ࡱ> ` bjbj 4I%       ttt8tuy2vv"vvvvvvԫ֫֫֫֫֫֫$h9 {vv{{  vv3՛՛՛{ v vԫ՛{ԫ՛՛h  vv @t &ԫI0y6_   v:w՛xyIvvvkjvvvy{{{{$iBmBm       TRI-COUNTY HEALTH CARE CONSORTIUM Policy: Approved Abbreviations for Use in Medical Records Policy Manual: Clinical Approved: ______________________________Date: _______________________ Revised: _______________________________Date: ________________________ Policy: To avoid misinterpretation, symbols and abbreviations are used in the medical record only when they have been approved by the Medical Staff (Providers) and when there is an explanatory legend available to those authorized to make entries in the medical record and to those who must interpret them. Guidelines: A copy of this policy will be maintained in each providers office, all patient care/nursing areas and each medical records file room. Any proposed additions or deletions to the list will be directed to the medical director, to be taken to the providers for consideration. OTCS APPROVED SYMBOLS AND ABBREVIATIONS LISTING SYMBOLS: # Number ? question % percent & and % Degree + positive +/- positive or negative < less than greater than @ at ! Decreased ! Increased or elevated @& Female B& Male negative ABBREVIATIONS -A- A.A. Alcoholics Anonymous AAA Abdominal Aortic Aneurysm ab abortion abd abdomen Abd Hyst abdominal hysterectomy ABG arterial blood gases ABI ankle brachial indices abn abnormal Abx antibiotics AC acromioclavicular a.c. before meals Acid Phos acid phosphatase ACL anterior cruciate ligament ACLS advanced cardiac life support ACOS American College of Surgeons ACTH adrenocorticotrophic hormone A.D.A. American Disability Act ADA American Diabetic Association ADDM adult onset diabetes mellitus ad lib as desired ADL activities of daily living adm admission adj adjustment AFB acid fast bacillus AHA American Heart Association AICD Automatic Implantable Cardioverter Defibrillator AK above knee AKA above knee amputation Alk phos Alkaline Phosphatase a.m. before noon A.M.A. American Medical Association AMA against medical advice amb ambulatory AMD Advanced Medical Directive AMI acute myocardial infarction amp ampule Amt amount ANA Antinuclear antibody ant anterior ante before or pre AP anteroposterior AP & lat Anterior, posterior and Lateral AP repair Anterior & Posterior repair approx approximate appt. appointment ARDS Acute Respiratory Distress Syndrome ARF acute renal failure A.S. left ear ASA aspirin ASAP as soon as possible As tol. As tolerated ASCVD arteriosclerotic cardiovascular disease ASD atrial septal defect ASHD arteriosclerotic heart disease Aso titer anti-streptolysis titre Asst assistance Atm atmosphere of pressure A.U. both ears AV aortic valve AVF arteriovenous fistula aVF augmented unipolar ECG leads aVL augmented unipolar ECG leads aVR augmented unipolar ECG leads AVR Aortic Valve Repair/Replacement -B- BBB bundle branch block BCC basal cell carcinoma b.i.d. twice daily Bilat bilaterally Bili bilirubin BIPAP Bi-Level Positive Airway pressure BK below the knee BKA below knee amputation