7878 192.6249 Tm -.0028 Tc -.0354 Tw [(personal representative)17.6(s identity is required for mental healt)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 505.598 192.6249 Tm .0528 Tc 0 Tw (h/)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 514.5245 192.6249 Tm -.0028 Tc (developmental)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9735 192.6249 Tm 0 Tc ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 182.375 Tm -.0028 Tc .0575 Tw [(disability)73.7(, genetic testing, HIV)91.8(, and dru)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 197.6654 182.375 Tm .0528 Tc 0 Tw (g/)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 206.5919 182.375 Tm -.0028 Tc .0575 Tw [(alcohol records. )54.7(Additionally)73.7(, signature of )]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 382.79 182.375 Tm 0 Tw (patient)Tj ET EMC /Artifact <>BDC .633 w q 1 0 0 1 382.79 181.325 cm 0 0 m 28.339 0 l S Q EMC /P <>BDC BT 9.5 0 0 9.5 411.1287 182.375 Tm .0575 Tw [( is required for mental health records if)]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 575.9736 182.375 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 172.125 Tm -.0028 Tc .0278 Tw (over the age of 12 and under the age of 18.\))Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 223.3975 172.125 Tm 0 Tc 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 161.8749 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 151.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36.2766 141.375 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 349.6877 141.375 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 384 141.375 Tm (Date: )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 412.9333 141.375 Tm (________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 539.7361 141.375 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 542.6394 141.375 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 131.1249 Tm .0278 Tw (Witness Signature )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 116.2574 131.1249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 120.875 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 110.625 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36.2766 100.3749 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 349.6877 100.3749 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 384 100.3749 Tm .0278 Tw (Phone #:)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 423.7642 100.3749 Tm 0 Tw (______________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 540 100.3749 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 90.1249 Tm .0278 Tw [(PRINT)17.6( Witness Name )]TJ ET EMC /P <>BDC BT 9.5 0 0 9.5 132.1676 90.1249 Tm 0 Tw ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 79.875 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 69.6249 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36.2766 59.3749 Tm (___________________________________________________________)Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 348 59.3749 Tm ( )Tj ET EMC /P <>BDC BT 9.5 0 0 9.5 36 49.125 Tm .0278 Tw (State Relationship to Patient)Tj ET EMC /P <>BDC BT 7 0 0 7 36 35.7499 Tm [(RUSH1928 \(07-15-24\))]TJ ET EMC /P <>BDC BT 7 0 0 7 109.168 35.7499 Tm 0 Tw ( )Tj 35.2847 0 TD ( )Tj ET EMC /P <>BDC BT 7 0 0 7 533.1396 35.7499 Tm .0278 Tw [(P)73.7(AGE 2 OF 2)]TJ ET EMC /Figure <>BDC Q q 1 i 288 756 288 -15 re 576 35.75 m W* n 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n 0 g /GS3 gs q 1 0 0 1 426.823 743.992 cm 0 0 m 1.3412 -2.049 2.2539 -1.3598 2.2539 -1.8068 c 2.2539 -2.0303 1.2108 -2.0303 1.0431 -2.0303 c -.3167 -2.0303 -1.0431 -1.0804 -1.7509 -.0186 c -3.8185 3.2411 l -4.4891 4.2842 -4.2097 4.2283 -6.2959 4.2283 c -6.892 4.2283 -6.7802 3.8931 -6.7802 3.7068 c -6.7802 -.2235 l -6.7802 -1.8254 -4.843 -1.248 -4.843 -1.8813 c -4.843 -2.0676 -5.0107 -2.0303 -5.1597 -2.0303 c -5.3273 -2.0303 -5.7558 -1.9558 -7.3018 -1.9558 c -8.0096 -1.9558 -8.7175 -2.0303 -9.4253 -2.0303 c -9.5371 -2.0303 -9.6116 -1.9372 -9.6116 -1.8254 c -9.6116 -1.3598 -8.2518 -1.6205 -8.2518 -.2049 c -8.2518 9.2763 l -8.2518 11.064 -9.8537 10.301 -9.8537 10.934 