ࡱ> on  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXY[\]^_`abcdefghijklmqrstuvwxyz{|}~Root EntryFH@ObjectsӾHHQuill  ӾHHEscher ӾHHVBAӾHӾHEnvelope Internal ContentsZJ'CompObj^SummaryInformation( ȧDocumentSummaryInformation8EscherStm 4   !"#$%&'()*+,-./01234568՜.+,0h8@ HPX`  FMicrosoft Publisher 3.0MSPublisher.39q((  ,R$Ϻ)8n$,I- `Oh+'0 (@Lindsay DisneyGN  SqS  i- !i-qS@ i(ikkkxxx؇^^^߯ϟﯯ߿TTT,,,HHH ___```[[[hhh 000$$$ TTT eee```  ###000### ܶ~~~***  """```000AAAPPPOOO000***ggg000߱yyyҷ ---444 000*** >>>∈___VVVoooȾ 444AAA 000 TTT???000;;; ʨ}}}lllëqqq???000TTT{{{AAA000 HHH 000555000CCC 袢uuu׫ttt``` TTT 000 ```000  𽽽qqq𶶶~~~tttى{{{:::TTT000ddd000000000TTTCCC888߆000000000000222GGG:::222mmmAAAJJJmmm000000000ggg000mmm888===000000000GGG000000000ddd000000AAA̪TTT͒mmmyyy{{{zzzʳ̚{{{}}}򳳳xxx߁ttt՗߿ƽƪ~~~窪κ얖yyyɢ῿uuuzzzoooXXX 888AAAAAA ׯ'''666''' '''뫫uuuuuu౱ȉrrr 000 III JJJ ((( WWW  椤ooowwwggg>>> """FFF  ### PPP'''qqq݊jjjxxx000 TTT^^^wwwMMM%%%!!!444 ``` $$$ۙ}}}pppiiirrr000TTT׳ϟ   ``` 000///!!! 333((( RRRPPP eee ```  (((@@@***eee PPPڤ000SSS FFF ppp  ```  TTTǾ:::NNN***PPP ppp&&& eee ^^^翿￿￿翿߿࿿ǿ,J'2 h     J' tC:\Users\vschober\Documents\Release of Medical Info.pub 2      N  <                                                                                                     !   "  #  $  %  &  '  (  )  *  +  ,  -  .  /  0   1   2   3   4   5   6   7   8   9   :   ;   <   =   >   ?   @    ABC   D   E   F   G  H   I   J   K   L   M   N   O   PQRS    T  U   V   W   X  Y   Z    [  \   ]   ^   _   `   a   bc   de   f   g   h   i  j   k   l   m   nop   q    r    s    t   u   v  w   x   y   z   {   |   }   ~                                                       (pp p ppppp  v zp!ppp p!p"p# *8pOK/y ,-1h< A Dp$F vp \ \( p p A Master Page A  J J  < ,someone@example.com2Web Site Form Response@Your information was receivedFORMDATA.HTM fhttp://example.microsoft.com/~user/ispscript.cgi (p%p&p'p(p)p* \ \(p# p  p  h  J J< ,someone@example.com2Web Site Form Response@Your information was receivedFORMDATA.HTM fhttp://example.microsoft.com/~user/ispscript.cgiZ h! ( p p h  xU D  < ,someone@example.com2Web Site Form Response@Your information was receivedFORMDATA.HTM fhttp://example.microsoft.com/~user/ispscript.cgiZ \ \( p p h  J J  < ,someone@example.com2Web Site Form Response@Your information was receivedFORMDATA.HTM fhttp://example.microsoft.com/~user/ispscript.cgiZ \ \( p p h  J J  < ,someone@example.com2Web Site Form Response@Your information was receivedFORMDATA.HTM fhttp://example.microsoft.com/~user/ispscript.cgi"ppp.  X L h& h' h( h) |  X| X|  X| X|  X| X|  X| X|~ Zx    f   f  f3  Bluebird X( v z( v zp   |"#X     M g g  F D  h   v z 0e 0e PS PS PS PS" Symbol" PSSymbol" Symbol" Symbol" Symbol"* Symbol p" 4 "   & :  4 "   & :  rl f d Letter q  .