Bld blood BM bowel movement BMI Basal Metabolic index BMR basal metabolic rate BMT bilateral myringotomy tubes BP blood pressure BPH benign prostatic hypertrophy BRP bathroom privileges BS blood sugar BSA Body surface area BSO bilateral salpingo-oophoectomy BTL bilateral tubal ligation BUN blood urea nitrogen Bx biopsy -C- c with C1, C2 first cervical vertebra; second cervical vertebra, etc. C&S culture and sensitivity Ca calcium CA carcinoma CABG coronary artery bypass graft CAD coronary artery disease Cal calorie Cap capsule CAT Scan computerized axial tomography scan Cath catheter (ize) CBC complete blood count CC chief comlaint CCA Common Carotid Artery CCU coronary care unit CDC Centers for Disease Control chemo chemotherapy CHF congestive heart failure Circ circumcision Cl chloride cm centimeter CMN Childrens Miracle Network CNS central nervous system c/o complains of CO2 carbon dioxide Coag coagulation COLO Colonoscopy COPD chronic obstructive pulmonary disease CP Cerebral Palsy CPAP continuous positive airway pressure CPD cephalopelvic disproportion CPK creatine phosokinase CPR cardiopulmonary resuscitation CQI Continuous Quality Improvement CRF chronic renal failure C-section Cesarean section CSF cerebrospinal fluid CT chest tube ct count CT scan computerized axial tomography scan CTA clear to auscultation cult culture CV cardiovascular CVA cerebrovascular accident CVD cardiovascular disease CVP central venous pressure Cx cervix CXR chest xray cysto cystoscopy -D- /d per day d day, 24 hours D & C dilatation and curettage D & E dilation and evacuation D-5-S dextrose (5%) in saline D-5-W dextrose (5%) in water D1, D2 , 1st dorsal (thoracic) vertebrae,, 2nd dorsal (thoracic vertebrae) dB decibel DDS Doctor of Dental Surgery Demo demostrate dept department DES diethylstilbestrol DFS Division of Family Services (MO) DIC disseminated intravasular coagulation diff differential blood count Dig digoxin DIP distal interphalangeal (joint) DJD degeneraative joint disease DKA Diabetic Ketoacidosis D/L/R dextrose/lactated/ringers DM diabetes mellitus DME durable medical equipment DNR do not resuscitate DO Doctor of Osteopathy DOA dead on arrival DOB date of birth DP Dorsalis Pedis DPT diphtheria, pertusis, tetanus dsg dressing DT delirium tremens DTR deep tendon reflex DVT deep vein thrombosis D/W dextrose in water Dx diagnosis -E- EBL estimated blood loss ECCE extracapsular cataract extraction ECG electrocardiogram E.coli Escherichia coli ECT electroconvulsive therapy (electroshock) Ed Education ED Emergency Department EDC expected date of confinement EEA end-to-end anastomosis EEG electroencephalograph EENT ear, eye, nose and throat EFM external fetal monitor e.g. for example EGD esophagogastroduodenoscopy EKG electrocardiogram emerg emergency EMG electromyogram EMS emergency medical services ENT ears, nose and throat EOM extraocular movement Eosin eosinophils ER emergency room ERCP endoscopic retrograde cholangiopancreatogram ESR erythrocyte sedimentation rate ESRD end stage renal