ࡱ> kjm_ }bjbj"z"z  @f@f ]  ccggg{{{8t'{m/&( .......$1I4</gA A A /cc'/'#'#'#A dcg.'#A .'#'#V+@J\,Q~  + .=/0m/,T5-!5\,\,85g,DZV@'#4w//3"m/A A A A 5 ): 8 Attending Surgeon: Daniel Wiznia MD Other Surgeon/ Resident: _________________________ Assistant: Rene King Phone Number: 785- 3714 Beeper Number: _______________________ Fax Number: 785-7132 Admit Date: ____/ ____/ _____ Date of Surgery: ____/ ____/ _____ Type of Admit: ( Express Admission ( Outpatient/Ambulatory ( Inpatient Admission ( Inhouse Loc: ______________________  Location: ( Ambulatory ( Main SRC OR ( McGivney Same Day SRC OR ( Pedi OR ( Litho ( Cysto ( Special ( Smilow Procedure Room Time Preferred: ___________ Anticipated Length of Stay: ____ ( Post Op ICU Bed Patient Information  Patient: Allergies: ___________________________________________________________ ( Known Latex Allergy Special Needs: ( Hard of Hearing ( Deaf needs sign language interpreter ( Interpreter Required / Language: ____________________________ ( Other: ___________________________________________________________________________________________________  Surgical Information Anticipated Anesthesia: ( Epidural ( Gen-Epidural ( General ( General-PNB ( Gen-Spinal ( Local ( MAC ( None ( PNB ( Spinal ( Other _______________________________________________________________________ Side of Body: ( Left ( Right ( Bilateral ICD-10 Codes: _____________________________________ Diagnosis: _____________________________________ Surgeons Description: ______________________________________________________________________________ ___________________________________________________CPT Code: _____________________________________ Estimated Length of Surgery: __________________________________  PRE -OPPositionOR Table Attachments Instrumentation  ( Chest X-Ray ( EKG ( Urinalysis ( PT/PTT ( CBC ( Clot to BB (T & S) ( Lytes Zimmer Biomet, Paul Shortt, 203.997.6530 paul.shortt@zbcapitalny.com Depuy Synthes, J & J , Eric Urbinati,  HYPERLINK "mailto:eurbinat@its.jnj.com" eurbinat@its.jnj.com (860)335-6759 Smith&Nephew, Steve Dodge,  HYPERLINK "mailto:Sdodge8@gmail.com" Sdodge8@gmail.com 203-565-3569 Stryker, John DePalma 203-641-2324 john.depalma@stryker.com  ( Supine ( Lateral  ( Regular O.R. Table ( OSI Flat Top ( HANA ( Pegboard  ( Total knee ( Partial knee ( Total hip Blood Bank CompanyEquipmentOther Equipment( Type and Cross # Units ________ ( Autologous Blood # Units ________ Ordered On: _____/_____/_____ Script Sent: _____/_____/_____ ( Smith and Nephew System: ( Zimmer System: ( Stryker System: ( J&J Depuy Synthes System: ( OrthAlign ( Intellijoint ( MAKO ( High speed burr ( Visionaire ( Cell Saver ( Fluoroscopy ( Neuromonitoring       Cases for day of and weekends Phone: 688-2360 Fax: 688-4768 SURGICAL BOOKING Phone: 688-8888 Fax: 688-1000  EMBED Word.Picture.8  Patient Information Label PrecertificationInsurance Company:Name:Date: Auth #:Policy #:  CASE #: __________________________ Tentative CASE TIME:__________ Booked By: _____________________ ),/Rdpy|ؿ{ocZR{{{MH=h&hsCJaJ h&5 hWv5h&h&5hWv5CJaJh&hg5CJaJh&h 5CJaJh&CJaJh h|>^CJaJh hsCJaJh9h9CJ aJ h?"B*CJ aJ phh?"h?"B*CJ aJ ph1jh?"hQB*CJ UaJ mHnHphu+jh9B*CJ UaJ mHnHphu"jh9CJUaJmHnHud : m  4 T x $Ifgd $Ifgda$If $Ifgds dh$Ifgd;C `dh^`gd& `dh^`gds     ѾѶѫ}rg\rg\rPP\g\g\h;Chg5CJaJh;ChpCJaJh;ChCJaJh;ChsCJaJh;Chs5CJaJh;ChS5CJaJh&hs5>*CJaJh&h&5h h|>^CJaJh&CJaJh hCJaJhgCJaJh hsCJaJhWvhWv5 hWvhWvh&h-5h&h|>^5CJaJ  % & ' : U V m ޺鮟ވ|peZh;ChaCJaJh;ChCJaJh;Ch5CJaJh;ChS5CJaJh;ChsCJaJh;ChZ5CJaJ jrh;Chs5CJaJh;Ch 5CJaJh;Chm8CJaJh;ChZCJaJ jrh;ChsCJaJh;ChsCJaJh;Chs5CJaJh;ChgCJaJ"    " # + , - 4 5 6 < J K T U V ] _ k m x y øܪܜ܆{܆wk_h;Chs5CJaJh;ChS5CJaJhsh;Ch6CJaJh;ChbrCJaJh;ChmeCJaJ jrh;ChmeCJaJ jrh;ChCJaJh;Ch5/CJaJh;ChsCJaJ jrh;ChsCJaJh;ChCJaJh;ChaCJaJ jrh;ChaCJaJ% CAkd$$Ifl&F` `'\ t0-6    44 lapyt;C dh$Ifgd;C$dh$Ifa$gd;C    3 M U ` a b u v Ƚ|nbTFTnnh;Ch5>*CJaJh;Chs5>*CJaJh;Chs5CJaJ jrh;ChsCJaJh;Ch CJaJh;ChxCJaJh;ChsCJaJh;Chf CJaJ(jh;Chf CJUaJmHnHuh;ChltCJaJ h;Chs5B*CJaJphh{_h OCJaJhsh;ChsCJ aJ h;Chs5CJaJ   v  o p $If $Ifgd dh$Ifgd;C$qq$If]q^qa$gd;C   8 J o p q r       $ % t u ±ѣ|nh;Chs5>*CJaJh;ChZ5>*CJaJ jrh;Chh)2CJaJh;Chh)2CJaJh;Chh)25>*CJaJ h;Chs5B*CJaJphh{_hsCJaJhsh;ChsCJ aJ h;Ch CJaJ jrh;ChsCJaJh;ChsCJaJ+p q r  t u jhTK??? dh$Ifgd;C $Ifgd$qq$If]q^qa$gd;Ckd$$Ifl4n0``' 7*  t 0-644 laf4pyt;C /6bdoø筢vk`kTh;Chs5CJaJh;Ch>CJaJh;ChgCJaJh;ChrCJaJh;ChsCJaJh;Ch CJaJh;ChfDrCJaJh;ChaCJaJh;ChCJaJh;ChNCJaJ jrh;ChNCJaJh;Ch[UCJaJh;ChpCJaJh;ChsCJaJ jrh;ChsCJaJ u oWUkd$$Ifl4n0``' 7*  t 0-44 laf4pyt;C $Ifgd dh$Ifgd;C&)0>PQRS`afgst|}пxmV,h]Kh]K5B*CJ OJQJ^JaJ phh;Ch9jCJaJ jrh;Ch9jCJaJh;Ch@UCJaJ jrh;Ch@UCJaJh;Ch@UCJaJh@U h;Ch5B*CJaJph h;Ch@U5B*CJaJphh{_h CJaJhsh;ChsCJ aJ h;ChsCJaJh;ChZCJaJ&0>P $$Ifa$gd;CPQ kdV$$Ifl4r`$ `'  t20-44 laf4p2yt;CQR`fs|L[\ $Ifgdg $Ifgd9j$If[$\$gdAE $IfgdAE $Ifgd  $IfgdL; $Ifgdlt   56JKL[\juwxդդtդդii[ jrh;Ch@UCJaJh;Ch@UCJaJh]KhAECJ aJ #h]KB*CJ OJQJ^JaJ ph$h8h]K0JCJ OJQJ^JaJ 2jh]Kh]KB*CJ OJQJU^JaJ ph,h]Kh]K5B*CJ OJQJ^JaJ ph)h]Kh]KB*CJ OJQJ^JaJ ph)h]KhAEB*CJ OJQJ^JaJ ph#!()789=>?@AIJKLMNXYZ[ghistuvwøwwwwshF: h;Ch]5B*CJaJphh;Ch]CJaJh@Uh;Ch@UCJaJh;ChaNCJaJh;ChaCJaJh;Ch >CJaJh;ChaNCJaJ jrh;ChaNCJaJh;Ch@UCJaJ jrh;Ch@UCJaJh;Ch@UCJaJ+(7>?JKLYhu $IfgdF: $Ifgda $Ifgd- $Ifgdg $Ifgd $Ifgd uvw-$ $Ifgdltkd$$Ifl4r`$ `'`   t0-44 laf4p2yt;Cw$ t$Ifa$gd;C$6h$If]^6`ha$gd;C kd$$Ifl4r` !`'   T T  t20-44 laf4p2yt;C:;NVW`his{| $Ifgd8b$If $Ifgd $IfgdF: dh$Ifgd;C $Ifgdlt  :;<=MNVWXY_`hijs{|}~簰簰簰簤h;Ch]CJaJh;Ch]5CJaJh;ChCJaJh;ChaCJaJh;ChCJaJh;Ch,wCJaJh;ChF:CJaJh;Ch]CJaJ jrh;Ch]CJaJ;  >]^_pƻƻƻԷtppdhZh>5CJaJh9hZh9CJaJhh95CJaJhpI#jhpI#U h+V5jhZ$5UmHnHuh?"h?"5CJaJhF:h;Ch]CJaJ jrh;Ch]CJaJh;Ch]CJaJh 3CJaJh;Ch 3CJaJ jrh;Ch 3CJaJ#   $IfgdF: $Ifgd8b $Ifgd 3 -$`^`gdltkd$$Ifl4r` !`'   T T  t0-44 laf4p2yt;C>]^_p$a$gdf gd$a$gd$a$gd>gd9`^`gd.p  %,.3:ӼӰ}}}}}}}}}}}rf]f]fh{_5CJaJh}h{_5CJaJhYUhZ$CJ aJ h;ChZ$CJaJh;ChZ$B*ph h;ChZ$5B*CJaJphhshf hf 6hf jh>UjJ hCJUVaJjhUhhZh>CJ aJ hZhDCJaJh>CJaJhZh>CJaJ#{r $Ifgdlwkdk$$IflH  t 0644 lap yt;C $$Ifa$gd;C $Ifgdlnkdl$$IflH t0644 lap yt;C $Ifgdlnkdl$$IflH t0644 lap yt;C $Ifgdlnkdm$$IflH t0644 lap yt;C  $Ifgdlnkdm$$IflH t0644 lap yt;C:Yz{|}{{{yyp`^`gd.dhgd{_$a$gdZ$gdZ$nkdn$$IflH t0644 lap yt;C :CDPTVXYbeyz{|} h+V5hpI#hh[,%h{_5;CJaJh}h{_CJaJh}h{_5CJaJh{_5CJaJh}h{_5;CJaJ21h:p/ =!"h#$% @=cNuמSG"d˨ C(P@cx̝XfzfztbF@&LU)YA$*(0#UQ fEL`sZ1ݪѳ|wyoY3a1xs ce ,a":2n#͙~ӘaNbfr9ch-apVK,ܜΌ3J,3偫l,+NJ4m02S{qomNJh*7Pc_kaY28ȱmMeĽ.Xf_~3M>ve2u'l.@׃^BJky}5L?e/կ̛yy 1bOfDZ j0)ImWU^YbmFdrx5T`(1Xg >'׷q4ʙA(%LuI9%NK9dk̹:Y9_ϔ_^ Q1H-,it-ҥ̡,);4L̂Y~5]s?zlH8%n8mB|8ο+hڿa|b_[d )!tdZ L"Ud0a&U~ɛ6K4lќ_)C?MɺhgJ>}K<4kXd℥?.Ss<3qnښ 02B/nЦ$&==9?-Bתq0yx`i.\]UucM!z8*[]ae?f< wt̂2am@8\/BκJ5I0X¾i=a,#>7^TFE0ef\6έEÓtQ`MO6nPٚЬN2|-Ƨܝ-a@ްPjgˀ֭~7I߬V#k忻&6`]ümR{ ̛VFƥ]Te:]/ʣJr\+4S nb"Aةh%():*v+*f)ȇ)N{)v])rVa-#";)˿ry$\|uus:T*Gi]hFВw]S&a~g~`Whh RZ_| ?x.8KǛ]%ź[8C_K ouoܴkR_Kk:8Yyv'4|4wt-6b; ]~g9j%l]kj}ê3$raL.)ubjL4Y,.-1[-2Uk^V̶X0{eZbu'su -PN03s|.\iFvo3G=)?]