( v z    ( (4 ( (' +, 0Z |6 ( (' +, X@I |J ( (' +,-F G h) 84W ^b6 ( (' +, t; < ( (+,4 :p+  $UCCSlogo.jpg| pj$Times New Roman   HzAx @   / .xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxDD rhxshxF hThCh `h wh Ch `^h wbh  Ch `h  wh  Y>hCBh `h wh hCh `@h wJh [h ah eh \h xKh Oh Lh Jvh X\h Mrh! Mh  h  Lh  lh  h  h   h  Vh  fh* xxlh QuillSubOӾHӾHEscherDelayStmp-CompObj7VCONTENTSF%Ϻ)8n$,IJFIF``C    #%$""!&+7/&)4)!"0A149;>>>%.DIC; Y }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz?j(((((((((((((((((((((((((((Ig]B$^k6uܢȚ̛/Yq,7XiJ]eO~'ֳEⷁz1A(kWb Wzx~pεmu.gZ\g:5v(((((((((((((((+/V6ڰ O\FVdmw0_coMdITFSB }ȧ@6]-.wH?Q:?><ĵ,xWe_quvT0đKDB5b?]:պNsܹ\WiZ^}7QP2|UQEQEQEQEQEQEQEQEQEQEQEQEQEQEf!|ߥ.Oƚ$k)7}~_alOmMzV=6}'Q;o~y:((((((((((((+/' ֭tH3?М}Aצ|,[cixc[RpG:19_48ƹ# u +LׇX/GZaU;FEt4QEQEQEQEQEQEQEQEQEQEQEVVm6jSEQɯƝ[Wi-4eq?}_ |Om-elr/oC^>O-Uiӟj <n޺ ĺ/m}+C ej5WvF>_2k厙w]Αdvs_^Cv1 HP0>+3A mАM`:Zcҭ,PFv@ʭQ^8ei:( =r,¦9_Vy]G^K1OA_!ځյCQ$\(ϣ1#z96k{KH GGhe.[+Z bx)Y#aG{o;Q̸lA'aBjZ(/ 10_ϵr^׎xᏉ|#!6ܷv1в_#޵#W v⶧f ף~<׵x{:7,Γz>xGҵ袊(((((((((("EI#"YMy/>6ٴT{ k/^os?ui.S͹flM{rFG^ῇ4P\^U[©O~[ݜq-HDzg#?|~)Ѯ$Ԯ'֭NIH=ӵ;";:[[$m=ǵ{O6Zޘ?:/٣CՅ| /q,RmfXXX1c#v^EU{BMϿqO Eɬxfo&ld9|)o/$}掦+ks'׮kvgۦ>Hl ϽpxSOy󏺃1=bnJy<S=3Ƥm)ga.0TԭyOÍ04{|eRNޘv񯩪eE^u ?"*/EHK9_uqU(_Tm؄V\ƭ½7۟M_P^Sw<{a>@֯mi_\A[;/+O6'.6XJN Gz~5~ x))u{G\ IxTsX;uq?j<#{wh$!vH1k72Iazۢ(((((((((7ǟ[Wm֩"+`x_O<2(8wyLv*dbY?~|jඎeY.\yc_QxOz/,Zlp<۩0d=QEVK),ar | ?hMm7l ½/Kzg?&(2`#? !Ӿm%֏F1?W,JO&yKѴ[iv0ZEV$ ܞ^y3֧{;Fk u`2NKn:v xW-mpR ņN:^EQU 4:mK!QZwݱ2\[ ½_'[il.ePaܞDz  aM6M+ F>_6]GIJ%k{>rr:G>>2xֺ 6cE/Q<ERVF-\EyaCϡoxܦL72xa|Qr[=X/1MPy]QEQEQEQEQEQEQEQEW|JQVq~moA۩>QndAon-z޽=2_FdaIlr@toxWO<.{8LUO&t๖2!8g={וkZ=惬\wɲʷ#،n5qc÷31X>C^EWt|=mC2R&78ѮwR+ 6eAO(Ѣnl:_vZ'fU@~5|`̰s~4.3SeC5n(?G]}^u71~TQ\ʼn᦮,#2 ?5fj/KKBp'#'ska5(""P0(/xK]"Y6#F~^hw##` $~#zmPtM7s\@Pz+;< z֒K>nӇlt>]OUh?Jz~X.Mz7QEQEQEQEQEQEQEQE>(.h M0[ξ|:齼i!}97u\>ֽVO~Zs0[&yvqO'5G"Kr<%WWv77N^Izzk/xH:ՄYlU䏨zWiZދ[V2m:0G𗉭,kjH%_Ԯ+N?GR@]Ҧ$@OƙqkH]]2|O5|%z z{T|1\Su{{Gp&ddҸ xLc?jbTwC5KQD?f_ zg~0_\) ܷͥ.g~x$IQdцUh ,M,ǢU?P+#ShF\2O)vl%*yNzzݢ2`#V+h;b:E孄 qys +I!n9m(}°+-%<} dU3Vi=]{A_2q"0h@GC?x/nteaC/hb6kK ڱ,y/^flors⾃%XHS=AcY>e]Qf l쿩^&ky^pRpE^UKm>1/_*2\ugڏ4۩&F~c)5}Lȸqz\^zu}nI>оI5yi.VJgֽ.(((((((߈;1X_TR-h~"nt m$uCه85^%i]M<wֶJEI#*'W_'񖯵loix<}W~iڶ1;Xf?-u6_i-< ; :3G٭Xt>EX*UHѣ}SQUg4˜N=|UxF;úxS3+'ۼ0<. W+NDW%*ⵏ0ы4._kf|}>oW&$Q kCG'Qlo?ONj;2Mܡ}+ҭ%N=Vru?2⿁pJ$ϒ'w >G㟨;ӵ8i:9^^h^cm ` 7u>8uVOnR\jR![^gw7Pitsa |qQ 7:߉5˭Z-.xE / \=]|}-`PacB`+Ş Ѽ_b_۪P$3ѿ|R=NqzƊ((((((+##>|rG+ IM ,;-T~g׻O}ᯅܢ(>\K̷2cԞWjEqrNggg?*:s? +e/Yv&i2wn c`Iק3xH4k9f4{TMԠ0pyv ֽgGצ#saҽ_ZR^Goo y$8 +yX2g9W,?J_zXiRGgk<5 bLLo!=Y?jq/iል\y2#r~7ww7/syq-fo5)&,aӷ}X}=l!{`G,~cmI<;h1yzVoh1ѠVZTQEQEQExw -GĚVcگUDbiT$s)>5 {ú$^\f8uBLA%ՍNK('K۽>qqeu5$B;?<71&A:7}zn>FjxY!oU>Ҽc _ ә 5ryl+G_+L=݈¥Ya_{tԬ⼲;yrIaXWF[O3_/i{ڳlYHz@__[gkb8aAhP0*Z+ĿhXRDP4oUJYOm!(U.PzߞSS7~.Twrp *=5|>mnXuσ^WM1X?ʣ|x,%lt!ۆ+[?{X luOC?ƺVu(k;o%GśE=<}kzW9 kfF4?