disease Est. estimated E-stim electrical stimulation ESWL extracorporeal sound wave lithotripsy et and ET-Tube endotracheal tube ETOH alcohol EUA examination under anesthesia eval evaluate: evaluation exam examination; examined exc excision Exp. Lap exploratory laparotomy -F- 5-FU 5-Flourouracil F female FACP Fellow of the American College of Physicians FACS Fellow of the American College of Surgeons FB foreign body FBS fasting blood sugar FDA Food and Drug Administration Fe iron FESS functional endoscopic sinus surgery FEV1 Forced expiration volume in one second FFP fresh frozen plasma FH family history FHR fetal heart rate FHT fetal heart tone fib fibrillation fl fluid fl. oz. fluid ounce Flex flexion flu influenza fluoro fluoroscopy FM fetal monitor FOB foot of the bed FOV field of vision F.P. family physician fract. fracture frag. fragment freq. frequent FS frozen section FSH follicle-stimulating hormone FT feeding tube ft. foot; feet FTSG full thickness skin graft F/U follow-up func functional FUO fever of unknown origin Fx fracture -G- G gravida G-tube gastrostomy tube gal gallon GB gallbladder GC gonococcus; gonorrhea Gen general GERD gastroesophageal reflux disease GGT gamma glutamic trasaminase GI gastrointestinal Glu. glucose gm. gram gr. Grain grav gravid (pregnant) GSW gunshot wound GTT glucose tolerance test gtt. drops GU genitourinary GYN gynecology -H- h hour H20 water H202 hydrogen peroxide HC03 bicarbonate H & H hemoglobin and hematocrit H & P history and physical H/A headache HCG human chorionic gonadotropin HCT hematocrit HD hemodialysis HDL high density lipoprotein HEENT head, eyes, ears, nose, and throat HF heart failure Hg mercury Hgb hemoglobin H/H hemoglobin and hematocrit HHS Department of Health and Human Services HIV human immuno virus HNP herniated nucleus pulposus HOB head of bed HOH hard of hearing hosp. hospital HPI history of present illness HR heart rate hr. hour h.s. at bedtime ht. height HTN hypertension HVD hypertensive vascular disease Hx history hyper above or high hypo hypodermic injection; low hyst hysterectomy Hz hertz -I- I & D incision and drainage I & O intake and output I131 radioactive iodine IABP intra-aortic balloon pump IBS irritable bowel syndrome ICP intracranial pressure ICU intensive care unit ID identification IDDM insulin dependent diabetes mellitus i.e. that is to say Ig immunoglobulin IM intramuscular IMP: impression in. inch in situ confined to the site of origin in utero within the uterus info. Information Ing inguinal inj. Injury INR International Normalized Ratio Ins. insurance int internal IO intraocular IOL intraocular lens IOP intraocular pressure IP intraperitoneal IPPB intermittent positive pressure breathing IQ intelligence quotient ITP idiopathic thrombocytopenic purpura IUD intrauterine device IUP intrauterine pregnancy IUPC intrauterine pressure catheter IV intravenous (ly) IVP intravenous pyelogram IVPB intravenous piggy back -J- -K- k 1000 K potassium KCL potassium chloride kg. kilogram KUB kidney, ureter, and