c -9.8537 11.046 -9.7047 11.158 -9.4812 11.158 c -9.1459 11.158 -9.239 11.083 -8.289 11.083 c -7.2087 11.083 -6.1469 11.158 -5.1783 11.158 c -4.8803 11.158 -.7637 11.53 -.7637 7.9351 c -.7637 6.4822 -1.8068 5.2342 -3.1107 4.7127 c 0 0 l h -6.7802 5.1225 m -6.7802 4.7686 -5.6254 4.8616 -4.7499 4.8616 c -3.9489 4.8616 -2.1607 5.197 -2.1607 7.5067 c -2.1607 9.7792 -3.8931 10.543 -5.7185 10.543 c -6.3891 10.543 -6.7802 10.58 -6.7802 9.8538 c -6.7802 5.1225 l f Q q 1 0 0 1 430.651 746.936 cm 0 0 m 0 -2.9803 1.8404 -4.3401 4.2292 -4.3401 c 7.556 -4.3401 8.3169 -2.0303 8.3169 .1677 c 8.3169 6.2029 l 8.3169 8.1028 6.6713 7.3205 6.6713 8.0283 c 6.6713 8.1215 6.7951 8.2146 6.8482 8.2146 c 7.5383 8.2146 8.2285 8.1401 8.9186 8.1401 c 9.2548 8.1401 9.5733 8.2146 9.8918 8.2146 c 9.9803 8.2146 10.122 8.1215 10.122 8.0096 c 10.122 7.4882 9.0778 7.8979 9.0778 6.1842 c 9.0778 .4098 l 9.0778 -.5029 9.2902 -5.1038 4.1408 -5.1038 c -.5132 -5.1038 -1.3979 -2.3656 -1.3979 .5029 c -1.3979 6.7803 l -1.3979 7.8793 -2.8313 7.4323 -2.8313 8.0283 c -2.8313 8.1587 -2.5305 8.2146 -2.442 8.2146 c -1.9819 8.2146 -1.5395 8.1401 -1.0617 8.1401 c -.4955 8.1401 .0708 8.2146 .6194 8.2146 c .7078 8.2146 1.1856 8.2518 1.1856 8.0283 c 1.1856 7.5068 0 8.0283 0 6.6871 c 0 0 l f Q q 1 0 0 1 441.35 745.259 cm 0 0 m -.0745 .3726 .0186 .5774 .2049 .5774 c .4656 .5774 .4656 .3539 .5588 -.0372 c .7823 -.894 1.9 -2.8313 4.4705 -2.8313 c 6.2401 -2.8313 7.9724 -1.8441 7.9724 .1117 c 7.9724 3.7068 .4098 1.6951 .4098 6.5568 c .4098 8.9224 2.4029 10.059 4.545 10.059 c 6.7989 10.059 7.4136 9.3881 7.6743 9.3881 c 7.842 9.3881 7.8792 9.5929 8.0655 9.5929 c 8.1773 9.5929 8.2704 9.5371 8.289 9.3322 c 8.5684 6.7988 l 8.587 6.6499 8.5498 6.5195 8.3636 6.5195 c 8.1586 6.5195 8.0283 6.9106 7.9724 7.0783 c 7.4136 8.6802 6.0538 9.4998 4.4146 9.4998 c 2.9431 9.4998 1.3784 8.792 1.3784 7.0783 c 1.3784 3.5764 8.941 5.6254 8.941 .4843 c 8.941 -1.0804 7.842 -3.4274 3.6136 -3.4274 c 2.2352 -3.4274 .5402 -2.7382 .4656 -2.4029 c 0 0 l f Q q 1 0 0 1 452.804 753.548 cm 0 0 m -.0186 1.3597 -1.6206 .9872 -1.6206 1.397 c -1.6206 1.5647 -1.4716 1.6019 -1.3225 1.6019 c -.6333 1.6019 .0373 1.5274 .7264 1.5274 c 1.3039 1.5274 1.8813 1.6019 2.4588 1.6019 c 2.7754 1.6019 2.8127 1.4901 2.8127 1.4156 c 2.8127 1.0431 1.4715 1.397 1.4715 0 c 1.4715 -4.0234 l 1.4715 -4.2842 1.4715 -4.3588 1.7509 -4.3588 c 8.5685 -4.3588 l 8.7547 -4.3588 8.7175 -3.8931 8.7175 -3.8186 c 8.7175 0 l 8.7175 1.2853 7.3204 .9686 7.3204 1.397 c 7.3204 1.5088 7.3577 1.6019 7.6371 1.6019 c 8.2518 1.6019 9.2204 1.5274 9.5743 1.5274 c 10.264 1.5274 10.543 1.6019 10.915 1.6019 c 11.4 1.6019 11.437 1.4156 11.437 1.3038 c 11.437 .9686 10.189 1.2853 10.189 0 c 10.189 -9.8724 l 10.189 -11.232 11.884 -10.897 11.884 -11.363 c 11.884 -11.418 11.81 -11.586 11.679 -11.586 c 11.176 -11.586 10.599 -11.512 9.9283 -11.512 c 8.7361 -11.512 8.2145 -11.586 7.8606 -11.586 c 7.693 -11.586 7.4136 -11.642 7.4136 -11.344 c 7.4136 -10.897 8.7175 -11.158 8.7175 -9.9841 c 8.7175 -5.5137 l 8.7175 -5.2156 8.792 -5.048 8.5685 -5.048 c 1.695 -5.048 l 1.4715 -5.048 1.4715 -5.1597 1.4715 -5.3646 c 1.4715 -10.003 l 1.4715 -11.269 3.2411 -10.86 3.2411 -11.437 c 3.2411 -11.53 3.1107 -11.586 2.9431 -11.586 c 2.7009 -11.586 1.3412 -11.512 .3539 -11.512 c -.9686 -11.512 -1.1735 -11.586 -1.248 -11.586 c -1.3971 -11.586 -1.4529 -11.493 -1.4529 -11.307 c -1.4529 -10.767 0 -11.381 0 -9.5371 c 0 0 l f Q q 1 0 0 1 412.773 747.444 cm 0 0 m -.4563 -3.5532 -3.2819 -6.2545 -6.6994 -6.2545 c -10.109 -6.2545 -12.929 -3.5313 -13.396 .0099 c -11.011 .0103 l -10.68 -3.1144 -8.8756 -5.5029 -6.6994 -5.5029 c -4.5295 -5.5029 -2.7091 -3.1084 -2.3704 .0027 c 0 0 l f Q q 1 0 0 1 412.769 749.529 cm 0 0 m -.4676 3.5396 -3.2872 6.2609 -6.6956 6.2609 c -10.105 6.2609 -12.926 3.5377 -13.392 -.0034 c -11.007 -.0021 l -10.675 3.1213 -8.8713 5.5094 -6.6956 5.5094 c -4.52 5.5094 -2.716 3.1223 -2.3842 -.0011 c 0 0 l f Q q 1 0 0 1 407.187 741.961 cm 0 0 m -.4808 4.2766 .1771 10.578 y -2.404 10.578 l -1.7461 4.2766 -2.2269 0 v -2.2269 .0001 -.8857 -.4555 0 0 c f Q EMC /P <>BDC Q q 1 i 0 792 612 -792 re 306 396.015 m W n 0 792.015 612 -792 re W n /GS2 gs BT /TT2 