=O\W)[8ZLZi>zsW~!H5l_RҼ"$} ~HgskAmcVy3z*x:EfDz{O iPKyƧu<:ǵzTCm AoC $qUQRQEQEQEQ^C4|gjoInvgݏzEsmC0ȡyׇnO-o)&2WJxKZk61G':Um^<;|/t-vz0Gy7ŭ74PGM'SI?5CuuSq_XvVZ/ x^{ncWՄQk=_ѼoĪ4ụ||ߥ^ Zj+]KsQUHoW_i ٶ}("7.}OZUu/__JW.?EQ]"|a!-61PSּirK3NI59}z6' cL=>wr?DK2;[tcSyQEQEQEQExyqƭs>+cB k;藽tO@[?Ơ}Z]0#`^Z,ړˡCwr"!#_>0Kci'bnZ/gߨ=.8of< #۷2k a~cS_N~2Q5-V@Fzo꧱C_'2۶bqFO^m@ܭ.;cEtQI$~uxfͬ=<_ oQNYIb^ǰ}+? Э1\3#rkMQK1 dp-'ƾ5#M7v0^MMOo_ѿֺ>4΃}.otIc̰>{צEQEQEQEQEQEcV֭s#yL󯅴K7u+7oyǦrzdzWӶYZkm(8`*xL֣Bo)ss.OnY$m [2zU{K^Լ羼ĻW2]R=gZdXf8 ڏ۠Zխt-TpF\qܜ&NtE}Fukr}WOH92g} u=O11nɡcLA׸IO߇"1n:2{fPrr:G^xI܇GI0mkV ܥ.>\ bmV˱9y1B|.wܰv7#3$cV^՝]LJ$@4@ >[k:L}[C;Q_2\ê7to,ў)GjgFխuTm]FszAU)9KEQEQEQEQEmxhֲfLb7F?^IcۨjK>G(Ÿ<]Wf.-]F!y="{%ui 91.=/x[ژ\e!Tq=9|kli'A,^ܖ?_$]ttț1O+vg@:gzgo x Vh," <[}S/c[xdhV6z{<iRMBu wq?^O,14i8U?d_J3L5t>ݮ.gmھv"WqLϸ z~QEQEQEQE.[? 3N]?x ]X9pʐ_* oH͛'ڤׂ?7I4ςON?ƏS> %Ɠǂ_h1|ƛ4zbgxWRZމVm7Rqvaفu #M+aHh̽L }GׯV>>cHoSpyH׷_P|C&2aFP4]R )kiQEQEQEQEQE / j /U=no¼?_^0[d";?*`kܼcm/zzߖir #?y|ո;OX5Λ# #A"'Gp{[_xIgF/snIO<9ױ9k7sc18̱kz0x~x]uL4Pp^~~߃\gngBӦΝfe~h1x7q}Cyx~9F}?|VIyv(T&^/4)o8 $cԨ>k) [{I n] ?~?iq4v%JҪ1ۃ>-CYUV?=b]ruv ."IS,r*<Fc{ڼ տ\VO(O=k(x|#Az`KB=G,]rI><]sT~so{=k袊+[X)uk,L cwZ? v8Wxzm@7@9jKu1-+HiJ9Z©xǥgxkľ* _.EdrPU0O]uYh7Z]^]BدP8=/ 0x4x72Z!EsǭRVgiYc zجHr*OᨖZN&V{:wvs#(3/5V Iҙr;aO:ڵeIe2̃qVʂ=k_IxsS!Ǚkg,ɑU ʼo_ 3kΥ~nun,YI$}+ ձGzgd_ "mWRPI/8ru}n~,|>u q# iƒu??&P~}G Կ?A{Y!km\hww.}HUJV:e8 k?>;>"NMRPּ߁džuEMbB:Gj붿| uk̿( c<K)}?kv"-uk&7(nrPSEhE<3d@n4,Mߑ\w ?M'GQ`((((+3Ě^61k eň|D?x훝bk~7x^HSbp>Coq\Gld$ : WCcc=mI 2A_GW VڑƤI]d m [Ef\dM89^]:l`#*澡g?C̊ۙnd>?_>^|x _$'"OW$>R.?cMOM3Ěľ >s^3|}~}{{o_EE;I1m%w/S5tQEW)Sѿs%n\̩4Bihhg^O5 H T+(% ^D\4ϩʹ&G_w?9뮯<@(KtTvEAAr eQu H͌K ^w 5T`6ZIUP9'&.}? KW ˟SZ'kc yBD ]UkMBذWFy]߽o^ǃP>'hij#W[nVĘ.p xt|gǁ趮oo/]y>'ˡ:SꚠȠ1HW89=1^&{~1Wu1mQ9s^O? Cf%ӵEfDpTy5| m;91 G4o 4@:4\ BJTk|-;ƚO,n-ocr+>,:l_z>랒}CZWu]Rm uF،H>$ՠߞ= |:ïYdu#~3״ i[fx"S+Gϛ79\_+Wo^>-u DŽ`}@|$ɼOg)>pCƤ~fE\q8>x"xđJ) w>"ayG}Aiu 7vY#aXdQEQEQEQEW|z6Vg?i#3An5 51?2?V 򯈞$WѶhm\<'-׽|5tX[iv_'q$[On'_#Ѡ|\jmb\5| jW#Lm!3~ qtfdi╣`]#Fz?,3&' ߂տZ\%?<Pr~Љ.B8_9j h>'ji|dF1+/LѴm6?.0ù=M[( !TyR\IPzG]IdO-˩e|qVd_ |#b8ARyi6Z-XFW9=~f$^eY =>&73rijORjS]*5y5eB yw7( c8O8Gzg,Ǫ%!(lr=EgiдF-E D2]?CZ:·Zjvq`VFX`^t{,{v,7;)rvUjj/d@nP@qԞqKP}Ճ3[JXaAE]<H@q?KG,ǯ_u^/㖾y2/[@z-rv˞q0>O֗뚎=laԆa29*G @jpa0Nzq^NGҥ?K}W/#[q ăiÆTc+~lqB+V;xG|ss5ԷW&̒;uf'$u#ER=R}鶽.n{-d3Ɗ?2#?MEQEQEQEQEs<$x \ 5sI]&э]xO gQ/ *ܽW>)i"[9@clz鑎1b~"U-ϽS,Hk&SAh/muu`g2U[yqrxX4O ːw28l_?&M4j^J{9]ܷϝrtuQ^}kY+x{*5o޾vGT'd2#ީi *h ǧfQ^^;.LuɎ`?}>r>x-㸆Exe@FAkxķڬJ|1bUXG<6qz37`}>z<-[x~ c/6I |?Y;iw36>{~+ôR0Dxsv\ }]%$GtۍNsXtd{$FhCMz_W Z-ȿHfH~*>l>":4/'DK6 .S15?.5ĦS弙 @>P~soxLAo2ļ={_UEDU@t+|C_F~9Ks+Xbg*?`;׳4WȲE"GC>((5n-;yVK  P~5XOK}Zk{5L/,=.j:|#^i͒Xi͸֮?4}r9K}v:;>7ZutJTge^K==~}xrT)b_/p)ÜSD ڀo)Xvdžč s#7UsI]&э]ZKq;.z**oh|Q]z5Gʂܱ^Ol׬~5Ki]'גk?%I;3BGQ&4߆Iωr RUi׉S-Jkx-e%^g88YmI1_'zuv>93rjR2VFA +=|cL۠WgŇn49:njes|â /=W#+G6M4V ?k9i ; 7 = C_]pKE|OX`=yCW|-_SwI! ZMn>zPHuۜ~ݥWp]ۡ56V(((ߏ:𽖘G eib:&DEʮ^|m^iw:e-@&8'i#5#3x^H-.;\J>usU< z`kn~ QEs$3WQ&DeN?eߴ+_> g`iqЕZ֫>^jniv{W M _{|TD䏫gQ^%s?