$,"_MA3j"MHA= \IA %&X*@=е@Bv|1 #rq^ ^JAk~ƌ ~UDU=Lm{)ɱ'2Lz[xOts2ݭ'$0'ڕ2 TMq=Q꞉Կ򴉠v"X'=*g(kD+ʻ=Qƅ`䗞 `L^y^(0HI" -^4$azSJZ"e=E* D\"fWoN})[sD"%_Ny[W:::h8EdĶtԼ9v: }3Zeƃ t*k<;uP*d5 c|9K>( t4mIGs5]8pHGFÏtuݏԞ~K(*jW}EޗKS}`yӾi<ߋU}QA¼}nY}}'/Sw߸/jP޼I]E(rIHFׇD&OV-9M߸^z:<2_oڦwOe}i3f'L%K`]:uk7&c5X KfL;%W)wNW%1]ݐt"嗌K$b%$u$9!9*(9$U~@r/SIjp>~^~$UR)V[g+++ V2V.UJTΒXXX9Xf$VI${Tm%GTsǪFU $UM$ST%UEI' AI/ꐤ-VSXÒ8ﰞaǺu g>ynY^3-Mbˇ[onFA3a⾖hzeϳ)rR͢庝ˆODgs-( %>bZ5s@֭VYh+?n =: u΃'>B-hu>JI&Iۗ76Д36nJr)g郦ߩJjG{Gj?j6pGh!MH@HBx3eG(?5 l9w}5jhN೷Ml>_n~qlom()gnx&hJQcƌH&7|GRĕ#q&퐸v8~ȸ~8;ȸmxҚ#+kGȁ{(;R7v 9BAnOu$!GH!$~MuZuv rvĸQ;hܨ3Q?>s~5,v~Mv~8\BBHdN_܇C>GoM&{~x~GyS;9yq›Pכ\ޛ37d^yBH )G!W$3B2<$$#C-cb.2ωd: ~uA"I #:#qFOHʑz$Τw./'b7bGb'Wb7g!IH&$q $q!/5?{{NO{? LY\A&88aYlapLw#j02^RwSNuSv5@9ӎr].LyNng|hT> R lAf%tXvX2w }6qMXsFX-v_xwv]iw6reVf[ʹkځhTVY:lq8bpJ߁rvv[;:$ZwiP=+T̉u3{X'`aqJn䤷dop-^[}qjU6ˬv;ζZ8+ת̙hrVYe;o|ĪU(Vμ5r9뭵 j*9XcyX*gra j,A<[9o1!\+twV*8+Uaq2^X+z)w;):)kUW/JSp#w:&4r 89eaadX͜\g?1.`3 J̙|.L"Lhtxy;= lDg)ؗp~;h0d'ĽvBvI#yxj; 9: C+^9١hy0();OІV4ur\ !Î%t37J|@4*6sZԯ88hNsnj8'Ggz5hӦpa?e{&fTح*1Px^lKML[Gu+!U>:ڿjP_M~Z m/ް w0;S̸òOwbtnI% wl FPq"nfm+/G $jn):8R 0bag3*Fk#Q3;}̏zK 6;jiwhw~OMѠkzI5AV~0ui80' c[6ٰ@ %d8JN{uzTr; m3> ccu7: 5cE|&MC٩`ԪUܼ.<N/YоGJj:.:f/wхGL8]>N(]@ip 1|K׮HSE0tov( ҇hoLJ69`e?v Fi`A(2AM4Hv@k0nB!o:K0G4kCuP-ow <8)dz`?H#|F:>wt}gt)ﶂtϿ>??hYeoXqdg;:dԛU&w*zuQxy]QT(xN= u=  s=HX@e{rde+snnJ[krkPrL8R$wI"])\V(ZtWsQ*.\F[xʽ\"]6 wq׺=]]\;\]y֘f׸}qd=ٝ/[m=&hGs9yi&+̔}(Lf*'K]ʭ\ȕM]N KbkCa^8Wx:MhAv;*r.ls{,j!}#}}.o>#m1?m=ѭovj%[$%#dNdM]y=w='焩rNhᶸ?sN/X01g'+Mvѹgz8oF2ZF$-:x<@Vj~ ITN'.pSy"QS5\LDp4Uç Rl!Q'LYzM79K3q!q|x8Zn/*{7ᬆ}-R5#XjWEXtv95~׮AgPV1GŠbP4`tW := bs4֑uCpnߍCWuמuGA7 pxx x7xI};<0-N_'#H='1I*RbU z<-@])hrAp48G IA_ @5uF7!=npdXX?Y,ͅ%4L^"jc"5L@ʢ|0Y тeo6膌طZW\@J^Kkcr|~~+[w[ĠYp#.ȵ~Tk@oaO4D>3mk"ahM`><Еڧ?OACU3jFgfѨl+b_uEsώ9׺ gGvsXGJ}E>1>K4|g^峍+}N_/Ͻw޼һ섷w>Ov{}>4oQ~}}&(z+&V,[(X' ~B_wRp{&Hdʭ@P63Ag et N[LV=Ay;O{r(ew2{2;Cl❬4U>)Jnxe ^s75B6!0pp`Ly% BO߅|Za!6w)&4*xB| ɾ? C}sJBo7Pk?Qݣ;K WqVLQ*:3>[c'˃{yx]!WVR^x%޿6+xxw?g]Oޭyg|w?Ň}Xf|}vXZ_ i(_k~_wm_mʿm[y29Vv|[gL>y1x?3/rdZI@d(|5a!Ka|aI` tQCf\_ O8_ r21:BCׅ0Xӹ 7<=]44 Р'ヱ]ݠ! [Cp~<,oc{$RI M%K`}.W`b*tg\w=3?Uݒ5p?cH$CCBKL=RI:; H}|:N!qn8)y~^ףOC_쇮;,B+s 21u1xyg8~2q.t #aI!LwAh(% 3\^E4}n3:$(Id+/f'by%ݘ$ny8 w2(&NYn"0 >LCUeIb0BdHSQа_K43c?n|\Umwk)sK#y]uK}Q>%' ߤ^(?.T}G9Vf"kYNV-kD^V@vWΨ_{5j%~>x_zQu*yXUeNR~B^~6D>>WuRWVJzFaMZ]HSUG UcTU*/RT"UݕU}((I0n^*{0rs!0(f1V!`dXeX-dXk*<2~*>&? ??ƇO#-Otٴ˹x3&K 2V<7|;7̦!!)%iQ (?6RO?d֑~x._zg'lˢaX >x&;i6GG-sv.2F~E(0Jܧ{vǍv3]GQ? D"F~'R' z%l?#!ρگjoQBsF9~Q? Uyoz$I4^&|GR6Olz?-N粒b?˳lz?5׳/Cnl1āΓaaastfXgM>j;j=Z`ɰowS .v%_;hs86߭ i=ZG,[)ȑo[a8tF@9`!`6`_pß x% h)Y85kPY 8$ "\x.\`7( W>StTZF+&)` PQ&)wj*ig*%Jυgګ QvVk0V2Vgo~$oO}DdZnY,[$AyHKnZ >g?*@z)@X|=b:Nm}i72W5 la<28s<F'IAyI!d؞t lVG}mhC>zqtI  ҳ aq)"tS8dӶP?-~na!Y;}Z{ss8(]\d33>ş EO5i*bTOE`,J琱>G,Q2"K:墏_1cMLE{~q fV.R0sMch\Xĭ&bGc\0F.:碦U8m'rneR%e"c*SSBZD?׉~DN~"&~MkbΉ,9Tihg!Үq^S?zB>~Dq++Dxq5q.y0Ayy8/L$$ɺc tLs%==}AdcMZMH0<(` Sr.V@tV +/>Xz>JORvG+zP2G@9N*' W)4a~V!`X32~V)"~n/?R;N޺3o[O7@^v !oR׈o^הw^?Vu.X16|/yݑ=+FWKBxx;0&0/1|p$|p=DxB+(xEB# B/!D}E!I5!]CCT!3! C$+!υ!W!G6 wBcb JQv' =;)z.JJb LH<$o ׄE!|~#-oF[yCGa8:4?C`ǒC[byv:&8]ZVv?>)QuBPљ 2+ < ˏ@|`(p)y} E#π]P `}j4H`‘mȉ GuG6mNk8 ~ F8/@O%e"ׯp:;6}@#րm@4lW Jkw_E{:ہhJ S 9{ ҡW]CJ3{}puhiS+SrÏR&?Dy/'RvMH9LOzN_=h?>;i9Ԏ[PB4vkB.i@[մTAoo+`;I%z"w; {})D?s-I,mby8H׺rm$=*H]Y-#ywG Vn[w ,/XJ6nun.ۯ,㶉⺐Z:}>rboՓ=jra׺RDؖ6nDz;7>swKao cMb^mWƺ+V]KؖKnu?ݍ/pwdpڟO׀</&2OGhuh Ǚ1NSq /zŏ h;üojU@*S ڙX@fb D?P QoBBBc ` PFX>7)(z|z hCG|@>agJyW'框'ny*~ HZ0Ӌ.qӜ8~ڨ<8:^Tm3*Kw߁rĝ$vhZn )))fYS}>yC884Tfcalt4]?dB/@7#3Ѝ`zV00Ch og@M.fO9] guځj 86l@#_ؽtTQ4k ?