1 Tf 9 0 0 9 36 698.25 Tm 0 0 0 1 k 0 Tc .0278 Tw [(P)73.7(A)73.7(TIENT)17.6( NAME)]TJ ET EMC /P <>BDC BT 9 0 0 9 105.8174 698.25 Tm 0 Tw (__________________________________)Tj ET EMC /P <>BDC BT 9 0 0 9 276 698.25 Tm ( )Tj ET EMC /P <>BDC BT 9 0 0 9 36 674.25 Tm .0278 Tw [(DA)73.7(TE OF BIR)17.6(TH)]TJ ET EMC /P <>BDC BT 9 0 0 9 105.8174 674.25 Tm 0 Tw (__________________________________)Tj ET EMC /P <>BDC BT 9 0 0 9 276 674.25 Tm ( )Tj ET EMC /P <>BDC BT 9 0 0 9 36 650.25 Tm .0278 Tw [(MEDICAL)36.6( RECORD #)]TJ ET EMC /P <>BDC BT 9 0 0 9 125.8389 650.25 Tm 0 Tw (______________________________)Tj ET EMC /Artifact <>BDC 0 0 0 1 K 0 J 0 j .5 w 10 M [] 0 d 111.25 755.75 101.5 -17.5 re 276 650.25 m S EMC /P <>BDC BT 9 0 0 9 117.1984 744.3896 Tm .0278 Tw [(\(For Of)17.6(ficial Use Only\))]TJ ET EMC Q endstream endobj 282 0 obj <>/ExtGState<>>> endobj 6 0 obj <> endobj 5 0 obj <> endobj 177 0 obj <>stream endstream endobj 178 0 obj <> endobj 179 0 obj <> endobj 180 0 obj <> endobj 283 0 obj <> endobj 284 0 obj <>stream Hbd`ab`ddTps,K-*NK-/.,p !C,X_?'~&=Rpn!fFFLC SSʢdMCK  ii\Y\[_T_XUZZT$vF@h|_wϘ;@$χ?B?;DB6>l˻Xp `>`% endstream endobj 285 0 obj <> endobj 286 0 obj <>stream endstream endobj 287 0 obj <>stream HėPTǿX@ta>Ս?E5讶*F4رճ#Fʓ8ω&cѲ:ڱ5qp9s9ܲ?2<1~v`Tާȍk^-=X@)dОnZ;&Ƭ U4ύ8/q=b*o]ztU톍ySq Ư]WX'Ն6v 烌^;08{-*7Ȓ/~1T[gI3h )a(PYsRs:kȹ|s t`^G+xz:V.8+b$&Q,i^pp L-ѻ[\{vx0Ywy|R,E ]: 1eX̜l.0[l䣄8-5 N䲺&f/6qܬ2KuHGq\\[W&of'I#?cV^OHۤ5kr\Bë$Ўs'#nKN9A 7'_GxJ$!npb([ď>)-rB$WF#yҼ`~$sx [yBf-rEXKYK%C\Zg↸-I4P&eIQ\-_?(TImVo:1vl5wpfQUup<.[K "EL 9"FTCiK)N,%Iå2iT+*gr+o+=*Ca\eZ [JGu:K-VaAmVnG11 b4v.gG"Fx+V'fBU!^euH7s> A^f܂?S2WP1Bنo^aߋdu.w.4z223ǎqG#$;6tHA8TE}zAP3 e^Xc ^T7Ђv75Dz"=="A9ٚO׌?xu-*/Sq[DY |FA}U2]d[?,[ mrr"|Fɺn_(YyS]m4GNvU'v+vF=X !r 2t}iHPevv-*UQƴҎ;jv[,SF3|*R$\R<)>= (%{ENvskoɳ\skחvq̹vNC+7YTOTDʧ21YCbnCu eTy xS3Fs'Zx/ZB;,պ^^osU׺ƪjL,* -@CYEQĕ ;(#yJVr.ritQ{:[+`WW *6g:*#q$X'',᎞@jZLgqV 0CMw;|͠E<bo(@Qz*弥]Dg?7'Ҹy&<7"V;&1^"KX"'GG^қRV&1~?"x89`~'@o#_F7U,<|u?yk.WpdtfʯnȲ,P/M(7ԂbKehLdRZG}.)3(E(l;%PN̹D )Jm)^ms-&Y51>OVƴR_y$7zZ,UusHLچu gôL ԧRsZl}R>Ĺ>kbgPE;Ve3$f2JYuFǗ˾Sǂ37Xx=At,-ݖveLD'H BAEVTÖٔɔ<'-Ȩ;@yhG(bg9!6!E+iK&9ħ}>q8)1Er @xnHXUTV4)E z3)5Mc֟(kL4j]bWMjR[+^PA|! > mԡEwYdqY͗}XP":pf;sPC9q9o~"bL># ?:=r,yMavBIUg}])Kd .V̠c`(/E5/BIfՊ+2X!l#<̏FW5/U|f" 2UϮ8 [ZX9 HvZlɇ@UBAIcXbh4{L>O(E{(a)Hvq Gnskx|a;KVQ` d#Jш%tthJCs@c\Mxn:5ێ6DxWIu|_N ,q v~ޛW*V T6o~l\S" (7OdўS#ӹ_tה{Q;7S\bќlvL?ӓcS4S+_tJ+|q|~&w`u" `(n]E=.ua1S^nk%cdtwmE؆8Fa,Ԇn4mA_(FwQsFxY{}ejNX*b)@>PWWkk Ћb;[; >_#ĩA@~ endstream endobj 288 0 obj <> endobj 289 0 obj <>stream Hė{lƿ;5`Pzf Ə(<kllbcKb]` *J \B(jBІTJI*U ڦT4~36=3gC _USv`i 7mx[% $yvݦ/{#xkB- nOцaIvƍ21i`ùZ0cf>xsߊCKgÒS6?PC|gSm{.T_ŵ7aFw|jSR#HS&b4`~Dj͝$u֛D7؅P*EQX"F RC)ykS7,zw4_M} ?X8̺77_[J(Хc0̹fنd>ZȔa8Gh;!fl2/ ћ ⸸&)/Ϳ$l^8:W|S4b䖶JǕjJ0 9/@[ܒr(7_ %s=z1Os/6ZDQvWx56 |F"/&N;W;h1(uJFy;[1][?{qJ{ROc{B2c\Q#3R)_1|XФ! PYA4qzQQC4zFSaC aZH7#tD$m6fj^]3~ѵXO}GhM[_l{l}uh^gأ"y¦p0]Mr76{F}r7Tmt+@M~[kՉ17--oȡ!\Csc=iHh!,ZU i!waX*FZ`f p.H(Ӽz0󷧺SE^nܹ%ͷ|sKuHsIyaNC7Y O Df01kYCbșY2"{ yYg&6Oҵm 7ZBGfmXu=B=cm6y׺ƪnL)]!ܒDŽ s{ q zݹVz?y4d=2q+ZTWGB-fR2홎h`" V ˸;ޣgGDPם_2hRn 9_7"t ؾ> 5RΛk5Oa͓|+Ks0E Z.#MZ߱uL~Dc"]ݕn3w.NeK=ބdm3!<_Lx6kηy|!<ݽ gnp#"?="}0B/||.~8E E6GDxq%᥏py'7JV&~?"x09`~;@o‘#_3G7,<|MW=y5kpL wj{3ϧTMF4\̫R+,Q e*%Ъ\Dv!Sـ ȹ2RZ1PLj.ᘉ*`J/)iM0o;h~>7ժsY[hkcLGqoY5Yg8͡mDwLo-gA}eeo}\gR8g`Mlqcu8#Nb._ 'U)8krΈrr XpF1O"'%%BNt (Tį:?l9AGFəDD=b'6QvP^(=ڛٮ p&ˆvJ~L8I!&Rw6u]{{<;΋kl'1vl .6#)f)BcBӺNll+-ʀ6$HM [GK&KZa)ν;wϽ7f"%z8$ {H+)Ww(tGXI.M8KJx8|Z[|R0xPw+~]\"։~L.qX Y%Y2KFI/IƢ0#$22. K8Omo$^ R1A8`dBV5T &xnLLU 2U[lT Q?RQ2jZ[K?;8G vv*gb70MW߿bd_O5nB46ҳ=}?U:lS]}wsdݪ9n>[۱;<%|}'Q}Y3s\5w⪯3֩Rql_N,&X0֎.[ ;SpB0)glϏHr\NES̢sP^Ğ^wL,B'M zCiMmJm5_7]$pIy_! f+V}B&`[v|-D-]7I4ږӗҵ5`(  Z 71^V߹|oUuL4^ I[}}?] 4Z Yݨ/fstHf|R= +X z :t?vNx&§gx{Tx۹t\'"kěgKXvKY2mݖDhH4N_…A l! 13`*$sgփ@3>Ms76aZ{@b}ez~+O!|7 !b m eI fLǪ7)Pk2 5U&^'hX<-5լdpW ~¼R EלPUy"VUta0ƬD.XXАcAY0KAi/W! ]Pͽto^&䷿3rwȑQՓQ]Mwݻӽtz޶a IdŪh)L m $1&sN`-~(0nZ|u#1ʴIIӛ&b~D L yÈꚀM ǖ5w-굍U;8u>7{x5O-!|.WyGLzݙQJ^Ҵ{q(wx ހAw'ff̷aPI8 j9Lq1D_ⵋ"Rt+Et;-}1r i ϐ&ϔ)FCV˳$$xDP-CiR G8Ď{Pvg[9VJӘgY Ƿ!"),rz%m۶QAFJY?j>q"ǿx/KddY&~acd{vQP_79@B ٟrZ9yE7<~NqtVkap!/YQD%YLq/l AK1AŊ(:]A|Lsu]i%(6] j4HgDlGvKIBI3a-.C2`CxpydPzU$E5tG}}10p4>hV>M~1_aággJ{rɉv(|K+7&{_qsՖG -V\q sLe&4}DiC}A?