_'U;l\d2[]Cſ j/\3==k<5^))Z gvo((O.JG-uu_io웼㻫oT˵o Gɐ:yԡ.eui`gRby|&C;=3NZ, a94әYl|ÂG|WE赬&G_w?9뮮o'o|4ӽo:,Xa=+u:O~<ӵ:e5A)ŀRy^ rzZWX@^kAv{aְFH`Hl~f;Kgu[]FkYT>,-osmU=>+fxlŨАO̧*Y_{k,t"+kv"Э5[F;oSEiR3*)f!T N'?x$m I${nfǵ{^/6,Һq>>~Nj\йr?G+>ڟ4-7[?vtQEQEQEQE|Q7>2SY.G1$k|lg*H;偐_>Jյ7^Q7nox帔8@M|;OQ݂Txgkj|MxTJդo%!(h`{^{O"M^X dhyvtlx)O7ٚby^A׬hֿ %rmQ`v ?U]\o W:N]2-D!X G| jWL^=|ukKoH! {zi ң;Kwz ߄Z&z(oM,3[-+) GQTl%5W-~D3FQƮi^a̞-R[2YV?c&i[HBTϽINO70[yU`I`'9$nvjUޝ;:w#!$g<ѦXEiVt  l*sU-`WHfR eرsZUD}ףVg=04"v|ed $BdeFNUFX?xf/H5úݞ?x^!4)I E2bu}Ey&/tQVǛ˞ #ѦiѝXu}?ZKOO"t{5j*EilxGZ[][H=N+/,l˦̿̏¼ŖokjX[p8I}3½'ƵZL@QByWǶy>^\XMk+lc;q]~m|oSy~q(O@LVowFbrGOj?_YK/,ƽُ`+KE4oVJH:s#v\I[?ʰ>jYnUotQEQEQEQE|Y[?593ߋT##ʽ5 ff裌!0?'}wrVM#`JoZ'^-Z崂Id$1<6E, CLG7-˹-EL&[ύ| ,2?_avjïuno濕bxM׊l=O:Vb]wGd}(i%ŴHpG^Qu~ӴR8~#Ҽiz}վGGP38>kĚbѼC Ge Iؐ@?*@AzKEQEQEQEs?kՙw4~l֮ފ]7H:h֤6| [ؑZ/xHԾ*Ze= 68{/ AZ˴$Wچvb<-6>*N2kRVefV~& )@\~>ԣ<{k,֮qpǯ ^iwoiݤ<(xC5g- i.eDkr<5'V6-ܐ3~(Ai& :J/Zi14 ’;kwW13l>~"S^7 fÁj[']RyJ Xmd^ &l8&~dwtmV?l?#Yc--JW}XJ2((()3¨>b_?tq\?ZAWꪤԭyo|t]5/ҊLe@$pz;WGߋ~.UͤN.VBIݷj_jڞmg,G>|7IleWmo-f)tW@3r=Wok#+jL߂?V~|cIq ;wlu|#ӿP﹎?е=%b,]>|;1v9&?)|!sx n5!:{6@'o*A㿥{-QERu7CV} $+zzѼMxNovcueu\aiIWh! }A B乴ħpvhfjgʶ+A#𫗷m p{][Z6.[ٙ1nc8V񟆵;u;I ŕVs?k՗w?t~lƮǟE]ÖP֥; `}ҸMW? lSReOzm@qV4m#7i" ɎIHy_56F<cm *>-xjh$T䟣<;kZ6um^rZb< &袎(XAD =vi#f5(J8F{^_N7zs9628yR3aNuUNbv7. #=pt=F״|p1t-eue};XYXA@z&!$D0VMcKniӨV_xn|A}1kF.-{y)$l]Owx{❜ .v'/Bk:((((/k7*pT8k~[y%靫WAx*izs&3a/vw4`WyEQ^S/TV; N=A?>7W𾟫gܓF yp @`{t]wM AHQ@ q\O/}k"Vjǫw~'ڽƊ(/iڪxIū-r(Թ_F[xZѵoص1ʐGw.P pG<Y uK* _ __5'XNen0kSw62ao++2b&%IҴ]w߁t& }9} tw7?htS9#dz0 hx rhcȀ)cs8}|!hXO:ŷ>+߮o'o>o ~j ?_B]D +G#4u2jڂčSԟ|vCoOuMHLHT3@O^oE-5U,mSzoa#E^|xOu<6ήp2 }C}vWnt?֙K6uR㲓?}ɮ~U.Y b9+F"Ƣq1̾p:M|ҎѺ ƾB>_J"MJ܄/y?߳ՉufVVR?MWާ|EaQf`p9kSI~y I$NIE¹<߆;g8 궕CT}DuÏ_O#*}E:(((~&|9֟8? k̾zgesII#Tw CTTssCdPC5<`O$i i"x㸓pXOj@oo՚?LWО>'A )6ZR5ؼ AELq{(Ox^U(L6<<>O5}.ƷK [쭍@0+}NkF]²=W#8>?RR.n@0IcI~w p\!8}GWyoD/4)oc(Qp-ccDuaF==<gVԡJ&+HZV 3ky[DCcl7Qym0''z|V0Ŏu&+ע1{AZs\[kʹNі#;XŤ޻:VV6cҼ+bz<'ZT֗O81Frr8uzB|BKV1xS4? =I=Gb`.WSB=׊mDE6zm\A(x`}j׉t]zĺN9)xdu oM}*̓D5}m3o< @?3] s?k՗sI]&э\e|80 U՜)?7ZY~Jt:_-CYk-tndN#Q+͎N;s^W /vvs<ݡl @z}0=kV?::4$9;{*τ2` pg֗+uʧQ^X.wldc0_Ï]}?R5_dD Ib`9SW)kO:I܌?+~+7"Xv#[@IxOĽ.Fccnјq®cRq^xzMM] M%o쑂I@I^GMK;X-K>VC$z7|φ+R̽z~^Q+=t1? ׿v^zp֕QEQEQE^p PN @W> /9?W-2F^Ok6be(pbN㨭 tլAڦ9GuOz N5s˟Lkwؿd-5!~,bgV%AkJK[6p} \/wtK1}݀V2p>Q$5=WCimFzz0zW~s$s("@A 'z߆t<5/ `Xף7r=w5 jv6mX9Tnk'}/ö2WWa*89Ӕb0F8>'ƋwMLe@*0#^o,u%dEv1T OGӥkxHo'nh,{  *@e'8 o)Nn X%?VH˲'}~C-։حh h*>QEQEQ\O'z5ekIcW47-2{%ֶ|0c*`~U봘p麟}$P8d#k&m $,:qƹ$|-s]4V_ieEP|Ϻ@9QxE\nW_}\A[{H;$~5t ͣOOϠ$d #MY1v,=F*QY|OkVFkVFM 7  ׼T7px8lb9>5ӗy<Z? cKNSVX&Cֽ,НH ij:, \3]W7oE?ָ/ūП x Cl,b^}]QEQEQE|f$|8{⹏=O^_wySi+\vJ=9^Wit 39?t;ku=#Rne=eBWKϊ)X^e=]R-K~rx"_"}t^7P$G4N2Fk~~ǍRk~15??1k 08BU` Z+F,mo[!H[د_KM:*hRY3>.? GWdv@ Ќc܁dr)k~|\tK('vqIhrlQӿh!