bladder -L- l liter L1, L2, etc first lumbar vertebra, second lumbar vertebra, etc. lab laboratory LAD left anterior descending LAO left anterior oblique lat lateral LAVH laparoscopic assisted vaginal hysterectomy lb. pound LBBB left bundle branch block LDH lactate dehydrogenase LDL low density lipoprotein LE lower extremity lg large LH luteinizing hormone Li lithium lig. Ligament liq. Liquid LLL left lower lobe/lung LLQ left lower quadrant LMP last menstrual period LOA leave of absence LOC local L.O.C. loss of consciousness LOS length of stay LP lumbar puncture LPN licensed practical nurse L-S lumbo-sacral LSH lutein stimulating hormone Lt. or l left ltd limited LTL laparoscopic tubal ligation LUQ left upper quadrant LV left ventricle LVH left ventricular hypertrophy lmphs lymphocytes lytes electrolytes -M- M male m. meter MAR medication administration record MAST trousers military antishock trousers max maximum mcg micrograms MCHC mean corpuscular hemoglobin concentration MCV mean corpuscular volume MD medical doctor Menomet menometrorrhagia mets metastases mEq milliequivalents Mg magnesium mg milligram MgS04 magnesium sulfate mgmt management MI myocardial infarction micro microscopic min minute ML midline ml milliliter MMK Marshall-Marchetti Krantz MMPI Minnesota Multiphasic Personality Inventory mod moderate MOM milk of magnesia mono monocytes MP metacarpo-phalangeal (hand) mph miles per hour MRI magnetic resonance imaging MRSA methacillin resistant staphylococcus aureus MS multiple sclerosis M.S. Master of Science MVA motor vehicle accident MVP mitral valve prolapse MVR Mitral Valve Replacement/Repair -N- N20 nitrous oxide N & V nausea and vomiting N.A. Narcotics Anonymous N/A not applicable Na sodium NaC1 sodium chloride NB newborn NBN newborn nursery neg negative Neuro neurology NG nasogastric NH nursing home Nitro nitroglycerin NKA no known allergies NKDA no known drug allergies NO nitrous oxide noct night norm normal NOS not otherwise specified NPH neutral protamine Hagedorn (Insulin) NPO nothing by mouth N/S normal saline NSAIDS nonsteroid anti-inflammatory drugs NSR normal sinus rhythm NST nonstress test NSY nursery N/V nausea/vomiting N/V/D nausea, vomiting and diarrhea NWB non-weight bearing -O- O orally 02 oxygen OB obstetrics OB-Gy n obstetrics-gynecology obs observe; observation occ occasional OCG oral cholecystogram O.D. right eye OD overdose oint ointment OM otitis media OMT osteopathic manipulative therapy OOB out of bed O/P outpatient OPC outpatient clinic OPD outpatient department O & P ova and parasites OR operating room ORIF open reduction with internal fixation Ortho Orthopedics os mouth OS left eye OSA Obstructive Sleep Apnea OSHA Occupational Safety & Health Administration OT occupational therapy (ist) OU both eyes oz ounce -P- p after P Para P.A. physician assistant PA posterior anterior PAC premature atrial contraction Pap smear papanicolaou smear PAR post anesthesia recovery Para parous, parity PAT paroxysmal atrial tachycardia Path pathology PBI protein bound