~ĔM HkLnTωd9h:]IM:$@qka) Lzy #wqOaқSN,]yVYص`Fx (ݐE€iv<@7)M zՋ* b8F#ŌEi['Zw3=?[uFo O>fт%w*/+8+ٚL|Ѹƾ6 `~އ@v8ܷ$RzrMOp}?;h$$,Zm!=B˵e“4st gX(ʁdH`Xc)1ij *pBgEZ?&qTo ͼhaIAЌᎃӕ{ :=רXAEgT@p8&X+aYi~fvҹ;Brb̒G)egW-±ս{)_PBeyj|N1@L: %[k4G󐓭fho 87fXސ]Q /֢P-SM=cٚQ`&'>νʘ̱ %fh:r&Rj0t> u:jA`|F4+,7S-/ص؉]otQ&'![] _Qu ̼TnEC扶\ k}헩س'\8~.{,,.KQP]TbմcDIj4VcT% ԴQ2Q;54vR11#bDQtInٹܳs{>ವLù7?GZ(FF}Qm_CP'&Hh*Nˁ? )sYWT הaSvMs3SL$AL(Om/"vhh}68jXXdqlX5i?́HzG~I!`j)@4:&kj2]pXm dV$gEU,:җ̏pV9S4[/w?sC'_o~N?o^#V| һOxqQ[Elˁڔ3ggM +c/ 6ʘ [ٳde ˺ǯGXSSJ'ВΟy~\|5A+9  ?>.̿7차-,16p>˰r/+{vaDx3>5jfO)|XhtT V&khre#5E!b/&mvư@1r[8b E:"X41%MdU7,Z7_wh϶_vX?_~KQ'.lӇ}zvv Q~Ž9^>$  VW9q<0 [B!7F]iۢW) C5-}N Iȁw% e:]_Vf%hRn6zg,9?Ỏ.f o]p;.L9N4sx$WXpv2D|~x .a,}rgt :>J:d_rC3(씬p4:Z.>g]izFX2c *['gdfȔ xxN`rsLyDJjfFZ,/OD3HWQgHܛ_7=3lxn .0.-\XcX$D91"@~ (M5NjOA~'{=x"LYJ(8b6tA-7]g]Sɗh0,dT!+ ޖc.XO9='lڝΔ/ic1gSvk+%GOٻ 2qB7O~^;uE+ Kۼ6g܂8?Ϥ5&^zvoG/(}f9wHB嘥T.T*RKbLF1Q$#3Xin/q;w|>{}] >l +.1 Ce^#ВpRTBxH4i,+Āe: j$VBh1 Z*6?{g zvo;|hr4VT HMA(v'RN X5-qif8% kچ5 ֞ /do'|ބ@d6\0sk(_aF_8T$]Y#$X4F^N/O'H=̓DmehȜqU"Wj l&펓چ&m*kntX,QKv69B_}a8717FJ AӠ1d\ 0}L5$)eCs!rkX'/xD#MQx Szʑh^wEإ*&֬"wp(fѴ n NUcCn@ ߻>uF{8?U92+<9D*6D,KC^hN؁3 e]qg,YQ|v])=++~T-V+)\pIAn(AV#uf[f:cTq {Ի,"'3A8Y6dK?fޒlW㗫o PHgetȱzvQc I1{,eOHjLKwelsGq ~E0HLpDˋ# I;,)1Z-B:Z${T":&#,m\8|Pw൘yc1{;W i{:g8ӮͪOq "|48=1g 'opqùG7lMDE:xdl$ f{>W|OtmodkÜ.{;d%f/ e@JS׍XX'SSV!͓ϗH CfVi8ؼ(>!.5UMÆ9} -zuϜp}r| c?lln-xtOm|e1]ė VZ3H.zYkTeV+ 2eOAeEH@dlW-""[DD`Ȍ`Ȍ|5[<-D" 7Hy &|ysN;yϼϼo;̫arc =k%*$ye<boJyxEʱ U]! IG e5(uBvj6F/~zrU oɾ|j8|H il2x="%bG= bܥ>HU+}aޟt6w1p]˶޾yﵙW-s4vjFSʵF.A}B&5lZzB >Yit]ywG+vÍĽ}}>Ẕ̻ٱ+M$E yn .JeC|eR eC 'J"{@1kH5"haeD{EڌTV~ӌ\d7M]gݻ.Vgl/D=М/1D- t^t)["7K?oZKiLKjK\QP8ۻƒ7v n.HVzA}%½qYb2KEg1/w 1Ygdo݊V3IȷRWW$N%l"4b)Bğz8rqϭ's]z5 2nBJ./on@9Ė`(3m dD^b"+F%FcDӰ?#_hH**od%yr Q2PϗF&uXv6q>>>}wvH$$x)$@&@ T`  DtBCUXR<RMSG*Akv&id0Uw_><ͯp>R  # QfC8](҃xwEHIІn2r!5~9hE𜵫':ZMG('bqz\cIU$],fJJA.%r4.i) B1a$h@5.lbz@i>͓bh'jOTtǾ 'lOun龍[]-WWUGZ?|"*WgS*ɨ82A32E%Dl$+\_ 2-q=X'پ[dJ`)$NW4İ5n) ;'w[~܃g'R4Œ^Yk&S6r;3!*d(~&>K!W*zd:"l礶q|wn-Ebu[YQnŖ[smkjޚͭC??{ZI^7ḦO5?krfWعU\~_7DЅG0~9';EeawI$$p&(v_=Qj\@H@AZYK0UpR1,Z.pfVӹa/wc_velO=R>&ܫByԀ+DB!nb2(P'[w5*dĺ[` }Fh"h8%$ѴhZBCQ],1PNSص/?ݫ'"8w.䯆dKn?`oP ;hm_KdQ\b X Vp;l8-]vf+kfs :ЪJL]Dҟ%8^)r)zFv"@ɅFȘ=9S2FZ4Հ*>>(9C7ׇ࢛`Uizaa{`vD)6̏6Ʃ$%OQ$($@PAH|hu1OF0羚]v&RmT >{\w`qڹYx:~1 LfwMp{=BO f֤5ǚͶX,v:7+%e(BH KBY VVczqKªr}])0 R$%SlW*"̤\^ѯ.(Å7+dRh-X$A,j}߇e!芡EpRk5qb hŬ6 e( 4"\Xr ıXSXh䷣mSvZohUd5۴>9|;F {o|q'7n_i8s~y{SbA5V\l;]X_ܚm*jt˻.:n5LK0j:sߛd/v<ȋ GB+e@i+(8Vg @[^Zq#>0j3m1w.qG;sw=s;, E`/PEL?39ΰM5~ݹ>:O1:}EoH {'JI~m쐎%>bU٪Ҁ SJ8wH]pN5edio_ 9C q>{Y#} ahIPlrA vϪ5M ͵[7keB8b(}ٚCJzЫS>S. ׭uZ)R+[(R%l)"g$:nТ[,qsNG%UTj77o5tP^ P:j'ʅ ~ʅ/<}d߸:>J]v{_ o0w=?cʲbnXku٠|] II2g}! C_Tԧנ]"[mȠ W JV`UhڤʍbrR-L9NfNgLu*PeQ &<وD(mB&)蔓ިF \`K4x~uc"ѽ?4+9BO#2U拱:[@Rg0!Ož\bcD 5trp1b#|#7ᙋ.=h/:Q1붶_owMRvb˄ zGYxGmO}gw%kapzEN^tajO 9mtrGؐ'=ڇI\An?Ije+;ffcKgR.Ɨ?K)ҺZwJN쎨cCtkȩ"{/*,vN^bcšIyx=30D1fQ𢕳Nas9SIS{\R.K.E=}Tp=bFp((<<bn[,( ,t(!Ѵ &O<Hᆀ1t7'/j5{6+1OZ{EZ6- >Jұհʱ󲵞5Ƿ+0:ɱ'Vzg=Z Aעe(V> endobj 291 0 obj <>stream H|W lS}&8MLLo`r8I $iJ3VjKB^'0cf0(TUD`j Nm5E۴FKe߹v`{sbDJC$R몍Sqx"5˽ b6w HJ'ftvO}#yD$ ld{<XAJrZ'Qc`[^n\9?G}xҲU}h@ |?%A%7`ǣ"0+bỹzJiR9KT0%3fv1wI\%v{Soc=JO E{sH,hn9=hulX  A=DK}x~˧f?q8'G5kp֖CV_hk4 ]li~?z_)mXs_XP-D`0Vsh`>0]uqGbAS MC͡aF=PҲׄjRTMe#OR=-ߡT PLu~'Ѐ>QAc2* IDm&/= {+4ԫQv g%i*\r`h_`:C=c/ʑo@glmb.@P>x\||J0$NDb6F ܸc6QY(g_|d*xC0NP-S>qH6F&D!;tHFDRh&6(bCL!ELaaJ*$8 :l!UGS¢f>*hoEߗ/ݙ&^vŽ6jL %Q/?2 iRk]Ǝxs+,Wk9yO2J{J490S*D14U*zAl gny`p9K ^avioby 3 oh]F`7p8 0㯀^^!;]L6Ƥ*ͱ[Ljfor '͘[ϛ*iY?,ekCzs[o`cEEkYv"i'_{uG^x!<={;$lJyE!c Ƥ~ZبdVu;խ쨾Ҙs&2fЖdHNpqG#8l8PbBxgc4e[`ƴKv?L̫w` /bMJK9,W/E߸uC\KOσvb֑9iYqZY ûTLk4h*_Gxwe6Y<9ngXvM͓Ԏf_YؖuݻzlҮ%h,yծrU3B(|j$$(!Bf֪&1GT=˪ ,)o^2Mx].˺{iw:sHi,aIpdqGV#;RT;;fPw1Ǎi=g,ќD4'9͉hNDs"ќD4'9'9i VDS#GŒ`Xc6/ӻ@j;To0@v' \ rLv?a``vN7;`tn vN7;ݓt;P-43o,=bWG=eOxu_jc-?_܃;zg^pu747;+o2x+6Bnɗk_F$;Ê Y ʤDRQJ6)iQ5+œgTTl,t=U=w^uzc,~ 0QC2WCLpe4Fh6~䰺R^&5D#sW| bf&"Z8_z>ǐTS&JP65bi[◉2:`A؝X,,@+*F9Ƣh)VhM$~46ŏcD)9hbӚP&F45MZcK{gWP1eν}J,Hja9,.t̘o-]V{oV%eca o[nP8 7C7,1 5W./,ܶٴ3-3:#:#:#:#:#:#z<:⪋Z]bItc$dcWոWUL^WU8{^WU8{UKf=RvxMZqOGwޣ?UwjmG 7XWljo3s&`{ʍn׾c}KUD~.)v_@yQ4rŗ9v{}d8 3Kj F=vCs82_]wTr(C P(B9ʡPr(C иr(Cy=_!W@ x} BA(F3v`ů"HFBHn`v#> n`vf70 n`vB_Pkj2)T E=+6M SmZj$15ِ/V8rGcwoM~w{&髗Wm[?krICE᳿Y;+^p]<䥙58?Kn$jmۮa#oHCs8 ݙ&)MS7)Mn pS:Lx]2 @&$ dLI2 @&$I2 pKwA}-TynޠM%5)lt0:C:C:C:C:C:C:Mݧcøc!cOa   n>:mN_pg,෇H-t#ª]8^'w\6u|o_v-\RHul%?