< Y 12/^EQEQEs?k՗sI]&э\§XsV2D3WG R F1s#b'WdC^I =v{VA8g'\py[9#-w5|]QOpm'.lg5WO,?ok8r" {RG==bԴȅ%Ke0FU [pX"/%y˻gȶ>$Iӱ$ui-Oڭ&sGm2wB0@nA\k(о$x[r6qӄq\UW y#!X־$E^=krz"Ai1(?qo [D`>䜏׈뚽V7OrFX!T(z־SF,fܟ"[`$1 <_^4>6;v/*屒Kw$[=FRȾk/G#z÷D8"ˊh(((,e_7ϏF9^EVӬKVOkgvjPjAg>I> "tYP=@ }@z )orvj:e~)i8JOMDxI_5W1?H7(8מ|kލHm,hd&1Ho, N>x}+ZE<.t*P<1|]oCW֭_^HR68$p2[o]k>V]>o)IT^ERu+$[F+^1gzfT y N8kFԴ}G&ӍKMg$h'[w,.|Mp%y5̛>T=FWԊ2 ^qimݫұ,rT(͎^|/T ķ׳|dw}7W ⶷xTP{W-|Hb,R[9EnY}O5+ suk:)}[SUS,:[HXf>h4]U&~.EXv RG3㿈3x։&,!HC/QҽzDŽCvx~ֽ|k+'Z+mygP?x.C3^\zhIФ IxQ)5>&G-BP[_W|2SyK(6b8)#r)C=PvrjV! 2ϸ?A)o#[mw2kO_Eiu[ii1c$'|}[½c}OtQEQEQEWr3'=XS~RJgٶkq E^T=[OѬS9X}^) {1iOܩ Nq$uW7kկsE{ 6f+F<|'"F xrM/,v ;=k4ra\GlOP q?"_0W׺@ӮImbq5t_F67*}Sm:zn,G7&`]:BA]_rKK:o4ʷWK=j5jj&exvQȴ%p_,wd3^KRPm͢>RNɄ${1PKnf5.2c}#OҴ{M>ȓmm e?l'"O%,YG$2gaE5,1 "(M\J> ѾT/ z3~$Ο7Lk?x}tzEih(,LN𶊭_ރy2I?yYocvVtIY>A"h[.a'U9ehdeeRt7øcs2ƟLlku&_iZg<VҼO¿0~c&%}+~"x?)6C6WO뷷Z-L&t}?aVQ_=vIc1iZoxB\u4QEQEQE|F{3VoW|g8a:URֵ-krD`pXuM~]zQG #^dt&0nR'ջM{G hZKSP'?A^Bs?VEߛ$ξ+xXyXJv?\W7Û|=%ݻmǟ2-s_۫M@Ped(W/>Ƽ0Oº6t?U;[\zM_|8]:]Q!lM÷J ~Q~jρ˛hchS2|\g񮖱_KxOR MsXp7@' Wh"L:' ֺA:n@:S|A?xNV5kܿ#n1߂[8 g޽A[G4cZ[G 8"?hW/#WѼ q N&H3?LW7Y7\metd6 s B şi}(Eo!ymRy}}k TƏvM: h8 ҽ⿋;=Eb"p>_F$n{⹅e D_.ޟ1+' ǒjڮ6ɾ$Ev~ux/W#\CB;*.[ŋ,XGrVIؑw Wy)h[}xJ8&-p:^z6U>c4=WΞ)ߌ|1,*<ƥy緿Yin!55P0+9K$~E@d_ǟҹO5ιWݾ,-V!"PIa^4~׺JdxxR~XiqooH\+]u;躵(i\W!$ k񧂤 wJ#3$9'^ƫ/4Oں x %lK`cV?zďj 8 $}wⰾ!B~ m4ZHp+G&h#Rne=;Ϝc(SJ?S_' tNG*_׈$k:^:Dd+jR_?ND_- I,=ӜWxk:!{\'"ncz0;Wў K-^ƹ̞⺊(1O|JWI 5?־Эͧb0a?$EQEQEQY 5;?{8E,oϋShM8HJp+='JsȺ9D)uڽ2(bb44TE>+Ve4◧^6>Mkdw Y9;6VK+e 7_@>3j[&HE8Q|igCQC[T>3_\Z[S.py'q͞Z)[[ZT+$Z?L` laIA1^Eyq  dT lx<׭Q^.iY嶺Yp"ʆվ\cTWMᾃ,޹vf ]ڎ`gu;TךUԴ~`'_)~:9'p3ȑx?EW/Bg/gPe \v{nWI5HҺ0<98e#xj"tuޢoo_H6ۏ*~kPկ>]~k6G {oa~5'|!&KK2Cm9$cJh5IgdCWB71YvDO)h%I&p|:߂nV/2I#cGLWI!vt"KE̥u.wq^K }n?y$y*s};S@_Gabz}#μ5erD5{(lmy[G>Վ1VgՋe{} ug4P6Uԕe>j'xJ߉gW-Z IB{H+=WIv_NN?*=o xƞ.6s$PDv<ׄ iqx%Ƙ+"c)*q5kGqmre@%2:?zdԼ7s%՜S9d:ѯ$@⃟a7YQ/,[lzb9k֫'wiamg+`p:M\[dO6iTpO?8|'_ҼoĚTRI2 xomqKxp9%@ =4ZL}^nD`0`b"GV:}~nRYavf9?xvk'U_RP@Xm  0y_beӵ؆"fO~fx!$T)^?[m6NK58R՟^>0i[AG{cᯎ|,mcr|ZrQU$p'|s}gxʑd+lp 5-ޱ|?ُaY9iX&ߍad/.c( ?t9d0_qfLjT;`}U@?h^1THs"C>w_=ʷg~51kk?=DԭR]STeuIE_WD'F @S_''(-{o|k4-\wi }U{ ߟ{3ƌB{ {Š a)7X@C_QEQEQEQE/;6%jMWtC젓}fKu?-儁% |2Q_0j^7^;vF\ ;úޮGvytE 2xuoo_sq8'D[|BkҹR3i|;edL\?-W5M!ۉ[SaKI-/XEhBu; *>k#Cv툞_"OM6 𯩫|sgA& V^wfA/qN4YF}:ExTо.BқW;7N V26M9Qce1CҽǾ,_xb]IQdv[Fϯ=#~ {Rqe-[6 q3ƲwIjo)ȉV$k_? 1MoHNW=Ks:u_RG`oq?𽺞kԩ3Uf'ZC3ɪܡn#ϻ?sGS4o 9Hs#y@|ѬoofծO v)zyR [_dz+ۄ;RB­Â~>1E9[\yQ휒@9@{߁>M'W>ّ_cm EkX-h'9?yhWMU ^PCRZq0Hj/~k|Ol'GXnj~pF>zW=τmW[ cvRL%x;p;{xEu+mn^٧ju *'7_"PuK pzȿ'Ekxzn-K'|8 z7 iZڑ:T?ZD0yO֯!0L"%GV`~t߄ֿem0 $<zF#rS/@g0D3ԟk)PUdY$F:(* @68-`s?AV[i[ |OνSᦒtU$/=.K >"ٟYJA.BSJ &(((( yZ*\[,G6_ 1;Ӳ{P [¯\]ϙ #Lvs]& i$5eGh6Mn ڂBII='ů x̆;]!w?M;-dcTӽx/$ě?n3Ll po7{c($A!')jۚhG mW`ЬKk(!RlOr8PrIs\x.!uֽុgoڻ$-.c ҹrxI$F^xܧ@x\Omr_=h ?'Ia|AYۋ*(¥+~-@nuzW2G$$=-gu|\-ˍ9d_j)E<<3cR+˼)ĺQ0ܒ͟1QEt4=i絆Odn 3z׵^AWT#1#A8$`U^8߅v [qIq{ۜ3x_~Km&)uk;TOO>ύ'kDAGy@;0ZZyLִK?Z4^c~QD}ZZħ%|7LN ɳ^^A}_. zl b/8>!m3Z#.#hx7?~Ҳ˳vҬ##=1֠>!}#Wk$$^?X?