iodine p.c. after meals PC02 partial pressure carbon dioxide PCP Primary Care Physician PD peritoneal dialysis PDA patent ductus arteriosis P. E. pulmonary embolus PE physical examination PEDS pediatrics PEEP postive end-expiratory pressure PEG Percutaneous Endoscopic Gastrostomy PERLA pupils equal, react to light PFT pulmonary function test pg pregnant pH hydrogen ion concentration PH past history PI present illness PID pelvic inflammatory disease PIT pitocin PKU phenylketonuria Plat. Platelets p.m. afternoon or evening PMH past medical history PMI point of maximal impulse PM&R physical medicine and rehabilitation PMS premenstrual syndrome po by mouth, orally PO2 partial pressure oxygen PO4 phosphate polys polymorphonuclear leukocytes pos positive post-op post-operative post posterior pre-op preoperative preg pregnancy prep preparation prev. previous PRN when needed procto proctoscope protime prothrombin time PSA Prostatic Specific Antigen psych psychiatric; psychology PT physical therapy pt. patient PTCA percutaneous transluminal coronary angioplasty PTH parathyroid hormone PTT partial thromboplastin time PUD peptic ulcer disease pulm pulmonary PVC premature ventricular contractions PVD peripheral vascular disease PX physical examination -Q- q every QA quality assurance q.am every morning q2h every two hours q.h. every hour qhs at bedtime qid four times daily QM quality management QNS quantity not sufficient q4h every 4 hours QRS segment of electrocardiograph qs quantity sufficient qt. quart quad quadraplegia; quadraplegic -R- Resp. respirations RA rheumatoid arthritis RAO right anterior oblique RBBB right bundle branch block RBC red blood count RCA right coronary artery RD registered dietitian RDS respiratory distress syndrome rec recommend; recommendation Re-eval reeavaluation reg regular Rehab rehabilitation REM rapid eye movement resp respiration Retic.Count reticulocyte count RF rheumatoid factor Rh rhesus (with reference to blood factors) R/L ringers lactate RLE right lower extremity RLL right lower lobe RLQ right lower quadrant R/O rule out RM room RML right mediolateral RN registered nurse ROM range of movement rpm revolutions per minute RRR regular rate and rhythm RSR regular sinus rhythm RT rspiratory therapy Rt. or right RTC return to clinic RTN return RTO return to office RUE right uper extremity RUL right upper lobe RUQ right upper quadrant Rx prescription Rxn Reaction -S- s without S04 sulfate S-A sino-atrial S & O salpingo-oopherectomy Sa02 oxygen saturation sats saturation SBO small bowel obstruction sed sedimentation sedrate erythrocyte sedimentation rate segs segmented neutrophils (polymorphonuclear leucocytes) SGOT serum glutamic oxaloacetic acid transaminase SGPT serum glutamic pyruvic transaminase SIADH syndrome of inappropriate antidiuretic hormone Sibs siblings sl sublingual SLE systemic lupus erythematous sm small SNF skilled nursing facility SNU skilled nursing unit SOAP subjective; objective; assessment; plan SOB shortness of breath soc hx social history