ࡱ>   ~bjbj2U2U P?_P?_LvB -----AAA8y=LA86*!!!!!###5555555$b9<5-###"##5--!!5[.[.[.#-!-!5[.#5[.[.:3,4yv'$3 560863R<)t<448<-G4\##[.#####55+h###86####<######### :  TEMPLATE FOR STANDARDIZED/SIMULATED PATIENT SCRIPT (Adult Patient) The following pages outline information needed to fully develop a SP script using the script format. If you are writing a new script: please fill in ALL historical information. If a physical examination is included please specify the portions of the physical examination that you anticipate the examinee will perform. If you are reformatting an existing script: please attach the script and complete the areas of the template where the requested information is NOT present in the existing script. Please explain any medical terminology, abbreviations and include pictures, diagrams or other information that will best help a lay person without medical training understand this content. While we recognize that a detailed description of the patient scenario is being requested, it is important to have this information to insure standardization of patients and accurate, reproducible portrayals. If you have any questions regarding a script please contact: Jamie Pitt Assistant Director of Education for Standardized/Simulated Patients Center for Healthcare Improvement and Patient Simulation (CHIPS) The University of Tennessee Health Science Center 26 S Dunlap Street Memphis, TN 38163 jpitt6@uthsc.edu This format was developed by: Karen Szauter, MD Medical Director, Standardized Patient Program at UTMB SP Case Template Section 1 Author information and General Case Information Date of case development: ______ / ______ / ________ mm dd yr Primary Case Author: (contact phone number or email address) Secondary / contributing authors: Course, exercise or examination for which case is being developed: Patient Presentation Patient name:  Presenting complaint:  Actual diagnosis / feasible diagnoses:  Case Challenges: (check all that apply) [ ] medical interview [ ] physical examination [ ] patient counseling [ ] difficult encounter / challenging patient Will a case content checklist be developed for this encounter? [ ] yes [ ] no To which level of learner is this case directed? Healthcare discipline: ____________________________________ Student [ ] year 1 [ ] year 2 [ ] year 3 [ ] year 4 Resident [ ] PGY 1 [ ] upper level [ ] fellow [ ] Practicing physician/provider Case Objectives List the specific case content and interpersonal skills assessed through this case. 1. 2. 3. 4.  Section 2 Patient Demographics and Description Gender: [ ] male [ ] female Age: Actual patient age: ____________ Acceptable age range for this portrayal: [ ] 15-20 [ ] 21-30 [ ] 41-50 [ ] 61-70 [ ] 16-20 [ ] 31-40 [ ] 51-60 [ ] 71-80 Race / Ethnicity: [ ] Any can be used [ ] African-American [ ] Caucasian [ ] Hispanic [ ] Asian [ ] other _______________ Physical Description Height: [ ] any height [ ] short stature [ ] tall Proportional Weight: [ ] any weight [ ] average [ ] mildly obese [ ] thin [ ] overweight Give BMI range if indicated ___________ Physical Limitations Scars: list any actual scars that would be incompatible with the case portrayal. Neck: Abdomen: Extremity [ ] tracheostomy [ ] upper midline [ ] arm [ ] thyroidectomy [ ] lower midline [ ] leg [ ] carotid [ ] appendectomy [ ] joint __________ Chest [ ] gallbladder [ ] sternotomy / cardiac surgery [ ] pacemaker [ ] Other: _______________________________ Physical limitations: Body Piercing: [ ] no piercing [ ] ears only [ ] any piercing okay [ ] okay except for: Tattoos [ ] no tattoos [ ] any tattoos okay [ ] okay except for specified areas: Descriptors for Case Portrayal Appearance Hygiene: [ ] clean [ ] poor hygiene / appears unclean Hair: [ ] neatly styled [ ] clean / combed but not styled [ ] unkempt: no attention to combing Clothes: [ ] hospital gown [ ] casual [ ] professional Clothes: [ ] clean/good repair [ ] clean but worn [ ] tattered/unclean Clothes: [ ] appropriate fit [ ] tight fit [ ] loosely fitting Jewelry: wedding band [ ] yes [ ] no [ ] other?  