$fi,VXA [ޒ^տr;@D7oO;sY< \ SS K)*>+=TPI<;I;fTh [&=rtowޯyZs}6z7>5Ν]:ymq;'.H`cED?#\c#Jρ {ˢc*$@XwU5hgK񱿎-jQ CE\}~?W\O&Vy7 }xlz | 7$d(OEzgo{N{&^?״W3J[k=]2z;ǰ ύ>h2Zq T }6q+ 1,?%~u#bnf  uc('(kxgb{V?W >KjTz|[c$G7+ oƞ3P) qDK9d@'ZG مmJQ*3/?vGKmmX y.~y?kQEx7ǝ[>$l̍*u_ 쟇b2M((((ZΜ{ۨ.{d¾oo7"kIոۻ?{wk\dԴ#'wM83Px5vjZٹԯgXa=tUϟw_,{ר |'[)5=iљ%b$d^%}IϨyB o1=;^K[<\^ea"-#ֶ~0{o\ƙOSJ<Ep|F-ukL%"~+>;k͵%|Бos$9!^GfkZ2Zn~G_Yoi Hwg5 5χ<}Ɲv$q8%9Ìpj[C C#!sWy{Z|t_%a UϦ*x>4u["{k*9;[S[񏎯o?Wz Eo! #\gOU?kC?>,2mFU sֶk'!FF[p6'%p^ wtPDžt?d1{){t6O?)om d>?WQPAcg5Ԃ( ۢ'򯓼QM_^d}BQO WW/yYӀ }x.Uk=&Z| ߐ >S # G`ᄒ^O 2 ٻmnIuc^O>.&2E ~▊Bp2kjo&c ]Ba"_PC vGJ8"(((((.hxȯ'w^]-Feck x_Xi^n'OZ1c𭔜KzT y|,-UeC: cbNԱE0jFHX9:8*FAiZcVF H$`QtdF`{xE`jE=%';O%cX;on$u+nRYVd{ָhZ+h~in3Pens0<}k<{/-qʽqHZ2J+OUI7Nj}}OO'u-n qϔ1k #Z6~:vp?.EP>{+im_.BI<`<`Fwm1.NZk1_4 1s࿇yc^MZwXs$ס",h*P05k,)QՈY>XFNXֺZxjM 6<˙G':`+㏋JV~\?v x_׊iu֯Q2_s_M]cٷfm0x=?9?xOt)gEiaƮ\O$^/ i!(WxjU)K%-@ N 2?//4˷tʅX~ |NvlٮI`{?>+ghr4۳``_vk`xRI6M,~D>O^K;C:3 1~[_AQEQEQEQEQ^e@:HLl1YWMx_>YP{+vױV7Gm_j$)qCW /﮵]B{k ǻ_G-"Fn}r0S?2k.PeªI^.a|C0}j ? A-9DY zs[>ᾙ{ww/2z82~ g>?YE + ^57ZFoJbIJ!OukR0rc}?C`ziV?LnG8OF>!ܽޱ9KKuSe =pޜ_tOΛ<崳hܯBaj^ž:p3}<?Y+qfm2Xͦ-<9SY֬-xa೎@U@xo N:nk&xA}zePx|cr?azgC+]ɞUФ5|K}N xKwZc+>' 19]֪;o$0+= { W"ZuߍUTs_HVF# /EP0*JZ^nY\O^mt P6*X,MkUmB 3NmDG]2yW­>xSު1ک#=HQ>Vo5OhwZb+t\*=^_n[=ԅv YO^VA?-$ oӐ~t>Z7ÿ)MWTEHF~j~}d9@?!wQEQEQEQEU}BKN]8a-"$k۴_iFSWQK8xPák篌~0M#cte7ѿ-06/UP[zI xoOauwA+k>"}Fk*U(~9ľ(sqA<+͡xRD[f6}R9}| DYqsa0g}GC?9oE.uiӡ MdEt`*\%7&fFɓdw$~9MwSHҵM4 f@=F=+9ԞLr?EЉ-lij#<#RXm7BL:V b\z¾ԥҖ 7rX#5>*o%WL`U3٘b^&2^Zz=?*n ?Lw}1oLz#W+OCk/I->{ ~e~5\'=`?9PW]; \UX\Nw6wc8ޝ4/3؆Y#v'q*>^rV0!}*9SJm>2>'jQ %f_]GeTukwxCǚ,ÂH52%φ@ kZ~Af2_Qϭzq_>Rʼ8HA ޏ yܹ-k'&tJ5 sع T4  ~'s --剎}=ȯ|i+/ )Db8ݎ=r. -/`v ~wqL\:Ǵo}+} X+]yە)? xVSfp_.OJw}|e {)YrIXzg׷v.5؊`*p+; {_UeR/)q' (R($qUQ(((((܏"`|> u .y3y<D~>=k;1h2{ck:p$1ea7G8TE%+ M4{ WxsW<_y0>Gz #К쫭iy g5 xR[F/̶͏F|_qOΝ{5- RHֽ۪{Ub>L/J}N}v-pۨJ8% kͼ[XxĞ efd|jђaA#Gx;HKY5; 9S ƒߩ$lCc3N5 juY(WdƭW|u2iVO]5j~P~3|#C/o#0GE>{ ɦy(R*Ԓz xZ:_57.GxnƼ?\0Wm$&V ГՎb} Ev%9aOB4-&.pL}^oO xzLK!9t;#}>˦fe%aXz' 3L]"hدaMs޽Ce? n@/ $ǹ"P~:("Rr2Ae{ yyD:~]ׇm.n&(k>0B[+y<3\J1{*hGw`[V%}+/ ²M~ԉNO(^)_AjHxyéڽOPr̺:W|Oૻ;du /zTc;y^ppá~ۥ^m@lnm7ߎTc|Km^qBK:^=񶨥ӭvh'~xAR=W G1#OYN-4<;m.&"["%<a'>M׉.#& bGDa8^EQEQEQEQEV_4+~H.c¾3~_8xKZբXe6ױp\`0 WC_$V[aΩ5G̏YOЃ^Zkzcl39ֽ>(_iz};{x̒1|w"7C}6=|WckݼW}ROVўѐ!Gd ,ǿJKh~R/9??sןim4[BIS}W @I|K%=60?ks7_O [!_`,NBt|>ePڝru+ N}fKfߴbBMd=pZGi6G |?s+O㞍 6O-Jw$C@@׫ɢ[\xhWZ fnݹVÞ#]&Y \ƹ?y}Ao# g#!UOKf688|“^}- q_ @Lr4xc CNYT^] Wď F V<9w).?!Ts^\ NҼ#%\_JzW<R=¿ ?$jBO:ʟI֊+Oޯ )g!: TEj|#`[L?OJt?oAq^u NxĬ!tI3_w[ץJ;GiO$!Y'%'ß [ȼf{Gl{/C)VMH;W=vS~8^ON?2}o'OmoČ^(((((je\鷩3=Ǹ=|4z?a["Lc ZVn-?zW DP:ĦݼQL}c+,({&5_ g==뼹'MӕcX}@#O[ɫ%Μ $?ľGZ|?k[ll6J_Wi:jV0DzFp}JY>' Z!DdsT}OɯtM7R'2]ft1A_N[P"ƋT SEQEQEQEQEQEyK (j:z\X{>["\i0O׾ͦ_52][ F\jF`Y I'^=I/&;)GB#=_>T qp#AܚDӆۅCT WJٴFn-toЏB=k?xSvM%p׉FÐGF~V-^aԱ;?^oJ ESI i,#?z7<Pӯ4l`t x6Q m8V{J xDu]9Fd?