+WgR\4JKfeu)OI}8%-.p9]tbCpLkL|2]J7ch&Z[fn[,ԭ1cfXϢ4̞Oܘ">EF0aXJ 7еcz;7E>޲"t;ܑro;KZ?ۀEbb#0ef|=.)7"zE4>$.Q0̣Ye#%GX-(/nC-Oұ< x)k{C^`Y<ԭX1ru< Cy1sQ 1@S%~< \ZD"ׯL5xi,7_w(n{&ddXD5"dܬS.Br4t0"BÎ(F-:T.@_ OrH/w4f-;W/G1wWo1^wGWs?h>ʱ9 &G{VێѨ_.Z=%;'oo齿.0D">3K8DHtCtVtdHiKH-Cp^!78JiH9'p!^ܽVݠׂ̫WY z:n Į ]T ŽJaEAl\+Ԋ `SllX+ COpld3{Q|vDvdvLO?nUhPgm B#еXt{(4- eulQhs6?]`W5`Wr FvuXOv] 8l4[69l-'gv_pX5{/ܝ3@"E40}q~X9"z""ثjX3-9;7=I%Iz+\%= H8Z:97"~K?E7q{8>7g)pa#ɸ] , 12Rњi5*4 QfJ>(xr1jjI3_^< kP@9nVٮAS/I~kдNWst:[`5{^-s$>Y]GiŬ,brByI]'NvrC6BB[o|m7rG 1`4pFXXO,ʱ\ ͹w|ɟY0ΊƙBMm䋉& y>z%P` Jh@醃ZS-R~>gw:zwagǥn-%y~|_q$5kϿf뤢9`Ax: }~$ϏR6OתTvJF?oCcfv1C1ր/#nK8}&i틸k ~9uV-. 0Thsrs4*GePmJ8 ^?)t  OMT|Ol+-qQZF?8Sd*C~nFGPEļ {g?$qz/OˋI~&l~3>꺗~Q]i6 w[к^t9豗~p4+84 ;藳]_gN77m#c+737N&5_k-9|ork#VOًkɻٚIXC؛ɉ0L5ّݒܜ)`$M"}|Rd#uK+m$MzY$=~O=I[_܆%*5T%G27Pw& A] ڏqAdMdshWYx~'+D?1ߘ$%+h\'vT:ʙjJqδm~_ pKjגͨa}h(Z>KL1}"L  0Nb3)%;Qɔj@IJe.ӱؽ/ID$ӂi3~J %qz0Y6(ɩ0v@ǭv0+Qu@J).0DK؀U4^xaxaxaxm㵺Jג*1^hUbFWxVx UbDZVQ?J\u/LҋI/rƴ!v<.6(#HeԎWբ]O{բ7E?VSoLLL(YQr=%hǀ)(iPb#gU9QEF$Y 7w1 Mhv!#^_6U(]qHxܺ&׿ / ٜj,Rx^1^ןoݲ/n-MlwCqCXzb &p#rsiiǸ)i{Ҵ\iW,M&=Hz3I:8N:!tnL:+%%'w8"w*w6uW::kw#'Vg,5w+FF=XkԟԩTjpj"[nKTv~#[ڜZK.O#+ҚkҚZ%im4{vc#9ͅݚnKdw|ٲ45[Lg?gaǞN/eOKJagw'QtKa';ӛaEQ=vOFsvC#S;+Q،DvxFvpF; c*'M؇u,yjF44#E+m.d@t_tGҲtt]t^k0~~M/r~Xۚv?gM\6i_GtvI=]n~l'sTG-']/GV[ۣa(wR*]v֟z&:"7 #*vtsDmje#ZxpDMQ2oy;I@;i\ 87Î֯{L}{H{`FG/FQe5u@':T}ဪ~> Mr@姀O};+&h,CnI\P^` ,pAo]@.s^{ ZA*tea  t.Ɣ˗7i]P?>(.b/sAd.i\hK3j$u=)>*ji'׮*Ꟑ/QQVxQxQxUFiMSxn8E2 NCK4t< o5t|x}[x oԗ7s!"pz57Ahe<QF]x=[. h׵`U/syT$O|ni7l((v [&|&r]h92OWǸC׃E.h`=g ^RlG`''do:dn-ӝPȂ`d|)=nvs^g^]i;) ?g;&AHR$ \`E6jb[!T***unZ_`=οGg̝{L>'63ȑu6EZ,U|@yG <;ԅ `RjRz _Ѷ+u fHWru4U$m$_K6Ҧwsv䯿M>Uc.LCV-"QUIs<ެI V9N\e 6G*/ٗJ/Y]Vt+~}\/*-DRfB۪ }wVuUpO}hzڤ^ KP:P@e$Q4ѨTACVuZV<PAS-i\о.h\ 솿 $0 LyxgV|0p ×ແFܼcw,;K&8U'QVdu/p}c|.! 8Oµ[qUR? LbpқkP%zjݴltH/C&@'ҞRoM(EҧRv:ri;F=Ղ4\'Kǩ9;\I}PWq'{k#uy;A@MzW=a~^oH]Op[OW /RG}KVu-OX[ C)x֥ ly†v /<;S%0j}K` *y^p2C< {['Tt,Oة*O٭4׸}e\2Kc:1@_b(hAC 4ϨB^h 1qA+\Pxa|;l8)ހ'oko+x}|1ߍwIeheL,^9ֲl,([oBm[c\jM 4t-ۅ &,S nc+=h+o VHeI4!b" 5Oӥ&}l(a8 =g!eLW]qۍZO1ʥF.xxK3Uv^nq'w-`,s 74zB+'r~zo͞{6uSdaiYEq'2JTt>9 4+ ?Jz侕:g4H:LM~Uw &{dcׅGؕM*j&lR_Ÿki$bMOFEȸk=iYQߩ6y&jɠ^4*G^$rGk4ri~$kNӡ}գ[|ۢ*`c!.1uWÀwzXQ=Ong-=+__F9C?/66~,q"vGm@Ef>H1hy[@<{m":lfϿ%R:.|xdh!=fe ٲ B_<`g^=lrea0/矜}.6-؈掚n#wT| H]t,ld֟s{~Z5"QC=$"kWyjWR[JQjE+,3]f\.2?F3RDoy|R=wg#}ѥ4)|K6R`߲dc3+׾aSx]H:clԖ%6)z <ZPF~=χyzE.%J0N\gy$yRkc,ݡ[?Ϟۃ i2tyx-e.-uA;g^Ix~<7yx>oׇ|V/{ ,@MWpE pNXO*fh޳(qQ=Fs8JDq=o{12adȼy#F={02aP2adͼyO={80ad8-"x3޹"rsl<EVE3dׅN\&Ds&&𞖯L=;g+gaYUj6ϼgksxOq=VāFƁ|.b#F#F-+1' @UdUȗRi{c"3D-<9pp/8!VàC3Qs=Wa+=wz2_~)qW "E"s˕q;CHClxy|xϸ8v_0a󞴽q;lߒ+g<6ϼ?󞧚8fî^='{sy{yI${n0~G${0s%8=-qb1 i&šY'j2q&ĕI^3֘]p*$w a!xx'6Ѽx X_*2|H_ܽ"r|+"ުyi xO75=` =-ׂq~K;ϼ?k{yk^=5=a׃y{>0ipq+"yS-]qǽ{>=OI i aˉ9Y,db?K*Zfbe2gZxe8.DK(n O-J,)6fGD+<77`+Rfo4U4+M{gN4/*4gQ6DEKͩ(<Y hy iÉl(,qD-(&f!4i iivZ^Y8ToG,]HO[t:m-.K5=b4ײ}fـFZ֠!ϲXQ{2Ԝ1qKsM M>D|'@G@GWנkќ7xpjҊ GCh Ac1[ܹ14-n$+7"f[\3nq@rlk,-ѲUB--8K!޲[6qi& iGޣC eie??܈o*okG:_UcB>&gAޖwx--ʯ;ߖsԎs?ԎݵG1~x6>zC;j{ځ}ca1@MߒBĿ/>OKߥp{'PiX_#Wa8 O?g >4,e{}]e}#n=~ŸRo.n嗈y-m M-MMnO3.؇ kGf'y&y'z9C#%ru_KL"I+mD$#hLI,%Y()#gDE)_|fJJ}$o IKM:IvJHnʡvn`t|)CCe$RY*$=oeE"Ir^ec݅cތew/.2ɽӄ˙ !6)9IL%LޕI&|Iܧ 3IMk20;ﻒ,/$ 3IyՓ<эL!E0$G_E.-N"DnsL4T|"*,. _/"<. |6XїB|7>ε[ IVRpj+te%W3B$le!J^-hkD"]{'n9E!}cTGV[كp`a+9vh%mƉHz嗲{@ rh_^Nwgs`|ńd '̅Tυv us.\mp}O-:,"xW[H5n\ŋHv4="aDK,Ȧ? eBh7lXB׮dv UBl#,zHh|K9e߾~z#8/CcS+iБgֱV4;*(H8A%\/M"?Ahf"fOóȑυE62U0Img1nIm+[oDVh!`%R}d?0J y ¸ BtA |HonKKً9IY.o /&?IOF)RqtPHH U<#D! PxiKHW( 7Oo\aGKrrLޅC4Pbǒr3%ߧQ:IN?J.695i4s.&Ou Nt1Ntu:պ~4=~tZK*b|sY^1M^aX#(8&qI E\S׿g>4FEE8K&|B9ax/W oPHß_ߖ? $~\kx!