Make up: [ ] none [ ] limited/ lipstick only [ ] full make-up Case Specifics: Please list any specific features the patient must have. Bruises and certain physical findings can be created with stage make-up if needed (INCLUDE A PHOTO):  Patient Behavior Affect: (check all that apply) [ ] relaxed [ ] cooperative [ ] pleasant [ ] confident [ ] uncooperative [ ] hostile [ ] demanding [ ] preoccupied [ ] anxious [ ] fearful [ ] apprehensive [ ] sad [ ] listless [ ] sad [ ] withdrawn  Body Language: [ ] relaxed [ ] withdrawn [ ] defensive [ ] uncomfortable [ ] anxious [ ] fearful [ ] nervous [ ] other Facial Expression [ ] relaxed [ ] tense [ ] worried [ ] irritated [ ] other  Eye contact: [ ] normal eye contact [ ] looks away frequently [ ] no eye contact Patient CommunicationVoice Level: [ ] normal [ ] soft spoken [ ] loud/ boisterousVoice tone: [ ] normal [ ] hostile / angry [ ] sad/depressed [ ] uneasyVoice clarity: [ ] clear / easy to understand [ ] garbledGrammar: [ ] correct word choices [ ] slang / grammar incorrectResponsiveness: [ ] responds to open ended/direct questions with information [ ] responds to questions primarily yes/no answers [ ] other:Specifics: List any additional mannerisms or behaviors that you would like the patient to exhibit during the encounter. If the patients behavior should change at a specific point during the encounter, please describe the prompt and the changes to be portrayed.  Section 3: Opening Lines, Case Info, Chief Complaint, History of Present Illness (Opening Statement is the scripted lines/info you would like the SP to give to start the encounter, this should be provided in the patients words using I statements.) SP OPENING STATEMENT: (first statement the patient will make after the introduction or in the response to the examinees opening question.) Chief complaint: (this must be provided in the patients words.) History of Present Illness: please complete all sections. If not applicable, please mark section with N/A Onset: (when did the patient first notice the symptoms that have caused the patient to seek medical attention at this time?) Context: (what was going on when the symptoms were first noticed?) Acuity: (is this the first time the patient has noticed this problem, or has he/she had similar symptoms previously?) Location: (for pain or localized symptoms, where is the problem centralized?) Radiation: (does the problem / pain go anywhere else from central location?) Character / Quality: (how will the patient describe the symptom?) Severity / Intensity: (if applicable, describe intensity on a 1-10 scale, with 10 as the worst) Progression: (since its very beginning, how has the symptom progressed?) Timing: (is the symptom constant or intermittent? If intermittent how often does it occur and how long does it last? ) Aggravating factors: (what brings on the symptom?) Relieving factors: (what lessens the symptom?) Associated symptoms: (what else has occurred at the same time / what does the patient associate with the primary symptom?) If specifically asked: what does the patient think is going on with their health If specifically asked: what is the patients primary concern about the problem Past Medical History Patients response to how is your health in general? Hospitalizations (specify dates or patient age and location) Medical Illnesses / chronic problems (has the patient been under a doctors care for anything? ) Past surgery (when?) Accidents or Injuries (when?) OB/Gyn HistoryAge of onset of mensesCycle frequencyCycle lengthFlowAge at menopauseNumber of pregnanciesNumber of live birthsNumber of vaginal deliveriesNumber of C-sectionsNumber of miscarriagesNumber of abortions Type of birth control used (specify when if pertinent) [ ] Birth control pills _______ [ ] diaphragm_______ [ ] none ______ [ ] condom/foam _________ [ ] IUD [ ] other __________________________  Medications: (include how to say drug name, dose, schedule of use and length of time patient has been on the drug and if SP can have meds on a card or if it should be memorized.) Prescription MedicationsDrug name dose schedulesince whenOver the counter medicationsDrug name dose schedulesince whenHerbal preparations / or supplements:Name dose schedulesince whenOthers: Other forms of therapy triedWhen Outcome?AcupunctureMassage therapyChiropractorOther Allergies Medications: Allergen: ________________ Reaction: ___________________ Allergen: ________________ Reaction: ___________________ Allergen: ________________ Reaction: ___________________ Environmental: Allergen: ________________ Reaction: ___________________ Allergen: ________________ Reaction: ___________________  Exposure History: Chemical Toxins: Blood Transfusions:  Immunizations: Year of last tetanus vaccination: _____________________ Annual flu shot [ ] yes [ ] no Specify other vaccinations received [ ] pneumovax [ ] hepatitis [ ] other ________________________ Preventive Healthcare: (specify how often this occurs (including never) and time of most recent visit) How often Most recent (how many months or years ago) primary care physician ______________ _______________________ emergency room ______________ _______________________ eye doctor ______________ _______________________ alternative therapy ______________ _______________________ (chiropractor / massage therapy etc) other ____________ ______________ _______________________  Health Care Maintenance: Test most recent outcome (# of months / years ago) PAP _________________ [ ] normal [ ]abnormal Mammogram _________________ [ ] normal [ ]abnormal Prostate exam _________________ [ ] normal [ ]abnormal Cholesterol check _________________ [ ] normal [ ]abnormal Colonoscopy _________________ [ ] normal [ ]abnormal Other: _________________ [ ] normal [ ]abnormal [specify: _________] Other: _________________ [ ] normal [ ]abnormal [specify: _________] Comments:  Family History This section lists medical conditions of the patient's blood relatives. Please include information on at least parents, siblings, and children. Father: [ ] alive [ ] deceased age (or age at death) __________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________ Mother: [ ] alive [ ] deceased age (or age at death) __________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________  [ ] Brother [ ] Sister: [ ] alive [ ] deceased age (or age at death) __________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________ [ ] Brother [ ]Sister [ ] alive [ ] decease age (or age at death) __________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________  [ ] Son [ ]Daughter: [ ] alive [ ] deceased age (or age at death) _________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________ [ ] Son [ ]Daughter [ ] alive [ ] deceased age (or age at death) __________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________ [ ] Son [ ]Daughter [ ] alive [ ] deceased age (or age at death) ________ Medical conditions: [ ] healthy, no major medical problems [ ] hypertension [ ] asthma [ ] depression [ ] CVA [ ] diabetes [ ] alcoholism [ ] MI/heart dz [ ] emphysema [ ] cancer (specify type______________) [ ] other ______________________________________________________________  Add any other relevant medical information from blood relatives (grandparents, grandchildren, aunts, uncles, cousins)  Social History Living Arrangement Location of Home: (town) _________________________________________ Type of Dwelling [ ] house [ ] apartment/condo [ ] mobile home [ ] other _________________ Length of time living in current area __________years or _________months  Number of people living with patient: ___________________ Marital Status [ ] married [ ] long term partner [ ] engaged [ ] single [ ] divorced [ ] widowed Number of prior marriages (list any important details)  Sexual History Sexual orientation: [ ] heterosexual [ ] homosexual [ ] bisexual Currently sexually active: [ ] yes [ ] no Number of current partners: ______________ Number of prior partners: ______________  Life Details Education: Level of Education: [ ] did not complete high school [ ] high school graduate [ ] attended college [ ] attended vocational school [ ] college graduate [ ] graduate school attended/completed  Occupation/ Employment: Employed [ ] full time [ ] part time Not employed [ ] retired [ ] unemployed Type of work: _____________________________________________________ Relevant details of job activities  Financial Status [ ] inconsistent income (depends on ability to find work) [ ] okay, but nothing to spare [ ] financially comfortable [ ] fixed income (pension/government) Other relevant details:  Life Stressors [ ] minimal stress [ ] moderate stress [ ] extreme stress Describe relevant / key stressors if applicable  Religion Religious affiliation: [ ] none [ ] Catholic [ ] Methodist [ ] Protestant [ ] Episcopalian [ ] Lutheran [ ] Baptist [ ] Jewish [ ] Buddhist [ ]Muslim [ ] Other _____________________ Level of participation in religion [ ] actively participates/ religion very important [ ] occasionally participates [ ] inactive Additional details Hobbies/ Leisure Activities:  Life Details: (gives a brief background and provides a context for some responses) Birth Place: Family situation growing up: Fathers Occupation: Mothers Occupation: Any other pertinent details Personal Habits: CurrentPastNeverQuantity# of yearsIf quit, how long ago?TobaccoCigarettes[ ][ ][ ]Cigar[ ][ ][ ]Pipe[ ][ ][ ]Chewing tobacco[ ][ ][ ]Alcohol Beer[ ][ ][ ]Wine[ ][ ][ ]liquor[ ][ ][ ]Drugsmarijuana[ ][ ][ ]cocaine[ ][ ][ ]inhalants[ ][ ][ ]IV drugs[ ][ ][ ] Add any relevant information about substance use:  Diet: [ ] regular, well balanced diet three meals a day [ ] lots of snack foods [ ] pick up fast foods frequently [ ] eat out a lot (restaurants) [ ] limits things in diet (specify what and why salt, sugar, fat etc.) Relevant details:  Caffeine use [ ] none [ ] minimal (1-2 cups of coffee or cola per day) [ ] moderate [ ] heavy ( > 8 caffeinated drinks per day)  Exercise [ ] sedentary [ ] minimal (walk a lot throughout the day) [ ] formal exercise 1-2 times per week [ ] formal exercise 3-4 times per week [ ] daily exercise type of exercise  Sleep habits [ ] < 6 hours per night [ ] 6-8 hours per night [ ] > 8 hours per night Has sleep pattern changes recently? [ ] yes [ ] no Has current medical issue impacted sleep [ ] yes [ ] no Relevant details:  List any other important social history or information relating to personal habits here:  Physical Examination Abnormal Findings: SPs can be trained to simulate a variety of physical findings. If the case being developed calls for specific findings (e.g.: areas of pain, weakness) please describe the findings and include resource material such as picture, diagrams, websites etc. that will be helpful for the SP to study:  Standardized Questions (cueing): (questions to be asked by the patient if a learner does not address an issue) How to react to unexpected/ unscripted questions Physical Examination The following list includes maneuvers that may be included in the focused physical examination. If the encounter being developed will include a physical, please check the areas that you anticipate will be included by the examinee. This allows appropriate preparation of the SP for the encounter. []HEAD[]inspection of the skull and face[]palpation of the scalp for lesions[]EYES[]tested visual acuity using pocket card[]inspection of the eyes (pupils, sclera, conjunctiva)[]assess extra ocular muscle movement[]assess peripheral visual fields[]assess direct pupillary light response[]assess consensual pupillary light response[]fundoscopic examination[]EARS[]inspection of external ear[]gross test of hearing by soft noise near ear[]using otoscope, inspection of the canal and tympanic membrane[]perform the Weber test (lateralization)[]perform the Rinne test (conduction)[]NOSE/SINUSES[]inspection of nasal passages using light source (nasal speculum)[]palpation of the frontal and maxillary sinuses[]MOUTH[]inspection of the lips for symmetry, lesions[]inspection of oral cavity including buccal mucosa, gums, teeth, tongue[]inspection of the posterior pharynx[]test for elevation of the soft palate[]test for motor movement of the protruded tongue[]NECK/LYMPH NODES[]inspection of the neck (skin, tracheal alignment)[]palpation of the submandibular and submental area for lymph nodes[]palpation of the anterior and posterior cervical chain[]palpation of the thyroid gland[]BACK[]inspection of the back/ skin and spinal column alignment[]palpation of the spinous processes[]percussion of the spinous processes[]percussion of the flanks/ costo vertebral angles[]POSTERIOR THORAX / LUNGS[]inspection of chest expansion with deep inspiration[]palpation of chest expansion with deep inspiration[]percussion of the lung fields []percussion for diaphragmatic excursion[]auscultation of the lung fields[]assess for tactile fremitus[]assess for vocal fremitus[]assess for egophony[]ANTERIOR THORAX (patient in sitting position)[]inspect anterior chest (including breast inspection in women)[]palpate supraclavicular area for adenopathy[]palpate axillae for adenopathy[]percuss anterior lung fields[]auscultate anterior lung fields[]assess for tactile fremitus[]assess for vocal fremitus[]assess for egophony[]ANTERIOR THORAX/NECK/CARDIOVASCULAR (patient supine) NOTE: does not include breast exam for women[]inspect skin of chest and precordium[]palpate precordium for point of maximal impulse[]auscultate precordium (four places) using diaphragm[]auscultate apex using bell[]auscultate precordium with valsalva maneuver[]auscultate precordium with posture change[]inspect neck for jugular venous waves[]palpate carotid pulses[]auscultate carotid pulses[]ABDOMEN[]inspect abdomen, skin and abdominal