=Eo3R@dW_C%ijO](oxFuk#p2I޾vأLpʓwtsV1$R8Գ1W:Ij[2[ğo{|Gh&f)n{ߠ<;'5jOyu,i!kVUIǹ}|Whm&kԋl^m{HVln:Y!H/X¾$i,meaA |--'>XpQ{$!$}7ɮrf^4-عH_n{׫-XQRKcܟA]QEQEQEQEQEQE|z4( O ]nX S:~G<l籯Nci7)om˻z@95?}&ZWB3'd~93E5Q]\?eԞ{ l<awHycTSһj* +mF[;{yl2+_ <0zJ֓doUk:_1MzW^KPqޒ!}~ޟ/ wTrLcfفeЏc_:)?^Bo'ǡ5Z^\QYIoKqos} )h፲t9/\=}SÓN~ě YkÿY/4۵E/?yÏY\Y3 폺8?@k$uу+  ZuCwuwRPBv<*k^ۯO>l\b<9M;IoqC?!x{ƶfGXnJcs1;8$ <]OL7xzEnɁ`t2=5 6c%甐z SottDHc׳) uxRӯ:"ĐOq+ҏ|g?טZla^R9ל>WS{xX_O#~~x־ rVK[H7#9?zcQ73H$zA,`a@P*QEQEQEQEQEQEV'|-c]2m'`2?fw2 bx0ڶN|R?/b+mZ~ xaHkk1\Iɍ0~쭴H,%ڑƸUJ(+WO;o W1G=DZȯ oxIun4x~#޴|'YтZJu[E{}4x[6 yVE̖W 7(ޞ#޹| /ϡ]>1|>ĿW Uss< -A1q@^kZKOUBWEvzgٕ[ųu"\Ҳ pI WWM=[f1P>z h:QIy_Uaڷ5߈l"ͮ#2E+Vd®= -ͭ%J`A(ٙǻϹQ:u|wu^p>v?#J?yq'$SnEOtjmnc̈xozL,T۰ 9?Zɶm+Di'F?6 Wx+ॶ4z$t%|ć_NZN&Hb8nʣu^]6GJM} CCMO14ݏnQEQEQEQEQEQEQEW)YJX/nqm[x@gÿ?d~}먢(((((((inM+uaWu´}k ~:->4x./ysjOi5|\_J>)?&~Dܶ!M>8N ?.0@;TS|AFn*kߍ{Þ<|g+\Υ@9tTl?j5_^3j?cGEeɹo֫)\>x_9N=r$}3]އ l[a\^C@4. w]?W9?lExXKo>wC\*̤>}xWdpYNC}k7#NfO+g9i#l><(O3zSG"(Qz ]>$x$YZݧf\M8 {{?vQEQEQEQEQEQEQEQExzotK_oUYTlɘ57DHM.9!ͅA'onjLsۈ59~0Џ>P՘ xOco) _'Mc~ַlg ]V `c31<۸/ ]\mQ'nяF7i0je^M)$:~Hu+57^K.;wzЎEW|tv$XD!F|UF{`z׎W懣]Ꚅ-ډO*'esGl6b1i:ղE*=ȭⷋekPᠽ}½^8|kuųu<*_w';p *fz3Uy~9 tj~lG>uh,9QGzc2f 2I8WͿ"^xRi"mDq﷮{w_ |kHkEܰfIqp TkRw}RFON9+[7|i;n-ۅ)v'y\i98׺QE# !LJ9+:֥ 'u&ǟ,Ӽ3"]]bҼ \i3s\e{?Wо 0Yir;)cA[tQEQEQEQEQEQEQEQEQE ݥpG<׎E =mdN#sۯ׶)k>e}!ml'o . _G_Fu(!}Lg_">:fL\ȯ>| ~!לć8?~KU|;֦FϳC5|+Xo/Ïz믍1B=r;|x[>rxrp[.q^e{mX{g2o:EQEV7\K̒WנkkOXqkPs#lAַfP/$R'ǪnJ;;m>;K8#%ڑơUG=QEQEQEQEQEQEQEQEQEQ\_>.W ,u,quׯx~<֥[[1!ӏz8G/em_B)}OBjSK `$NO*_|Bd2|/n@~'+L= 1} Ey#MK8."bwOFP ƽK›_ik!6pY``ֽ2 aA̮?Y|_ 7SwX!daq/:>dG?=M*iVoy]EknzI\(jOqU,+e\|DZ|퉯i3G^߆.6}QzgEQEQEQEQEQEQEQEQEQEQEŴos s "Vוxu߆V6b'NGҼ?>7]i}Wڽ'_Tvmk/Csl F}fGMtb]i] C^{㏃R4Qྸ!;6 #Z~xJOx]lnmy4-Fr2x@~9lp}㛨hUtvY| N|e#ی}1ںy#IhEtaVz_1R4wZpI3 lר ֮ ]X\t# ?zmCs˺M&56}kW/Y#a^MtIchPR2=v xJX$nZ?~׮%<3ojW]ْgp*$`23WcAnem`2!K#~ p=?x_Vh|)T rU@׾|*tqG^Hn%C2U?@$iEQյ3B7Z6+wI$mx<9`ӿAst6 $}+U|a#VuK8?zwشw~$_L""D#z>VZ@ 1$qUQREQEQEQEQEQEQEQEQEQEQEQU-Rѭ/ar`: ӯ xzye'پ/>^2s׏U㞹`kz^[ZXơ_=Z#%A$n2NAi>y&Ngsf?S7x=r;4S+H*Z֓0k*E7\ե}X7:r2I=XK߃ ': 몮3⏋|)'ۨ_flW2+>U`qs w$>7ZiaKc۫1Ӣox M%Ûk?"^9{O6ҕK\ةl>MedIEν/ t? \%ڕ TsIvWv04w[¿zI\" g;iԤ[G`5 j! Kdƹ71 5ې~?J | ҬBOܶ0)>>v6uZ[Emc HG*z(((((((((((() Xq kl^u|m IAG9u'Ӝr>G|30MSJ~f]&G߭tZW(K5GvgǽpSҮeO]=j j7 2]#D?ִ |L.d?\Zv1yVȐ OEr>)oxVQ.oEaUX=6}ia j%ė(&x8q(uMjV*3\X-vo\ ]+CoGG +2T%-!ӣW^KEQEQEQEQEQEQEQEQEQEQEQEQEQE<{;>z/)%|-LG ؕAֹ{zY6: ?a=slXhPxT.# (ccɫ1ߦ!R.?y;XNʗ?+ #V>{.?ځ,xcdu"OXA?~!k nCt_>~࿍. z{#Jlgu z/- 'I_]VCvjw>6?`κ+~6Z[:H((((((((((((((((B# /ei(%.=0j#iN8…4mZURSIEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQEQ_"<@B@B@0 0(   2  #  ?"@@ (    T "H`@@@B@BZB  T"<@B@BZ  |d(  \  3 :W?UCCS STUDENT HEALTH CENTERArial Black"B@B@BZ  6 X- Z h%4   `#"l@@@@@B?@BZ h _ X- Z h&Z  4   `#"l@@@@@B?@BZ _  ,$ YZ h'Z  4   `#"l@@@@@B?@BZ `$  X- aHZ h(Z  4   `#"l@@@@@B?@BZ $( +< X- p>Z h)Z    s A?.@@UCCSlogo`TTTT``s"`@@@BVfff?f@B.