=Sl ni2>< zX^7cPɂl;j A\ͰrCYV5).N5M^;ySZΖ7d.^O"$HNNv\:ұI##9'-ugyWPm3Y1XYF`Hh mX%.Mb!:(dPJ2@K7d4;L4H; N@4; N@4; <&S#wVYńPJu9˯'w,UO_zXm|ժGWnUa)Qj8*@'0 :@'` tN0 :@'^izā3b %w(IR*i!&s#1a+Xx= j9]MJ^{ٍ c/Ԍ $aro~E'zSx?+#>/ngѱլN=;<_O]![O&{v>Ѝ0mJ6&$ڄDhmBMH1!&$ڄDh3#&$M)ݔ9&Fo'[i18м>Ld$!2hJ|3׷]mqg~PfQ>^>Kzc_[ӴL}h-| n g4-՞Cm%/ /c_~3\65ՊjՉ1j]1ϋ|TO\s k~l_϶^v)e5?{_[{s5kNM-U&)QMWHi)W1"*"*"H"諈 0)R=}œҒ q-: R`l+*R]S(rzwΜ˧OhG}wYPuo~_lBOַ5>~}smņK,SX>?g΋C޶T[]S:ݞorh Sڼ\)bɑkun4GER!2IЭ4}YSЏ>KeG}NuipXD-鍶O&Ǫ]Um甔J%I^~#9V4|eg".>siG*>Y9.fƅt*&#d@C)%*ƔMhA`uD$ɻ=:w6i4 *;0-nQPcڷٜ5^^>1:ʲⷻψŸnݳRȳ"?on2CMuD+T3kP2QX͔O=%$הY =}ζ99,l(2?'2nv^Zs?qfma(R7tҮ[+TRjVMSUe^G^&匂u:!֍ e AtC'\K!+{"tNS$9 `"4?Ml;cߐۃ9g r}#%P#/0`;GNb&^w!,dBN„ܴt$ 'fƶmcY{U)b@Vc]ǃWb]'2`C "4+ҕjedUȲ3 e[lla'BzlBX9+cŋcI޺X;%K=)^?U.6_d HÇ=\3k7_W4z^1M[g'֗edW#?L-c%Ni;$ 2R|@|@|vi[(p@(* @(\@(*J\(* dLDNʐє2d *Cʐ2d *Cʐ2d *C *Co'TU *[FP`k``/vDt&^U=KlqEb|w>,eLӵ6]~=ټK==>E3Gn N"'Yr iR)[Y(2Rym<\R)ij5Ώ ~TG?*Q ~Tb֢G?:~tG?:G?OȒ&A|=|Ax=ak``/vŽ - C  C0 C0 C0 C0 C0 Cq C0d q?^?pA~\S ghi;RnQ~;Y}ٳO8pvd[s}w͇Of7\R/^5:|,n2IY#`u@3ν(B|rxPҍBR>!,f{X5xX5xX5xX5xX5xX5xX{X5kE3@"}3@ g> gK^`#%aMuRPEɭ ?n<2MI5o۔12}f6m̏۞cKOJ=f~eo"}V77_*;6v%k o[$l1O=̡&;c9EX4wXNd-#=AU Y2nix+6{J:e1S@Va.2ʽD Gð͐ڒ>!JFdLӏ+D)jྴgwgi `蛁geK&u6%qۈ"?s _OT]K1sDeK*{X Q5 Q-ZwnYkǡŲ`^2z4넔k_Go)o&NϨ. )ETNU*j*J&%AC7#'<ܒhКJa*üc(* nFjf\ۂxY4] Kw=49x>x+-66b@N~qSi%=LwL8s#Gc'~O?Og qs{!~?y?7|#z?3q%_(>_/|_G9\cHz2JqThNۋV0w"΄iKP򋜶 =V8m7;m/Gn3sFm]vt/mo+m\ٵ" TJ(A;p}ٻĹtVt&|X%UDX&mEdMKR_?U 8az&A`+XZ7ҭ,E; ~?:WvkId0!&: endstream endobj 292 0 obj <> endobj 293 0 obj <>stream H\U pE^@H&\@BB GBH2!n$,J&@EA"rTqR1( c+",r+ȲhLQ?u^@c\Ksp^,gQ p$OY4wЦPKz\O|8s ;T7h#ۑ%ef'@lי0i.?˼3|ww`2֗r=`HBRan^$?xe^t HDoFG2YIS1լg/Z@+\w߭@w\> +/bz>EC̔ðF&6#J 1SpW\\Z ] BbL!H=w^fXsĜckKنlZ71w<0 Q)6Qr+Zdƣvꇙ;06IT&d r7Zup!ϣ?=K3MiְT{vG{(,Ff g'dl!N=eʺZUc쒎Qf+m˱eHT>ղ'&4퐳҆Cϑ{xE\YՈjF[*SZI rֳ/%9?pH#hő<3NaQx+M)#7/CgV!g75e6(;lGg,0L=$Uʩٸ@=P!w{Yg=bsG3TWpyx._m3Y2J&A(1{Qᴩ=sƮ`[E*|ۢ$wH;4GӺtҹSsI:ǵo66&:* klV- iѼY&5lP^P:Nmi% \ΎibWo}Z7o=YL4v!->qG2ݮ*1(LwWk]k7 .OhI/.?kz"OA&V/(Ý16(>ۂѬGmRkO6: Hҝ?άaQAyVq~.UUϹf@{7M ,nԤtu1$vNw`> 8u dd4 .w4G:uZ9qy>{޲XĨ<"Ԋn,g%яِ.q!xy!PuEyy{>0x~m䅇,QQ 5/e46,O4 Ha}IgA:SzvF=gteGXEEE")khWݦ$Tro\Ϩyz2BOD8/5_+#2,sEnٍ0CX6P𩆞O[teOOxՍJ*/v$+1~I؟?,_ա>҆vE+|/IaX"i['61+ˣ瞹OgxųZ=n`_'Q`eo[hp}>䶹}^eJ4@-هL5z;#`ţ1ZFXMb&}zenDrx[)TV66``i]RKPedU\c^Na63X׀U"` x+ɾLA >2Ӏ<P r]c0 @V} #?,Mv ']`p*yvQ7_{ 6c 4_.~9__ "lg_qvޢ-@P%,Iq=.z@Hkkb6ƑA~D J@: f1@VIw F U@~y9 ې8ב2;fjdOM)Jr˵oD܌^Mr8ۛ,ڜֈz6z7,>2K*SD61s!i CfҖM%Y "L鮸5bKwULWч;cd!b̑ZwB{;Gn=w;,s޹\r:tgt9~s9t:G=f[wWMwۡe͟oHF93@ C*O ,Gy˃8<`=`=` $q?uzV%Û 6]\% K j^#T!u `[k W|Up Y񙼮ٵ}ZetQ3 ̭1#拕&>W7! 9d|Є\iT*K+'d|Z6!Ln"ZZZ.,].  {cQ`'4 ǀ },MCj)SԘH-Kk wʍcCۓOtiZ[3 W0:k_'^$ru[Ԁ~`Y':X4IiM⃓U){@o Yb6)5)hRӤlGA*eOr=6/Q!\ҿ ~sWث|U*zz/zyMxvin.B6 tkʯ4CSviJXW)z'5BnKuOnHZvL[(lP=PW>[c*>i#.2?i#]> c>7i#Կ u5ǿ/cQfw+zLחl=m9P#ܡaR"HZ2=Eǡ+~^w8v>[ m;6$7C4b't.+dٶq8i 'Ǿwh}M,O-wM%)zl8nS b%6?M;a VhWNl[;ŇAN`K}ǶqW=}4q8Ysq84ر}iKQ'uڴR-H MU%TR !c(M7T E?x}}ݨwB^W 2K4y{*VR˜c嚷+vKB:3$z27==ōp\q9x;o[fy cuw mѽYX*Yö1T2>!<ώIe\vԙUn3T~&_%U G:2v3yܠԵߪk@ޥ./,]47A>68ƅש<1ېCϒPsy-GT ]c0 Jz9M_#3J90" TTUQn ik*1id:( C=ɚXdf0) "7H!X`<  h ͨCCu #7 w+ŀ2Pȳw>'ߘҀO7u?Gu @W-?"""іGUմܰF-5$tʰÏט<̺Zi;=j<#~EuC@R߉LC IC-6B‹#~uFȆ@$RT\H(T}tY=1]JRm]-3 |I"-+ uExE|[񯢩Q\)Q,PB*R*?&*S ADVxn2U|*Ǭ_3| 8jK`7o1c/ >7)=yrC8ڶ(Vkqpgq?aO>3m:m~qb̒Zz{mq>fig>5dy&dǘ#HzʔkJ9:JRܡKW]p|-afj%sVT&5F&ǣlecMG#lz}D|Q_.6}9z'M;yzGdƽ?C޽ վk><0!gHkh0:q9,\4}`Z8.'"Bq`:qAQH#Noߐ%֛NP[95ёsi m}L-q͎Dկ{BX bH@pWiuZޞL4:+==g>ٱs ,ō5Ew}#9pwEڑ- " >C ln毷nsp6E[htC Z6͢}a[2uDF9qX*]8Y85ٮp& 8'%<p\S0 9xB{<_tv<3^xO߳w C|-x\pBmѿ/i => endobj 173 0 obj <> endobj 296 0 obj <>/DW 1000/W[1[278]]/CIDToGIDMap/Identity>> endobj 174 0 obj <> endobj 175 0 obj <> endobj 176 0 obj <> endobj 294 0 obj <> endobj 297 0 obj <>stream HTPn0 [ݐ:܀X ]BC#'2aDpU޳{EMFGq+;N:d32m8w4zh!?p0T' -)!