|\x>I?A?ŞQ7!uz]ݗ.E.u\u6I|.t\Bu]G.tnrv͆/:+/:r%I7eu*.:G:+盺'tw?;_w_q_rGHz<\hl{&o\ Y_yH(]e/:GוBſ.٥ϒl?/$$If!vh#v#v#v\ :V l& t0-6555\ apyt;C$$If!vh#v7#v*:V l4n  t 0-6)v575*/ af4pyt;C$$If!vh#v7#v*:V l4n  t 0-)v575*/ af4pyt;C<$$If!vh#v#v#v#v #v :V l4 t20-5555 5 / af4p2yt;C $$If!vh#v#v#v#v #v :V l4 t0-+5555 5 / / af4p2yt;CO$$If!vh#v#v #v #vT:V l4 t20-+55 5 5T/ / /  af4p2yt;C $$If!vh#v#v #v #vT:V l4 t0-+55 5 5T/ /  / af4p2yt;CdDd <0  # A"cNuמSG"dcGr@=cNuמSG"d˨ C(P@cx̝XfzfztbF@&LU)YA$*(0#UQ fEL`sZ1ݪѳ|wyoY3a1xs ce ,a":2n#͙~ӘaNbfr9ch-apVK,ܜΌ3J,3偫l,+NJ4m02S{qomNJh*7Pc_kaY28ȱmMeĽ.Xf_~3M>ve2u'l.@׃^BJky}5L?e/կ̛yy 1bOfDZ j0)ImWU^YbmFdrx5T`(1Xg >'׷q4ʙA(%LuI9%NK9dk̹:Y9_ϔ_^ Q1H-,it-ҥ̡,);4L̂Y~5]s?zlH8%n8mB|8ο+hڿa|b_[d )!tdZ L"Ud0a&U~ɛ6K4lќ_)C?MɺhgJ>}K<4kXd℥?.Ss<3qnښ 02B/nЦ$&==9?-Bתq0yx`i.\]UucM!z8*[]ae?f< wt̂2am@8\/BκJ5I0X¾i=a,#>7^TFE0ef\6έEÓtQ`MO6nPٚЬN2|-Ƨܝ-a@ްPjgˀ֭~7I߬V#k忻&6`]ümR{ ̛VFƥ]Te:]/ʣJr\+4S nb"Aةh%():*v+*f)ȇ)N{)v])rVa-#";)˿ry$\|uus:T*Gi]hFВw]S&a~g~`Whh RZ_| ?x.8KǛ]%ź[8C_K ouoܴkR_Kk:8Yyv'4|4wt-6b; ]~g9j%l]kj}ê3$raL.)ubjL4Y,.-1[-2Uk^V̶X0{eZbu'su -PN03s|.\iFvo3G=)?]$,"_MA3j"MHA= \IA %&X*@=е@Bv|1 #rq^ ^JAk~ƌ ~UDU=Lm{)ɱ'2Lz[xOts2ݭ'$0'ڕ2 TMq=Q꞉Կ򴉠v"X'=*g(kD+ʻ=Qƅ`䗞 `L^y^(0HI" -^4$azSJZ"e=E* D\"fWoN})[sD"%_Ny[W:::h8EdĶtԼ9v: }3Zeƃ t*k<;uP*d5 c|9K>( t4mIGs5]8pHGFÏtuݏԞ~K(*jW}EޗKS}`yӾi<ߋU}QA¼}nY}}  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`acdefghilopqrstuvwxyz{|}~Root Entry  F€ Data bnWordDocument ObjectPoolQ~ € _1255347676 FQ~ Q~ 1TablengCompObjhObjInfo  [(@(NormalCJmH <A@<Default Paragraph Font  l,2$h.L F$:ڻ%L"@"`_(  "  BCADEPFZpA_XE&g4/Pt_ 7sD*,@`  rB! C DEFp$$A!       | oQ I# " s P 0 q g G , D  }; '~=BW unAJL@`"  BC0DEPFZp0 /b 5P uAt!tD*,@`  BCDEFggrib[TMF@:3-' E9F6H4I3K0L.N+O*Q(S%U#W"Y[]_bdhlqv{19AIPW]djpw}  `_^a\c[fYhWiVlTnRpPsOtMwKyIzG}E~C@;72-(" r@`*  BNC1DETF^(;Obw  %1"@*@11*"% .5;AEGIJwKbKOK;K(KKKKKKKJHF|Bh=V7D/4&& @@1 %&4 DVh} VVV VVVVUSQ}MhIVCD<43&(  NN? 1&&4DV h|(;Obw & 1?"N*N1 1 *"(3 <CIMQSUVwVbVOV;V(VV,0@`  jBC+DEF F~u\BAk#a4 '+'x L!lpQG:& M u&C:QmvX=%&R D r*A[{.Ke{Dt /W1Oj7Ts"Ba}ybH,~T+_;bC"zspqwrS6@d@`@`   jBeC(DEF|xtxrkp]nPnBn3p%rt y~@]x6^"@;bR`ec^&VCJ`<|, uT!0& (''&$#!yk] O A3&9FU.a>mNy_q(7FVetym_O>,kvF_I3~\@*vE (4BwTagN~=.!=[fr~  "HL@`B   B`CDE`Fj:Xv '6 EX/l=ISZ^`^-YMRjH<- %{+_.E1?09030-0'.!--,+ ('%" &:M`sx`H-~o~^xNs<q*ooo ooooppqqrrsuvwx1AO^lz $*.2468z8i9Z9J9:9-9 99999886p5`2Q.C*6$( :24@`   BCDE$F.II9999998~6o4_1P.B)4$(  (4BP`o~ -:JYix #(-0356z8i9Z9J9:9-9 9@`   BCDEFpp9IYgv    tdUE8+zzzz|{r|h~^SI?6-$ ,0258;>ADGJMPS V Z ] a a d h l p t x |  vsokf`ZSLE=5~-|${zz zzz9@`   BSCDE,F6KKl|}xtle^U*K6AC6O+S+ $*.2468z8i9Z9J9:9-9 9999988~6o4_2P.B*4$(  (4BP`o~{l@`   B=CDE,F6KK^gmg|gfca\XRLE>4,!"-9 =  "(,02v4g5X6I797*77 77777765y4i2[0L,?(2"'  '3?M\kyZ^g@`   ZBHCVDEF(;Oas$$'1:AFKNQSsTaUOU;U(VVUUUTSQNKoFaAR:D26()  $&),/1 5"\|||{{zyxuromahRaDX6O)C5&&HH9+ )6DRaoVLB9.#w i\OB4(s@` z  JBCDEFxhZMB90(!teT?( gb^ZVQMHyBk;[5L.?&2$  !(/6>EKRX^dk} !#%s%c%U#F 9-! %.6@JS]hs~g  n ] L>/" vdTG;0&wgU@)^@` *  B5CDETF^$7K^s )88%-5:?BEFsG^HKH7H$HHHHHHHHGECz?f;T5C.3%%88)% 3CUh{ C CCCCCCB@>{:h6U/C(3%55&%3CTfz$7K^s&55(/6:>@BsC^CKC7C$CCC,0@`   BCDE(F2JJB HNTZ_dgjnk\kLi<e.`!XM AA|qf\TLD=6/o(`!M9a\XSNIE@r;d5V/I)<"/# (09CLV`is}"B @`  ZB8CDEF.=JWcq| &,269|<q>c@W@JA=A.ABBAAAA@w>k<^:R6G2<-2'(  "$'Dwk^RG<2(}tj __88, #( 2<GR^kw}sjaWtMfDW@`  jBuCDEF7ETamz #,5=ELvRgYY^Jd:i,nr xGJM{QpTfV[XQZHZ>Z4Y,V#SNG? 55  ,:JY!g(v/6?HR\huuvvviZI7Devetdqdlddd\eSfIj>m2s'|7 iT"B.39&EQ] ht~@`@`  jBuCDEF7ETamz $-6>FMvSgYY^Jd:i,nr xGJM{PpSfV[XQYHZ>Z4Y,V#SNG? 44  ,:JY!g(v/6>GQ[huuvvviZI7Deuesdpdkddd\eSfHj=m1s%|7!iT!B-39&EQ] hs}@`@`  B>CDELFV]Uodosqonlhd^XRKB9"..