Sol. Solution SOP standard operating procedure S/P status post Sp.gr. specific gravity Spont. Spontaneous SR sinus rhythm S/S signs and symptoms STD sexually transmitted disease Staph staphylococcus Stat at once, immediately STO short-term observation Strep streptococcus STSG split thickness skin graft Subq. Subcutaneous Surg surgical; surgery SVC superior vena cava Sx symptoms -T- T temperature T & A tonsil(ectomy) and adenoid (ectomy) T & C type and crossmatch T & S type and screen T3 triiodothronine T4 thyroxine Tab tablet TAH total abdominal hysterectomy TB tuberculosis tbsp tablespoon TEE transesophageal echocardiogram temp. temperature TENS transcutaneous electrical nerve stimulation TIA transient ischemic atttack TIBC total iron binding capacity t.i.d. three times daily TLC total lung capacity TM tympanic membrane TNTC too numerous to count TO Telephone order tol tolerated TPN total parenteral nutrition TPR temperature, pulse and respiration trach. Tracheostomy TSH thyroid stimulating hormone tsp. teaspoon TURP transurethral resection of prostate TV tidal volume TVH total vaginal hysterectomy tx treatment -U- UA urinalysis UCG urine chorionic gonadropin (pregnancy test) UC&S urine culture and sensitivity UE upper extremity UGI upper gastrointestinal unilat unilateral URI upper respiratory infection Urol urology UTI urinary tract infection UV ultra-violet -V- V volume vag. vaginal Vanco Vancomycin VBAC vaginal birth after cesarean section VC vena cava VD veneral disease VDRL veneral disease research laboratory (syphillis serology test) vent ventilator V-fib ventricular fibrillation via by way of vit. Vitamin VLDL very low density lipoprotein VO verbal order voc vocational vol. volume VRE Vancomycin Resistant Enterococcus VS vital signs vs. versus VSD ventricular septal defect V-tach ventricular tachycardia VTX vertex -W- w/ with WB whole blood WBC white blood cell (count) w/c wheelchair W/F white female WIC Women, Infants, Children Nutrition Program W/M white male WNL within normal limits W/O without wt. weight !"     : B L N  !;<STXYghxy%+,QRop h#:wh^1hfhh-h-h8=5hW]h8=hT RhHTh<R"#bc{|   > ? K L ] ^ _ ^gd< & Fgd<gd<$a$gd<Ӵ  * ^ x    4 6 B D | 6gd8= & Fgd8=^gd8= & Fgd8=gd<6Sbt%Ij!Bz+Lngd8=&'HI~ 01QRnost-.3456BCIJ\] ;<ef78Z[}hhfh#:w`n{-BV5[~2U{gd8={|/LXl'?dgd8=} 56QR\]qr,-DEij*+;<^_|}  &'?@chl'hT RhT RhT R5 h5hfhh-h5V&5Yw!:\q':Mzgd8=cdvw-.@AST~ DEef|};<XYtu/0NOQRSh-hXy5hXyhl'hf]?[w6Sq} )Hgd8=SUuw>?kl45TUhilmn'(BCYZdeilmnrsh-h-5 hXy5h-hXy5h.?hfhXyhXyhXyH*TH9e/Oh "=Ugd8= 0^`0gdfUdfghmn " < _ | !"!4!I!j!!!!!!gd8=  % & @ A c d !!(!)!8!9!M!N!n!o!!!!!!!!!""'"("F"G"Y"Z"w"x"""""""""""##3#4#a#e#k#l#~########$$$$?$@$K$L$v$w$$$$$$$$$$h-hw*5h.?hw*hfhXy\!""A"R"r""""""#/#>#_#`#e#f#|#####$<$F$q$$$$$gd8=$$%%/%>%N%c%v%%%%%%%&%&7&H&i&y&&&&&&&&&&gd8=$%%%!%"%4%5%B%C%D%M%N%S%T%U%V%f%g%z%{%%%%%%%%%%%%%&&(&)&7&8&9&:&;&<&M&N&m&n&~&&&&&&&&&&&&&&&&&&''#'$'2'3'X'Y'x'y'''''''''''''(( ( (( (h-hta5h.?htahw*hf\&'','S't''''''''((+(-(2(3(<(H(a(t(((((()')gd8= (+(,(.(2(5(6(@(A(M(N(f(g(z({(((((((((((( ) )T)U)g)h)u)v)))))))))** *!