`TTTT``Z h 6 ( AZ h* OQuill96 Story Group ClassCHNKINK TEXTTEXT,STSHSTSH,STSHSTSHJ^STSHSTSH<FDPPFDPPFDPCFDPCSYIDSYIDSGP SGP INK INK BTEPPLC BTECPLC 8FONTFONTPSTRSPLC 06MCLDMCLDf`PL PL 61420 Austin Bluffs Parkway, Colorado Springs, CO 80918 Phone: (719) 262-4444 Fax: (719) 262-4446 AUTHORIZATION FOR RELEASE OF MEDICAL INFORMATION Regarding Patient ____________________________________________________________ NAME : Last First ____________________________________________________________ Student ID # ____________________________________________________________ Birthdate 2. Records Release From: ___________________________________________________________________ Name (i.e. Health Facility, Physician& ..) 3. Records Release to: ___________________________________________________________________ Name (i.e. Health Facility, Insurance Co., Hospital& ..) 4. Type or extent of information to be disclosed (Checked all applicable categories) Medical Information regarding the following conditions: (List below) ________________________________________________________________________________________ Approximate date(s) and condition ___ Verbal communication between agencies or individuals ___ Psychological History ___ Pap Results ___ Office/Progress Notes ___ Other 5. This authorization will remain in effect for one year from date of signature unless otherwise specified. ________________________________________________________________________________________ I authorize release of my medical records in accordance with the specifications listed above and understood written notification is necessary to cancel this request. NOTE: There will be a charge for medical records copied for personal, attorney or Insurance Co. purposes, based on Colorado State Statutes. The charge is $16.50 for the first 10 pages; $0.50 per page or for 11-40; and $0.33 for each additional page. I hereby release the UCCS Student Health Center and my attending provider from all liability and claims of any nature whatsoever pertaining to disclosure of information contained in my records. Patient Signature:______________________________________ Date:____________________ 07/08 `CJ`C>2 "$           ,9"D "H "0(`C**______________*(8TVnp2XZ V   p vx ,^JB"X"4 " "|"W"""X""X""X""X". " "|W"""X" &(\   *,ppZ>( "" 9" "" 9">"  "|" 9"|  "|" 7 9"|>"  "|" 9"|>"  "PS" 7 9"PS  "PS" 7 9"PS>"  " " >" tt,,`CHl">Ph~Times New RomanSylfaenMangalVrinda RaaviShrutiSandnyaLathaGautamiTungaKartika Angsana NewBatang MS MinchoPMingLiUSimSunEstrangelo EdessaMV Bolic1| " "|"4,"+"L,"h."0Z"|""" " "B  """ ""5%" " "|"L,"4,"d,",."X@I"|""" " "B  """ ""5%" " "|"|,",""/"h."84W"^b""" " "B  """ ""5%" " "|"."D."."h."t;"""" " "B  """ ""5%" "*""" ""er 5. This authorization will remain in effect for one year from date of signature unless otherwise specified. _________________9q