#:> #(.146q7a8Q9B949%99 99999876p4b1S.F(9#-"    #&)-11-%~{xutsrrrrrrxrjrZrJr8s'sttuwxyz}''  ](,@`  B?CDELFV]Tocorqonlhd^XRKB9"..#;? $).145q7a7Q8B848%88 88888775p4b1S.F)9$-"    #&)-00-%~{xutsrrrrrrxrjrZrJr9s'sttuwxyz}''  ](,@`  B=CDELFV]Tocosqonlhd^XRKB9 ..#:= #)-145q7a7Q8B848%88 88888775p4b1S-F)9#-"    "%)-00-$ ~{xutsrrrrrrxrirYrIr8s'sttuwxyz}''  ](,@`j  :BCDEtF~]]XX+X@XRYdZu\^bflr{iiws`L9'|tlsdf[XRLI@?44)'  "( /7<xj]NA4(XX@`  jBuCDEF7FTbnz #,5>FMvShYY^Jd;i,nr xGJM{QpUfW[YR[H[>[5Z,W$TNG? 55  ,;JY!h)v07?HR\huuwwviYI7Eevetdqdlded]eTfIj>n2t'|7!iT"B.39&EQ^ it~@`@`B S  ? %  ttsntMMtMOt M tA Ot9Ot_O-t Ot7 D t O t t'Ot   wt  ; wt > { wt , wt |t|tmwtrt {t wt G}t@u`@GTimes New Roman5Symbol3& Arial"hkKkK&!r0Stephanie MarvinStephanie Marvin   FMicrosoft Word Picture MSWordDocWord.Picture.89q Oh+'0<HTd |    hAttending Surgeon: ____________________________ Other Surgeon/ Resident: ____________________________ObjectPool Q~ Q~ WordDocumentSummaryInformation( DocumentSummaryInformation8Y bjbjWW  ==] d]d]d]dqdsdsdsdsdsdsd$beVgjd]da]d]d]ddqd`qdqdqd]d qd]dqdqdqdqdqd ҼױMgd qd  jUmH     N N!B"B#&$&%Oh+'0l   ( 4 @LT\dssStephanie Marvindtep Normal.dotaStephanie Marvind2epMicrosoft Word 8.0@@wM@wM՜.+,D՜.+,0 hp  YNHHitlj  Title 6> _PID_GUIDAN{2878AC20-B97B-11D4-8D60-0000F6B1498C}'/Sw߸/jP޼I]E(rIHFׇD&OV-9M߸^z:<2_oڦwOe}i3f'L%K`]:uk7&c5X KfL;%W)wNW%1]ݐt"嗌K$b%$u$9!9*(9$U~@r/SIjp>~^~$UR)V[g+++ V2V.UJTΒXXX9Xf$VI${Tm%GTsǪFU $UM$ST%UEI' AI/ꐤ-VSXÒ8ﰞaǺu g>ynY^3-Mbˇ[onFA3a⾖hzeϳ)rR͢庝ˆODgs-( %>bZ5s@֭VYh+?n =: u΃'>B-hu>JI&Iۗ76Д36nJr)g郦ߩJjG{Gj?j6pGh!MH@HBx3eG(?5 l9w}5jhN೷Ml>_n~qlom()gnx&hJQcƌH&7|GRĕ#q&퐸v8~ȸ~8;ȸmxҚ#+kGȁ{(;R7v 9BAnOu$!GH!$~MuZuv rvĸQ;hܨ3Q?>s~5,v~Mv~8\BBHdN_܇C>GoM&{~x~GyS;9yq›Pכ\ޛ37d^yBH )G!W$3B2<$$#C-cb.2ωd: ~uA"I #:#qFOHʑz$Τw./'b7bGb'Wb7g!IH&$q $q!/5?{{NO{? LY\A&88aYlapLw#j02^RwSNuSv5@9ӎr].LyNng|hT> R lAf%tXvX2w }6qMXsFX-v_xwv]iw6reVf[ʹkځhTVY:lq8bpJ߁rvv[;:$ZwiP=+T̉u3{X'`aqJn䤷dop-^[}qjU6ˬv;ζZ8+ת̙hrVYe;o|ĪU(Vμ5r9뭵 j*9XcyX*gra j,A<[9o1!\+twV*8+Uaq2^X+z)w;):)kUW/JSp#w:&4r 89eaadX͜\g?1.`3 J̙|.L"Lhtxy;= lDg)ؗp~;h0d'ĽvBvI#yxj; 9: C+^9١hy0();OІV4ur\ !Î%t37J|@4*6sZԯ88hNsnj8'Ggz5hӦpa?e{&fTح*1Px^lKML[Gu+!U>:ڿjP_M~Z m/ް w0;S̸òOwbtnI% wl FPq"nfm+/G $jn):8R 0bag3*Fk#Q3;}̏zK 6;jiwhw~OMѠkzI5AV~0ui80' c[6ٰ@ %d8JN{uzTr; m3> ccu7: 5cE|&MC٩`ԪUܼ.<N/YоGJj:.:f/wхGL8]>N(]@ip 1|K׮HSE0tov( ҇hoLJ69`e?v Fi`A(2AM4Hv@k0nB!o:K0G4kCuP-ow <8)dz`?H#|F:>wt}gt)ﶂtϿ>??hYeoXqdg;:dԛU&w*zuQxy]QT(xN= u=  s=HX@e{rde+snnJ[krkPrL8R$wI"])\V(ZtWsQ*.\F[xʽ\"]6 wq׺=]]\;\]y֘f׸}qd=ٝ/[m=&hGs9yi&+̔}(Lf*'K]ʭ\ȕM]N KbkCa^8Wx:MhAv;*r.ls{,j!}#}}.o>#m1?m=ѭovj%[$%#dNdM]y=w='焩rNhᶸ?sN/X01g'+Mvѹgz8oF2ZF$-:x<@Vj~ ITN'.pSy"QS5\LDp4Uç Rl!Q'LYzM79K3q!q|x8Zn/*{7ᬆ}-R5#XjWEXtv95~׮AgPV1GŠbP4`tW := bs4֑uCpnߍCWuמuGA7 pxx x7xI};<0-N_'#H='1I*RbU z<-@])hrAp48G IA_ @5uF7!=npdXX?Y,ͅ%4L^"jc"5L@ʢ|0Y тeo6膌طZW\@J^Kkcr|~~+[w[ĠYp#.ȵ~Tk@oaO4D>3mk"ahM`><Еڧ?OACU3jFgfѨl+b_uEsώ9׺ gGvsXGJ}E>1>K4|g^峍+}N_/Ͻw޼һ섷w>Ov{}>4oQ~}}&(z+&V,[(X' ~B_wRp{&Hdʭ@P63Ag et N[LV=Ay;O{r(ew2{2;Cl❬4U>)Jnxe ^s75B6!0pp`Ly% BO߅|Za!6w)&4*xB| ɾ? C}sJBo7Pk?Qݣ;K WqVLQ*:3>[c'˃{yx]!WVR^x%޿6+xxw?g]Oޭyg|w?Ň}Xf|}vXZ_ i(_k~_wm_mʿm[y29Vv|[gL>y1x?3/rdZI@d(|5a!Ka|aI` tQCf\_ O8_ r21:BCׅ0Xӹ 7<=]44 Р'ヱ]ݠ! [Cp~<,oc{$RI M%K`}.W`b*tg\w=3?Uݒ5p?cH$CCBKL=RI:; H}|:N!qn8)y~^ףOC_쇮;,B+s 21u1xyg8~2q.t #aI!LwAh(% 3\^E4}n3:$(Id+/f'by%ݘ$ny8 w2(&NYn"0 >LCUeIb0BdHSQа_K43c?n|\Umwk)sK#y]uK}Q>%' ߤ^(?.T}G9Vf"kYNV-kD^V@vWΨ_{5j%~>x_zQu*yXUeNR~B^~6D>>WuRWVJzFaMZ]HSUG UcTU*/RT"UݕU}((I0n^*{0rs!0(f1V!