/WB5"(h[8 yp3,?pB]j QJUQ[8kέH;y2'b$[pZ+ϟjb endstream endobj 295 0 obj <>stream HTn q@ĸ鸿縿p'kِ56~ٳTJ1'ԃ<@2U'BNT;ňhV [&`>m endstream endobj 7 0 obj <> endobj 182 0 obj <> endobj 298 0 obj <> endobj 299 0 obj <> endobj 181 0 obj <> endobj 279 0 obj <> endobj 277 0 obj <> endobj 275 0 obj <> endobj 273 0 obj <> endobj 271 0 obj <> endobj 269 0 obj <> endobj 265 0 obj <> endobj 263 0 obj <> endobj 261 0 obj <> endobj 259 0 obj <> endobj 257 0 obj <> endobj 255 0 obj <> endobj 253 0 obj <> endobj 251 0 obj <> endobj 249 0 obj <> endobj 247 0 obj <> endobj 245 0 obj <> endobj 243 0 obj <> endobj 241 0 obj <> endobj 239 0 obj <> endobj 237 0 obj <> endobj 235 0 obj <> endobj 233 0 obj <> endobj 231 0 obj <> endobj 229 0 obj <> endobj 227 0 obj <> endobj 225 0 obj <> endobj 223 0 obj <> endobj 221 0 obj <> endobj 219 0 obj <> endobj 217 0 obj <> endobj 215 0 obj <> endobj 213 0 obj <> endobj 211 0 obj <> endobj 209 0 obj <> endobj 207 0 obj <> endobj 205 0 obj <> endobj 203 0 obj <> endobj 201 0 obj <> endobj 199 0 obj <> endobj 197 0 obj <> endobj 195 0 obj <> endobj 193 0 obj <> endobj 191 0 obj <> endobj 189 0 obj <> endobj 187 0 obj <> endobj 185 0 obj <> endobj 183 0 obj <> endobj 168 0 obj <> endobj 166 0 obj <> endobj 164 0 obj <> endobj 162 0 obj <> endobj 160 0 obj <> endobj 158 0 obj <> endobj 156 0 obj <> endobj 154 0 obj <> endobj 152 0 obj <> endobj 150 0 obj <> endobj 148 0 obj <> endobj 146 0 obj <> endobj 144 0 obj <> endobj 142 0 obj <> endobj 140 0 obj <> endobj 138 0 obj <> endobj 136 0 obj <> endobj 134 0 obj <> endobj 132 0 obj <> endobj 130 0 obj <> endobj 128 0 obj <> endobj 126 0 obj <> endobj 124 0 obj <> endobj 122 0 obj <> endobj 120 0 obj <> endobj 118 0 obj <> endobj 116 0 obj <> endobj 114 0 obj <> endobj 112 0 obj <> endobj 110 0 obj <> endobj 108 0 obj <> endobj 106 0 obj <> endobj 104 0 obj <> endobj 102 0 obj <> endobj 100 0 obj <> endobj 98 0 obj <> endobj 96 0 obj <> endobj 94 0 obj <> endobj 92 0 obj <> endobj 90 0 obj <> endobj 88 0 obj <> endobj 86 0 obj <> endobj 84 0 obj <> endobj 82 0 obj <> endobj 80 0 obj <> endobj 78 0 obj <> endobj 76 0 obj <> endobj 74 0 obj <> endobj 72 0 obj <> endobj 70 0 obj <> endobj 68 0 obj <> endobj 66 0 obj <> endobj 64 0 obj <> endobj 62 0 obj <> endobj 60 0 obj <> endobj 58 0 obj <> endobj 56 0 obj <> endobj 54 0 obj <> endobj 52 0 obj <> endobj 50 0 obj <> endobj 48 0 obj <> endobj 46 0 obj <> endobj 44 0 obj <> endobj 42 0 obj <> endobj 40 0 obj <> endobj 38 0 obj <> endobj 36 0 obj <> endobj 34 0 obj <> endobj 32 0 obj <> endobj 28 0 obj <> endobj 26 0 obj <> endobj 22 0 obj <> endobj 20 0 obj <> endobj 18 0 obj <> endobj 16 0 obj <> endobj 14 0 obj <> endobj 12 0 obj <> endobj 10 0 obj <> endobj 8 0 obj <> endobj 300 0 obj [10 0 R 10 0 R 10 0 R 14 0 R 14 0 R 14 0 R 16 0 R 16 0 R 16 0 R 18 0 R 18 0 R 22 0 R 22 0 R 22 0 R 24 0 R 28 0 R 28 0 R 28 0 R 28 0 R 28 0 R 28 0 R 28 0 R 28 0 R 30 0 R 34 0 R 38 0 R 38 0 R 40 0 R 40 0 R 40 0 R 40 0 R 40 0 R 40 0 R 40 0 R 40 0 R 42 0 R 42 0 R 44 0 R 44 0 R 44 0 R 44 0 R 46 0 R 46 0 R 46 0 R 46 0 R 48 0 R 48 0 R 48 0 R 48 0 R 48 0 R 48 0 R 48 0 R 50 0 R 50 0 R 50 0 R 50 0 R 50 0 R 52 0 R 52 0 R 52 0 R 52 0 R 52 0 R 54 0 R 54 0 R 54 0 R 54 0 R 56 0 R 56 0 R 56 0 R 58 0 R 58 0 R 58 0 R 60 0 R 60 0 R 60 0 R 60 0 R 62 0 R 62 0 R 62 0 R 62 0 R 64 0 R 64 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 66 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 68 0 R 70 0 R 70 0 R 74 0 R 74 0 R 76 0 R 76 0 R 76 0 R 78 0 R 78 0 R 78 0 R 80 0 R 80 0 R 80 0 R 80 0 R 80 0 R 80 0 R 80 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 82 0 R 84 0 R 84 0 R 84 0 R 84 0 R 84 0 R 84 0 R 84 0 R 84 0 R 84 0 R 86 0 R 86 0 R 86 0 R 86 0 R 86 0 R 86 0 R 86 0 R 86 0 R 90 0 R 90 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 92 0 R 94 0 R 94 0 R 94 0 R 96 0 R 96 0 R 96 0 R 96 0 R 100 0 R 104 0 R 106 0 R 106 0 R 108 0 R 108 0 R 108 0 R 108 0 R 108 0 R 108 0 R 108 0 R 110 0 R 110 0 R 110 0 R 112 0 R 112 0 R 112 0 R 114 0 R 114 0 R 114 0 R 116 0 R 116 0 R 116 0 R 116 0 R 116 0 R 118 0 R 118 0 R 118 0 R 120 0 R 120 0 R 120 0 R 122 0 R 122 0 R 122 0 R 124 0 R 124 0 R 124 0 R 126 0 R 126 0 R 126 0 R 126 0 R 128 0 R 128 0 R 128 0 R 130 0 R 130 0 R 132 0 R 132 0 R 132 0 R 132 0 R 132 0 R 134 0 R 134 0 R 136 0 R 136 0 R 136 0 R 136 0 R 136 0 R 138 0 R 138 0 R 138 0 R 138 0 R 138 0 R 138 0 R 138 0 R 140 0 R 140 0 R 140 0 R 140 0 R 140 0 R 142 0 R 142 0 R 142 0 R 142 0 R 142 0 R 142 0 R 142 0 R 142 0 R 142 0 R 144 0 R 144 0 R 144 0 R 146 0 R 148 0 R 148 0 R 