contour[]auscultate abdomen for bowel sounds[]auscultate abdomen for vascular sounds[]percuss abdomen in four quadrants[]light palpation of the abdomen[]deep palpation of the abdomen[]percuss the liver span[]deep palpation for liver edge[]deep palpation for spleen tip[]deep palpation for kidneys[]midline palpation for aorta[]palpate for rebound tenderness[]percuss for shifting dullness[]INGUINAL REGION[]palpate for inguinal lymph nodes[]palpate femoral pulses[]auscultate femoral pulses []LOWER EXTREMITIES[]inspection of the skin and muscle formation of lower extremities[]firm pressure on shin for edema[]palpate lower extremities[]palpate dorsalis pedis pulse[]palpate posterior tibial pulse[]palpate popliteal pulse[]assess for range of motion of hip[]assess for range of motion of knee[]assess for range of motion of ankle[]UPPER EXTREMITIES[]inspection of the skin and muscle formation[]inspection of the hands, finger nails[]palpate upper extremities[]palpate radial pulse[]palpate ulnar pulse[]palpate brachial pulse[]palpation of the joints of the fingers[]palpation of the wrist[]assess for range of motion of shoulder[]assess for range of motion of elbow[]assess for range of motion of wrist[]assess range of motion of fingers[]NEUROLOGIC[]CRANIAL NERVES[]assess CN II[]assess CN III[]assess CN IV[]assess CN V[]assess CN VI[]assess CN VII[]assess CN VIII[]assess CN IX[]assess CN X[]assess CN XI[]assess CN XII[]REFLEXES[]assess biceps reflex[]assess triceps reflex[]assess brachioradialis reflex[]assess patellar relfex[]assess Achilles reflex[]assess plantar (Babinski) reflex[]MOTOR STRENGTH[]assess motor strength of the upper extremities[]assess motor strength of the lower extremities[]SENSORY[]assess upper extremities for light touch[]assess upper extremities for discrimination (sharp/ dull)[]assess upper extremities for vibratory sensation[]assess lower extremities for light touch[]assess lower extremities for discrimination (sharp/ dull)[]assess lower extremities for vibratory sensation[]GAIT / BALANCE / COORDINATION[]inspect patient walking with normal gait[]inspect patient in tandem walk[]inspect patient walking on toes[]inspect patient walking on heels[]assess ability to balance on one foot[]perform Romberg test[]assess rapid alternating movement[]assess point discrimination (finger to nose)[]assess outstretched hands for tremor[]MENTAL STATUS[]assess orientation to person[]assess orientation to place[]assess orientation to time[]assess immediate recall (three objects)[]assess delayed recall (three objects after five minutes)[]assess (serial sevens)[]BREAST EXAM (women)[]inspect breasts with patient in sitting or standing position[]inspect breasts with patient in supine position[]palpate breasts[]palpate axillae[]assess for nipple discharge[]PELVIC EXAMINATION (women)[]inspect external perianal area[]using speculum, inspect cervix[]using speculum, inspect vaginal wall[]bimanual palpation of the uterus[]bimanual palpation of the adenexal region bilaterally[]digital rectal examination[]GENITAL EXAMINATION (men)[]inspection of the penis and scrotum[]palpation of the scrotum[]palpation of the inguinal region for hernia[]digital rectal     Updated October 2018  PAGE \* MERGEFORMAT 6 3DEd 9  7 N X  " & / 3 4 b k ǺqqgZgZgZgZghIhIOJQJaJhIOJQJaJhAahYOJQJ\aJhAah$}OJQJaJh:OJQJaJh$}h$}OJQJaJh$}OJQJaJhAahYOJQJaJhAah:OJQJaJhAah:5OJQJhAah:CJOJQJaJhAahYCJOJQJaJhAahHCJOJQJaJ"4DE 9    X     l m  $a$gdYgd:$a$gd:gd:k l m n  !KLpz'(gij"#UVm 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h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkd$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#vp #v =#v I#v 1#v =#v6#v :V l ,0'6,5,55,5p 5 =5 I5 15 =565 9a]pytOkd$$Ifl5a K?3i Aw !'','','p '='='='='='='I'1'='='6'6'6'6'6'6'6'  ,0'6XXXX44 la]pytO$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytU kdn$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytU$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdyt kdg$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdyt$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytU kd` $$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytU$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytU kdY$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytU$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkdR$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#vg#vJ#v@#v:#vE#v=#vI#v1#v=#v6#v :V l 40'6(,5,55,5g5J5@5:5E5=5I515=565 9a]pq(ytOkdo$$Ifl@5a R K?3i Aw !'','','g'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  40'6(hhhh44 la]pq(ytO$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytU kd)$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytU$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytU kd.