`dXeX-dXk*<2~*>&? ??ƇO#-Otٴ˹x3&K 2V<7|;7̦!!)%iQ (?6RO?d֑~x._zg'lˢaX >x&;i6GG-sv.2F~E(0Jܧ{vǍv3]GQ? D"F~'R' z%l?#!ρگjoQBsF9~Q? Uyoz$I4^&|GR6Olz?-N粒b?˳lz?5׳/Cnl1āΓaaastfXgM>j;j=Z`ɰowS .v%_;hs86߭ i=ZG,[)ȑo[a8tF@9`!`6`_pß x% h)Y85kPY 8$ "\x.\`7( W>StTZF+&)` PQ&)wj*ig*%Jυgګ QvVk0V2Vgo~$oO}DdZnY,[$AyHKnZ >g?*@z)@X|=b:Nm}i72W5 la<28s<F'IAyI!d؞t lVG}mhC>zqtI  ҳ aq)"tS8dӶP?-~na!Y;}Z{ss8(]\d33>ş EO5i*bTOE`,J琱>G,Q2"K:墏_1cMLE{~q fV.R0sMch\Xĭ&bGc\0F.:碦U8m'rneR%e"c*SSBZD?׉~DN~"&~MkbΉ,9Tihg!Үq^S?zB>~Dq++Dxq5q.y0Ayy8/L$$ɺc tLs%==}AdcMZMH0<(` Sr.V@tV +/>Xz>JORvG+zP2G@9N*' W)4a~V!`X32~V)"~n/?R;N޺3o[O7@^v !oR׈o^הw^?Vu.X16|/yݑ=+FWKBxx;0&0/1|p$|p=DxB+(xEB# B/!D}E!I5!]CCT!3! C$+!υ!W!G6 wBcb JQv' =;)z.JJb LH<$o ׄE!|~#-oF[yCGa8:4?C`ǒC[byv:&8]ZVv?>)QuBPљ 2+ < ˏ@|`(p)y} E#π]P `}j4H`‘mȉ GuG6mNk8 ~ F8/@O%e"ׯp:;6}@#րm@4lW Jkw_E{:ہhJ S 9{ ҡW]CJ3{}puhiS+SrÏR&?Dy/'RvMH9LOzN_=h?>;i9Ԏ[PB4vkB.i@[մTAoo+`;I%z"w; {})D?s-I,mby8H׺rm$=*H]Y-#ywG Vn[w ,/XJ6nun.ۯ,㶉⺐Z:}>rboՓ=jra׺RDؖ6nDz;7>swKao cMb^mWƺ+V]KؖKnu?ݍ/pwdpڟO׀</&2OGhuh Ǚ1NSq /zŏ h;üojU@*S ڙX@fb D?P QoBBBc ` PFX>7)(z|z hCG|@>agJyW'框'ny*~ HZ0Ӌ.qӜ8~ڨ<8:^Tm3*Kw߁rĝ$vhZn )))fYS}>yC884Tfcalt4]?dB/@7#3Ѝ`zV00Ch og@M.fO9] guځj 86l@#_ؽtTQ4k ?+WgR\4JKfeu)OI}8%-.p9]tbCpLkL|2]J7ch&Z[fn[,ԭ1cfXϢ4̞Oܘ">EF0aXJ 7еcz;7E>޲"t;ܑro;KZ?ۀEbb#0ef|=.)7"zE4>$.Q0̣Ye#%GX-(/nC-Oұ< x)k{C^`Y<ԭX1ru< Cy1sQ 1@S%~< \ZD"ׯL5xi,7_w(n{&ddXD5"dܬS.Br4t0"BÎ(F-:T.@_ OrH/w4f-;W/G1wWo1^wGWs?h>ʱ9 &G{VێѨ_.Z=%;'oo齿.0D">3K8DHtCtVtdHiKH-Cp^!78JiH9'p!^ܽVݠׂ̫WY z:n Į ]T ŽJaEAl\+Ԋ `SllX+ COpld3{Q|vDvdvLO?nUhPgm B#еXt{(4- eulQhs6?]`W5`Wr FvuXOv] 8l4[69l-'gv_pX5{/ܝ3@"E40}q~X9"z""ثjX3-9;7=I%Iz+\%= H8Z:97"~K?E7q{8>7g)pa#ɸ] , 12Rњi5*4 QfJ>(xr1jjI3_^< kP@9nVٮAS/I~kдNWst:[`5{^-s$>Y]GiŬ,brByI]'NvrC6BB[o|m7rG 1`4pFXXO,ʱ\ ͹w|ɟY0ΊƙBMm䋉& y>z%P` Jh@醃ZS-R~>gw:zwagǥn-%y~|_q$5kϿf뤢9`Ax: }~$ϏR6OתTvJF?oCcfv1C1ր/#nK8}&i틸k ~9uV-. 0Thsrs4*GePmJ8 ^?)t  OMT|Ol+-qQZF?8Sd*C~nFGPEļ {g?$qz/OˋI~&l~3>꺗~Q]i6 w[к^t9豗~p4+84 ;藳]_gN77m#c+737N&5_k-9|ork#VOًkɻٚIXC؛ɉ0L5ّݒܜ)`$M"}|Rd#uK+m$MzY$=~O=I[_܆%*5T%G27Pw& A] ڏqAdMdshWYx~'+D?1ߘ$%+h\'vT:ʙjJqδm~_ pKjגͨa}h(Z>KL1}"L  0Nb3)%;Qɔj@IJe.ӱؽ/ID$ӂi3~J %qz0Y6(ɩ0v@ǭv0+Qu@J).0DK؀U4^xaxaxaxm㵺Jג*1^hUbFWxVx UbDZVQ?J\u/LҋI/rƴ!v<.6(#HeԎWբ]O{բ7E?VSoLLL(YQr=%hǀ)(iPb#gU9QEF$Y 7w1 Mhv!#^_6U(]qHxܺ&׿ / ٜj,Rx^1^ןoݲ/n-MlwCqCXzb &p#rsiiǸ)i{Ҵ\iW,M&=Hz3I:8N:!tnL:+%%'w8"w*w6uW::kw#'Vg,5w+FF=XkԟԩTjpj"[nKTv~#[ڜZK.O#+ҚkҚZ%im4{vc#9ͅݚnKdw|ٲ45[Lg?gaǞN/eOKJagw'QtKa';ӛaEQ=vOFsvC#S;+Q،DvxFvpF; c*'M؇u,yjF44#E+m.d@t_tGҲtt]t^k0~~M/r~Xۚv?gM\6i_GtvI=]n~l'sTG-']/GV[ۣa(wR*]v֟z&:"7 #*vtsDmje#ZxpDMQ2oy;I@;i\ 87Î֯{L}{H{`FG/FQe5u@':T}ဪ~> Mr@姀O};+&h,CnI\P^` ,pAo]@.s^{ ZA*tea  t.Ɣ˗7i]P?>(.b/sAd.i\hK3j$u=)>*ji'׮*Ꟑ/QQVxQxQxUFiMSxn8E2 NCK4t< o5t|x}[x oԗ7s!"pz57Ahe<QF]x=[. h׵`U/syT$O|ni7l((v [&|&r]h92OWǸC׃E.h`=g ^RlG`''do:dn-ӝPȂ`d|)=nvs^g^]i;) ?g;&AHR$ \`E6jb[!T***unZ_`=οGg̝{L>'63ȑu6EZ,U|@yG <;ԅ `RjRz _Ѷ+u fHWru4U$m$_K6Ҧwsv䯿M>Uc.LCV-"QUIs<ެI V9N\e 6G*/ٗJ/Y]Vt+~}\/*-DRfB۪ }wVuUpO}hzڤ^ KP:P@e$Q4ѨTACVuZV<PAS-i\о.h\ 솿 $0 LyxgV|0p ×ແFܼcw,;K&8U'QVdu/p}c|.! 8Oµ[qUR? LbpқkP%zjݴltH/C&@'ҞRoM(EҧRv:ri;F=Ղ4\'Kǩ9;\I}PWq'{k#uy;A@MzW=a~^oH]Op[OW /RG}KVu-OX[ C)x֥ ly†v /<;S%0j}K` *y^p2C< {['Tt,Oة*O٭4׸}e\2Kc:1@_b(hAC 4ϨB^h 1qA+\Pxa|;l8)ހ'oko+x}|1ߍwIeheL,^9ֲl,([oBm[c\jM 4t-ۅ &,S nc+=h+o VHeI4!b" 5Oӥ&}l(a8 =g!eLW]qۍZO1ʥF.xxK3Uv^nq'w-`,s 74zB+'r~zo͞{6uSdaiYEq'2JTt>9 4+ ?Jz侕:g4H:LM~Uw &{dcׅGؕM*j&lR_Ÿki$bMOFEȸk=iYQߩ6y&jɠ^4*G^$rGk4ri~$kNӡ}գ[|ۢ*`c!.1uWÀwzXQ=Ong-=+__F9C?/66~,q"vGm@Ef>H1hy[@<{m":lfϿ%R:.|xdh!