148 0 R 150 0 R 150 0 R 150 0 R 152 0 R 152 0 R 152 0 R 154 0 R 154 0 R 154 0 R 156 0 R 156 0 R 156 0 R 158 0 R 158 0 R 158 0 R 158 0 R 160 0 R 160 0 R 160 0 R 160 0 R 162 0 R 162 0 R 162 0 R 162 0 R 164 0 R 164 0 R 166 0 R 166 0 R 168 0 R] endobj 301 0 obj [185 0 R 185 0 R 185 0 R 189 0 R 189 0 R 191 0 R 191 0 R 191 0 R 191 0 R 193 0 R 193 0 R 193 0 R 193 0 R 193 0 R 193 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 195 0 R 197 0 R 197 0 R 197 0 R 197 0 R 197 0 R 197 0 R 199 0 R 199 0 R 199 0 R 199 0 R 199 0 R 199 0 R 199 0 R 199 0 R 199 0 R 199 0 R 201 0 R 201 0 R 203 0 R 203 0 R 205 0 R 207 0 R 207 0 R 207 0 R 207 0 R 207 0 R 209 0 R 211 0 R 213 0 R 213 0 R 213 0 R 213 0 R 213 0 R 215 0 R 215 0 R 217 0 R 219 0 R 221 0 R 221 0 R 221 0 R 221 0 R 221 0 R 223 0 R 223 0 R 225 0 R 227 0 R 229 0 R 229 0 R 231 0 R 231 0 R 233 0 R 235 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 237 0 R 239 0 R 241 0 R 243 0 R 243 0 R 243 0 R 243 0 R 243 0 R 243 0 R 245 0 R 245 0 R 247 0 R 249 0 R 251 0 R 251 0 R 251 0 R 251 0 R 251 0 R 253 0 R 253 0 R 255 0 R 257 0 R 259 0 R 259 0 R 261 0 R 265 0 R 265 0 R 265 0 R 267 0 R 271 0 R 271 0 R 271 0 R 273 0 R 273 0 R 273 0 R 275 0 R 275 0 R 279 0 R] endobj 302 0 obj <> endobj 4 0 obj <>/K 5 0 R>> endobj 303 0 obj << /Dt (D:20240715172638) /JTM (Distiller) >> endobj 304 0 obj /This endobj 305 0 obj << /CP (Distiller) /Fi 304 0 R >> endobj 306 0 obj << /R [ 2400.000 2400.000 ]>> endobj 307 0 obj << /JTF 0 /MB [ 0.000 0.000 612.000 792.000 ]/R 306 0 R /W [ 0 1 ]>> endobj 308 0 obj << /Fi [ 305 0 R ]/P [ 307 0 R ]>> endobj 309 0 obj << /Dm [ 612.000 792.000 612.000 792.000 ]>> endobj 310 0 obj << /Me 309 0 R >> endobj 311 0 obj << /D [ 308 0 R ]/MS 310 0 R /Type /JobTicketContents >> endobj 312 0 obj << /A [ 303 0 R ]/Cn [ 311 0 R ]/V 1.100 >> endobj 3 0 obj <> endobj 313 0 obj <>stream Lisa Stuart 1928-Auth Release PHI QuarkXPress(R) 17.01 2024-07-15T17:26:36-06:00 2024-07-15T17:26:36-06:00 QuarkXPress(R) 17.01 %%DocumentProcessColors: Cyan Magenta Yellow Black %%EndComments endstream endobj 1 0 obj <>/MarkInfo<>/Lang(en-US)>> endobj 2 0 obj <<>> endobj 268 0 obj <> endobj 25 0 obj <> endobj 31 0 obj <> endobj xref 0 314 0000000000 65535 f 0000409754 00000 n 0000409977 00000 n 0000406141 00000 n 0000405436 00000 n 0000083480 00000 n 0000083307 00000 n 0000393075 00000 n 0000401960 00000 n 0000000000 00000 f 0000401909 00000 n 0000000000 00000 f 0000401848 00000 n 0000000000 00000 f 0000401796 00000 n 0000000000 00000 f 0000401744 00000 n 0000000000 00000 f 0000401693 00000 n 0000000000 00000 f 0000401647 00000 n 0000000000 00000 f 0000401592 00000 n 0000000000 00000 f 0000000016 00000 n 0000410066 00000 n 0000401546 00000 n 0000000000 00000 f 0000401476 00000 n 0000000000 00000 f 0000000087 00000 n 0000410134 00000 n 0000401430 00000 n 0000000000 00000 f 0000401382 00000 n 0000000000 00000 f 0000401223 00000 n 0000000000 00000 f 0000401171 00000 n 0000000000 00000 f 0000401101 00000 n 0000000000 00000 f 0000401049 00000 n 0000000000 00000 f 0000400991 00000 n 0000000000 00000 f 0000400933 00000 n 0000000000 00000 f 0000400866 00000 n 0000000000 00000 f 0000400805 00000 n 0000000000 00000 f 0000400744 00000 n 0000000000 00000 f 0000400686 00000 n 0000000000 00000 f 0000400631 00000 n 0000000000 00000 f 0000400576 00000 n 0000000000 00000 f 0000400518 00000 n 0000000000 00000 f 0000400460 00000 n 0000000000 00000 f 0000400408 00000 n 0000000000 00000 f 0000400326 00000 n 0000000000 00000 f 0000400194 00000 n 0000000000 00000 f 0000400140 00000 n 0000000000 00000 f 0000400051 00000 n 0000000000 00000 f 0000399997 00000 n 0000000000 00000 f 0000399939 00000 n 0000000000 00000 f 0000399881 00000 n 0000000000 00000 f 0000399807 00000 n 0000000000 00000 f 0000399705 00000 n 0000000000 00000 f 0000399623 00000 n 0000000000 00000 f 0000399545 00000 n 0000000000 00000 f 0000399221 00000 n 0000000000 00000 f 0000399167 00000 n 0000000000 00000 f 0000399053 00000 n 0000000000 00000 f 0000398995 00000 n 0000000000 00000 f 0000398933 00000 n 0000000000 00000 f 0000398886 00000 n 0000000000 00000 f 0000398836 00000 n 0000000000 00000 f 0000398788 00000 n 