$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytU$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd3$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd8$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkd=$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#v' #v=#vI#v 1#v =#v 6#v :V l &־0'6,5,55,5' 5=5I5 15 =5 65 9a]p־ytO'kdH$$Ifl֦5a?3i Aw !'','','' '='='='I'1'='='6'6'6'6'6'6'6'  &־0'6LLLL44 la]p־ytO$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdP$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdU$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdZ$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd_$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V 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la]pq<ytO$$If]!vh#v,#v#v,#vY$:V l (0'6,5,55,5Y$9a]p(ytl`$$If]!vh#v,#v#v,#v#vI#v1#v=#v6#v :V l ֠0'6,5,55,55I515=565 9a]p֠ytOskd$$Ifld5a?3i Aw !'','',''I'1'='='6'6'6'6'6'6'6'  ֠0'6@@@@44 la]p֠ytO$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd}$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdv$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdo$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v 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h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd|$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdu$$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdn)$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdg.$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd`3$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdY8$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdR=$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdKB$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdDG$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd=L$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd6Q$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkd/V$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#v+#vE#v =#v I#v 1#v =#v6#v :V l .0'6 ,5,55,5+5E5 =5 I5 15 =565 9a]pq ytOkdLa$$Ifl5a K?3i Aw !'','','+'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  .0'6 \\\\44 la]pq ytO$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdj$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdo$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd{t$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkdty$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkd$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#vp #v =#v I#v 1#v =#v6#v :V l ,0'6,5,55,5p 5 =5 I5 15 =565 9a]pytOkd$$Ifl5a K?3i Aw !'','','p '='='='='='='I'1'='='6'6'6'6'6'6'6'  ,0'6XXXX44 la]pytO$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdx$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdq$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdj$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdc$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kd\$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v h#v,#v#v,#v#v#v<#vJ#v@#v :#v .:V l d0'6, 5,55,555<5J5@5 :5 .9 a]pdytl kdU$$Ifl 5a R '','','''<'J'@':'. d0'6((((44 la]pdytl$$If]!v 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80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkdG$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v E#v =#vI#v1#v=#v6#v :V l 80'6<,5,55,555<5J5@5 :5 E5 =5I515=565 9a]pq<ytOIkdR$$Ifll5a R K?3i Aw !'','','''<'J'@':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  80'6<pppp44 la]pq<ytO@$$If]!vh#v,#v#v,#v#v:#vE#v =#v I#v 1#v=#v6#v :V l 00'6,5,55,55:5E5 =5 I5 15=565 9a]pqytOYkd]$$Ifl5aR K?3i Aw !'','','':'E'='='='='='='I'1'='='6'6'6'6'6'6'6'  00'6````44 la]pqytOb$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v v#v =#v I#v 1#v =#v6#v :V l .0'6 ,5,55,555<5J5@5 :5 v5 =5 I5 15 =565 9a]pq ytOkdZg$$Ifl5a R ?3i Aw !'','','''<'J'@':'v'='I'1'='='6'6'6'6'6'6'6'  .0'6 \\\\44 la]pq ytO$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v #v =#v I#v1#v=#v6#v :V l 20'6,5,55,555<5J5@5 :5 5 =5 I515=565 9a]pqytOkdp$$Ifl*5a R ?3i Aw !'','','''<'J'@':''='='='I'1'='='6'6'6'6'6'6'6'  20'6dddd44 la]pqytO$$If]!vh#v,#v#v,#v#v#v<#vJ#v@#v :#v #v =#v I#v1#v=#v6#v :V l 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