=fe ٲ B_<`g^=lrea0/矜}.6-؈掚n#wT| H]t,ld֟s{~Z5"QC=$"kWyjWR[JQjE+,3]f\.2?F3RDoy|R=wg#}ѥ4)|K6R`߲dc3+׾aSx]H:clԖ%6)z <ZPF~=χyzE.%J0N\gy$yRkc,ݡ[?Ϟۃ i2tyx-e.-uA;g^Ix~<7yx>oׇ|V/{ ,@MWpE pNXO*fh޳(qQ=Fs8JDq=o{12adȼy#F={02aP2adͼyO={80ad8-"x3޹"rsl<EVE3dׅN\&Ds&&𞖯L=;g+gaYUj6ϼgksxOq=VāFƁ|.b#F#F-+1' @UdUȗRi{c"3D-<9pp/8!VàC3Qs=Wa+=wz2_~)qW "E"s˕q;CHClxy|xϸ8v_0a󞴽q;lߒ+g<6ϼ?󞧚8fî^='{sy{yI${n0~G${0s%8=-qb1 i&šY'j2q&ĕI^3֘]p*$w a!xx'6Ѽx X_*2|H_ܽ"r|+"ުyi xO75=` =-ׂq~K;ϼ?k{yk^=5=a׃y{>0ipq+"yS-]qǽ{>=OI i aˉ9Y,db?K*Zfbe2gZxe8.DK(n O-J,)6fGD+<77`+Rfo4U4+M{gN4/*4gQ6DEKͩ(<Y hy iÉl(,qD-(&f!4i iivZ^Y8ToG,]HO[t:m-.K5=b4ײ}fـFZ֠!ϲXQ{2Ԝ1qKsM M>D|'@G@GWנkќ7xpjҊ GCh Ac1[ܹ14-n$+7"f[\3nq@rlk,-ѲUB--8K!޲[6qi& iGޣC eie??܈o*okG:_UcB>&gAޖwx--ʯ;ߖsԎs?ԎݵG1~x6>zC;j{ځ}ca1@MߒBĿ/>OKߥp{'PiX_#Wa8 O?g >4,e{}]e}#n=~ŸRo.n嗈y-m M-MMnO3.؇ kGf'y&y'z9C#%ru_KL"I+mD$#hLI,%Y()#gDE)_|fJJ}$o IKM:IvJHnʡvn`t|)CCe$RY*$=oeE"Ir^ec݅cތew/.2ɽӄ˙ !6)9IL%LޕI&|Iܧ 3IMk20;ﻒ,/$ 3IyՓ<эL!E0$G_E.-N"DnsL4T|"*,. _/"<. |6XїB|7>ε[ IVRpj+te%W3B$le!J^-hkD"]{'n9E!}cTGV[كp`a+9vh%mƉHz嗲{@ rh_^Nwgs`|ńd '̅Tυv us.\mp}O-:,"xW[H5n\ŋHv4="aDK,Ȧ? eBh7lXB׮dv UBl#,zHh|K9e߾~z#8/CcS+iБgֱV4;*(H8A%\/M"?Ahf"fOóȑυE62U0Img1nIm+[oDVh!`%R}d?0J y ¸ BtA |HonKKً9IY.o /&?IOF)RqtPHH U<#D! PxiKHW( 7Oo\aGKrrLޅC4Pbǒr3%ߧQ:IN?J.695i4s.&Ou Nt1Ntu:պ~4=~tZK*b|sY^1M^aX#(8&qI E\S׿g>4FEE8K&|B9ax/W oPHß_ߖ? $~\kx!|\x>I?A?ŞQ7!uz]ݗ.E.u\u6I|.t\Bu]G.tnrv͆/:+/:r%I7eu*.:G:+盺'tw?;_w_q_rGHz<\hl{&o\ Y_yH(]e/:GוBſ.٥ϒl?/$$If!vh#v:V l  t 065p yt;C$$If!vh#v:V l t065p yt;C$$If!vh#v:V l t065p yt;C$$If!vh#v:V l t065p yt;C$$If!vh#v:V l t065p yt;C$$If!vh#v:V l t065p yt;C1Table5SummaryInformation((DocumentSummaryInformation8 CompObjrYale New Haven HospitalNormalDaniel Wiznia7Microsoft Office Word@J6@ @ ^@[l  ՜.+,D՜.+,` hp  BYale New Haven Health  fAttending Surgeon: ____________________________ Other Surgeon/ Resident: ____________________________ Title  8@ _PID_HLINKSA *Emailto:Sdodge8@gmail.com>Hmailto:eurbinat@its.jnj.com   w666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH66666666666666666666666666666666666666666666666666666666666666666p62&6FVfv2(&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv&6FVfv8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@6666_HmH nH sH tH @`@ ltNormalCJ_HaJmH sH tH DA D Default Paragraph FontRi@R  Table Normal4 l4a (k (No List jj s Table Grid7:V0HH :| Balloon TextCJOJQJ^JaJ44 tHeader  !4 "4 tFooter  !B^@2B AE0 Normal (Web)dd[$\$6U`A6 ]K0 Hyperlink >*B*phcRv!QR ]K0Unresolved MentionB*ph`^\q PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|Uw{@՘tAm'`4T֠2j ۣhvWwA9 ZNU+Awvhv36V`^PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] @s\} @s\_} ^  p:} "#'. p u PQuw }  !$%&()*+,- 5Jw} XXs_:l,"$NuמSG"dc4^@(    <A ? ? C"`??z  C S"?? t  3 S"?? b  C Ԕ"?   S oS"?? b  C "? B S  ?  } (ht lt= tjiYt`  t`'t OLE_LINK1 ~ ~ jVjVkVkVkVkV* ~ - ~ ?*urn:schemas-microsoft-com:office:smarttags stockticker .37< \h   { ~ /4   { I O { ~ 33333333QQ  = = v v M V ` i s |    { ~ QQ  = = v v M V ` i s |            ~ H <2 }eC2 3-m,c^`OJPJQJ^Jo(r^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hH^`OJPJQJ^Jo(r^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH3-mH <}eChj        j~d        Gv}A!j$^L|n} i\2 f wO@UQyT?Z[!99j%&&Pkm?"pI#o$[,%)hO+-Z-5/]Y/h)2 3w7m8T/93^:v ;4=> W@;CAE<0FSHF,H]KKNS[U+VHVs['!^|>^{_Xa8bme. fmfDrt>t2u,w:|.<Z5)NbsgpaN]r ? >GACd9[gZ$zK-AL;6-#6Way[]Sbr?'lOA Dltx8F:&Fe]aWvbt O >  @   } @Unknown G.[x Times New Roman5Symbol3. .[x Arial;Wingdings7.*{$ Calibri5. .[`)TahomaC.,*{$ Calibri Light?= .Cx Courier NewA$BCambria Math"qht=jlqG&l l !24 3QHX ?2!xxx