*8*9*G*H*g*h*x*y***************++0+1+8+9+>+B+H+I+g+h++++++++++h-h%5h%h-hta5hfhtaX')Q)d)q))))) **2*C*d*t********+-+8+:+<+=+B+C+a+gd8=a+{+++++ ,,J,`,t,,,,,,---C-T-c-t-----.0.J.gd8=++++,,$,%,O,P,c,d,w,x,,,,,,,,,,,,,,,,,----#-$-I-J-Y-Z-c-g-h-y-z--------- . .5.6.O.P.m.n................./// /.///L/M/O/S/V/W/e/f/h-h:;5h:;h.?hfh%hT RZJ.g...........//*/L/N/S/T/^//////,080X0t00gd8=f/i/k/////////001020>0?0]0^0y0z000000000000000110111L1M1c1d1m1n1q1r1~1111111111122222&2'2/24252P2Q2V2W2o2p2}2~22222222222222h-h3!5h3!h7hT Rh.?hoh:;X00000001+1G1^1j1111112!2/2Q2k222222222gd8=2222<3=3K3L3\3]333333333334444"4#4;4<4K4L4i4j4{4|444444444444555 5.5/5P5Q5e5f5555555555566#6$6D6E6G6K6P6Q6f6g666666666666666777h-h3!5h.?h3!ho]22383F3W3333333 4454G4b4v44444455*5K5`555gd8=55566D6F6K6L6`6|666666677$767L7e77777778gd8=77'7(7<7=7P7Q7j7k7777777777777777777888,8-8U8V8o8p888888888888888889999996979Q9R9b9c9}9~9999999999999::::<:=:S:T:i:j:::::h-h"5h"hh3!ho\8&8Q8k88888888889919L9]9w9999999::5:O:gd"gd8=O:c::::::;.;=;H;J;O;P;Z;c;~;;;;; <0<A<\<o<<<<<gd":::::::;;2;3;A;B;H;I;K;O;R;S;\;];h;i;j;};~;;;;;;;;;;;<<6<7<F<G<b<c<u<v<<<<<<<<< = ="=#=%=&=7=8=]=^===========> >>>@>A>N>O>f>g>w>x>>>>>>h8fhh9,h-h"5hoh"Z<==1=X======>>;>I>_>q>>>>>?%?C?S?x??????gd">>>>??*?+?H?I?Z?[?}?~????????????????@@@)@*@@@A@d@e@@@@@@@@@@@AA4A5ADAEAmAnAAAAAAAAAAAAAAAAAAABBB B5B6BNBOBlBmBBBBBBBBBBh_h-h8f5hh8fho\??? @"@<@]@}@@@@@A.A?AhAAAAAAAAAA BB2BJBhBgd"hB|BBBBBBBBCC;C\CrCCCCCDD(DADTDtDDDDDEEgd"BBBBBBBBBBCC"C#C@CAC`CaCvCwCCCCCCCCCCCCD DDD-D.DGDHD`DaDxDyDDDDDDDDDEEEE"E#E0E1E;EFNFh/)h7h9,hh-h_5hoh_XE,E6EOEeE}EEEEEEF!F8FSFjFFFFFFFFFFFG#GAGUGgd"NFRFXFYFdFeFoFpFFFFFFFFFFFFFFFFFFFFFGG'G(GEGFG]G^GxG}GGGGGGGGGGGGGHHTHUHbHcHsHtHHHHHHHHH I I&I'I?KL]^_7@GPQ_`fg'9Pd/Sw?Ok3@Mhw  F ` p ~ C U r  @ A F G a |   1 M h  ) H b n p u v  <JX!6Uiw?S~ <Vfq6BSfhmn{ n{*JX}-G]q)+,-23Nw$A]~/Kfz7dm$%*+AL 6d~(;Qg .>Pn|~9O^iu &9[x ) 6 G g !)!9!D!V!c!v!!!!!!!!""""&"@"Z"{"""""#%#9#L#^#i######$$($9$P$k$$$$$%,%R%h%%%%%%%%%%%%&&&&#&e&v&&&&&&'9'W'l'w''''''' (#(/(Y(n((((((()0)D)g){))))))))) **M*k******** +'+;+H+U+e++++++,%,F,y,,,,, - ---%-A-\-q-}--------.*.I.\.i.w...../0/E/S/i//////////0"0<0M0[0k0}0000001(1U1i1t111112 22222(2C2[2~222223!343[3x3333334G4k44444455$565R5m5555566=6L6d6u66666667"7B7X7f777778-8O8i8k8p8q8{88888889-9A9e9~99999999:!:7:S:m::::::;;9;P;~;;;;;;;<*<B<_<}<<<<<<<=/=J=\=k=m=r=s=======>>C>>>>?$?4?V?a?????? @/@A@[@p@@@@@@A$AFA[AtAAAAAAAAAB(B7BDBgByBBBBBC;CVCpCCCCCCD*DLD\DDDDDDDDDE8EMEjE~EEEEEEEEEFFAFPFeFFFFFF G2GCGQGyGGGGGGGGGG H(H9HLH}HHHHHHHHHH I,IMIOITIUI_IoIyI{IIIIIIIIIIIIIIIIIIIIIIIIIIII0000000000000000 00 000000000000000 000000 00000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000000h00y00h00y00h00y00h00y00@0h00h00@0@0y00(\=k=m=r=s=======>>C>>>>?$?4?V?a?????? @/@A@[@p@@@@@@A$AFA[AtAAAAAAAAAB(B7BDBgByBBBBIj00$h00h0008h00h00h00h00j00h00h00h00h00j00h00j00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00h00j000 $$$'}cS$ (+f/27:>BNFJNQ).1358;=@BDGJLOQSVX 6n{HU!