0000000000 00000 f 0000398737 00000 n 0000000000 00000 f 0000398682 00000 n 0000000000 00000 f 0000398607 00000 n 0000000000 00000 f 0000398548 00000 n 0000000000 00000 f 0000398489 00000 n 0000000000 00000 f 0000398430 00000 n 0000000000 00000 f 0000398363 00000 n 0000000000 00000 f 0000398304 00000 n 0000000000 00000 f 0000398245 00000 n 0000000000 00000 f 0000398186 00000 n 0000000000 00000 f 0000398127 00000 n 0000000000 00000 f 0000398064 00000 n 0000000000 00000 f 0000398005 00000 n 0000000000 00000 f 0000397950 00000 n 0000000000 00000 f 0000397883 00000 n 0000000000 00000 f 0000397828 00000 n 0000000000 00000 f 0000397761 00000 n 0000000000 00000 f 0000397686 00000 n 0000000000 00000 f 0000397619 00000 n 0000000000 00000 f 0000397536 00000 n 0000000000 00000 f 0000397477 00000 n 0000000000 00000 f 0000397427 00000 n 0000000000 00000 f 0000397368 00000 n 0000000000 00000 f 0000397309 00000 n 0000000000 00000 f 0000397250 00000 n 0000000000 00000 f 0000397191 00000 n 0000000000 00000 f 0000397132 00000 n 0000000000 00000 f 0000397069 00000 n 0000000000 00000 f 0000397006 00000 n 0000000000 00000 f 0000396943 00000 n 0000000000 00000 f 0000396888 00000 n 0000000000 00000 f 0000396833 00000 n 0000000000 00000 f 0000396783 00000 n 0000000000 00000 f 0000000158 00000 n 0000063863 00000 n 0000390560 00000 n 0000390861 00000 n 0000391203 00000 n 0000391742 00000 n 0000392258 00000 n 0000083539 00000 n 0000353682 00000 n 0000353784 00000 n 0000353884 00000 n 0000393591 00000 n 0000393300 00000 n 0000396735 00000 n 0000000000 00000 f 0000396679 00000 n 0000000000 00000 f 0000396342 00000 n 0000000000 00000 f 0000396288 00000 n 0000000000 00000 f 0000396230 00000 n 0000000000 00000 f 0000396163 00000 n 0000000000 00000 f 0000396065 00000 n 0000000000 00000 f 0000395997 00000 n 0000000000 00000 f 0000395917 00000 n 0000000000 00000 f 0000395861 00000 n 0000000000 00000 f 0000395805 00000 n 0000000000 00000 f 0000395753 00000 n 0000000000 00000 f 0000395688 00000 n 0000000000 00000 f 0000395636 00000 n 0000000000 00000 f 0000395584 00000 n 0000000000 00000 f 0000395519 00000 n 0000000000 00000 f 0000395463 00000 n 0000000000 00000 f 0000395411 00000 n 0000000000 00000 f 0000395359 00000 n 0000000000 00000 f 0000395294 00000 n 0000000000 00000 f 0000395238 00000 n 0000000000 00000 f 0000395186 00000 n 0000000000 00000 f 0000395134 00000 n 0000000000 00000 f 0000395078 00000 n 0000000000 00000 f 0000395022 00000 n 0000000000 00000 f 0000394970 00000 n 0000000000 00000 f 0000394918 00000 n 0000000000 00000 f 0000394820 00000 n 0000000000 00000 f 0000394768 00000 n 0000000000 00000 f 0000394715 00000 n 0000000000 00000 f 0000394641 00000 n 0000000000 00000 f 0000394583 00000 n 0000000000 00000 f 0000394530 00000 n 0000000000 00000 f 0000394477 00000 n 0000000000 00000 f 0000394407 00000 n 0000000000 00000 f 0000394349 00000 n 0000000000 00000 f 0000394296 00000 n 0000000000 00000 f 0000394243 00000 n 0000000000 00000 f 0000394185 00000 n 0000000000 00000 f 0000394132 00000 n 0000000000 00000 f 0000394084 00000 n 0000000000 00000 f 0000394022 00000 n 0000000000 00000 f 0000064053 00000 n 0000409997 00000 n 0000393957 00000 n 0000000000 00000 f 0000393895 00000 n 0000000000 00000 f 0000393833 00000 n 0000000000 00000 f 0000393775 00000 n 0000000000 00000 f 0000393727 00000 n 0000000000 00000 f 0000393674 00000 n 0000000000 00000 f 0000064129 00000 n 0000083183 00000 n 0000353985 00000 n 0000354206 00000 n 0000354533 00000 n 0000354753 00000 n 0000354813 00000 n 0000358023 00000 n 0000358229 00000 n 0000373861 00000 n 0000374078 00000 n 0000384202 00000 n 0000384393 00000 n 0000392426 00000 n 0000392778 00000 n 0000390996 00000 n 0000392493 00000 n 0000393527 00000 n 0000393553 00000 n 0000402005 00000 n 0000404281 00000 n 0000405388 00000 n 0000405585 00000 n 0000405648 00000 n 0000405672 00000 n 0000405723 00000 n 0000405770 00000 n 0000405856 00000 n 0000405908 00000 n 0000405970 00000 n 0000406005 00000 n 0000406080 00000 n 0000406452 00000 n trailer << /Size 314 /Root 1 0 R /Info 3 0 R /ID[<1beaaa84ddc430ac17b6cb7ac7e61df1><1beaaa84ddc430ac17b6cb7ac7e61df1>] >> startxref 410202 %%EOF