$&')a+J.0258O:<?hBEUGJeMOִ*,-/024679:<>?ACEFHIKMNPRTUW[\+  '!!TU,V4WX =YCZ ԓ["\l]<^_ `aԡb;c Ldde tf"g"h$i//<<aaj0)0)++/k0#22I     22??iqq2)2)++/m0'22I   =*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceTypei*urn:schemas-microsoft-com:office:smarttagsState0http://www.5iamas-microsoft-com:office:smarttagsh*urn:schemas-microsoft-com:office:smarttagsCity0http://www.5iamas-microsoft-com:office:smarttagsV*urn:schemas-microsoft-com:office:smarttagsplacehttp://www.5iantlavalamp.com/  '*>OPSimt$0knos~9?   # 0 < = B U X   |   x  ( 9 > ? G b d ik68NRSX[ePWetv~Ub5@ Q\nyv#'>Bnp$,-8ORuyPZ6 9 \ f D!G!!!!!%#'#######$$p$$$$d%f%z%%%&+'8'l'n'|''''''(((() ) ))g)l){))))**********t+}+~+++++++,M,X,r,x,,,,,,,------\.`.......6/?/////00-0;0[0_0p0v0i1k111k2q2222222333334#4/404:4;4F45 55#55566 61666666666666677m7y7z77777788888888e9g9999999::::::; ;;$;&;2;P;R;<<<< = =\=_=======> >>!>C>G>T>_>a>r>>>>>>>>>>>>>> ?$?&?I?U?V?X???A@F@[@`@@@FAJA[A_AAAAAAAAAB'B-B6BBBBBCC;C@CCCCCDDD)DDDDDDEjEpEEEEEFF FFUF\FlFsFFFFFWGaGlGxGGGGGIIIIIIIIIIIIIIIIII}gkPTW]wy36hkw{   ` d g k r v y } | v w  \`!&fhxSX{|68np*.  dfgknt>BnpOSV]^`dhikuy !9!;!?!C!D!H!K!M!V!X!\!b!!!!!!!####^#`#d#h#i#k#######$ $$$$$%%%%%%&&e&h&&&&&&&l'n'''''/(5(C(G(((g)l){)))))* **********'+,+;+>+U+W+++++,,,,A-E---\.`.i.m.////00<0@0C0H0[0_0i1k1112222(2,2/282!3%3(3-3334465:5=5F55566=6@6L6S6d6h6u6{6666666666666"7'7X7Z7^7e777u8z8888888888888-909j9r9~9999999999::::; ;B<E<s=t===> >>!>C>G>>>??$?&?V?X???A@G@J@R@[@a@FAKAAAyB}BBBBB;CACDCICCCDDLDODSD[DDDjEpEEEEFFFFFFF2G5GCGGGJGPGGGGGGG(H+HHHHHUIWI_IbIoIqIIIIIIIIIIIIIIIIIII33333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333333Lgn'Pdw3@h ` p r  | v X!6fSi{ {*Jdm(g >PnOou !9!V!c!!!!#%#^####$($%%%%&#&e&v&&&&&l'w'''''/(Y(((g)))))****** +'+H+U+e+++++,%,,,A-H---\.w.///"0<0M0[0k0i1t1112222(2C2!343334465R55566667"7B7X7f778q8{8888-9A9e9999::::;;B<_<s====>>?4?V?a???A@d@FANAAAyBBBB;CVCCCDDLD\DDDjE~EEFFFFF2GQGGGGG(H9HHHUIoI|IIIIIIIIIIIIIIIIII>>IIIIIIIIIIIIIII"DXm9\RP;a(EA6-KH]Dw@QN_PWGGG^G`o(.) ^`hH.  L ^ `LhH.   ^ `hH. xx^x`hH. HLH^H`LhH. ^`hH. ^`hH. L^`LhH.`^``OJPJQJ^Jo(^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hH0^`0OJPJQJ^Jo(^`OJQJ^Jo(hHo  ^ `OJQJo(hH  ^ `OJQJo(hHxx^x`OJQJ^Jo(hHoHH^H`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH0^`0OJPJQJ^Jo(-^`OJQJ^Jo(hHo  ^ `OJQJo(hH  ^ `OJQJo(hHxx^x`OJQJ^Jo(hHoHH^H`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH`^``OJPJQJ^Jo(^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hH"Da(E-KH]N_\H        T=\        L?x        % >%!$ 4dsIsI2QHX ?<2!TRI-COUNTY HEALTH CARE CONSORTIUMdbuynar Don McBride      Oh+'0 $0 P \ h t$TRI-COUNTY HEALTH CARE CONSORTIUMdbuynarNormal Don McBride2Microsoft Office Word@@jFYX@n@n >՜.+,0$ hp   Ozark Tri-County Health Care%sI "TRI-COUNTY HEALTH CARE CONSORTIUM Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]_`abcdeghijklmnopqrstuvwxyz{|}~Root Entry F/Data ^1TablefðWordDocument4SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89qRoot Entry Fc!Ȣ@Data ^1TablefðWordDocument4, SummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q՜.+,D՜.+,h$ hp   Ozark Tri-County Health Care%sI "TRI-COUNTY HEALTH CARE CONSORTIUM Title4 $