ࡱ>  86bjbjWW b556.)))))4]]]h$]]fuuuuuPPP>]@]@]@]@]@]@]_aF@])PPPPP@]))uuU]:::P)u)u>]:P>]:::U]u4bG](WH*]k]0]Xa"a]a)]$PP:PPPPP@]@]:PPP]PPPPaPPPPPPPPP :  Indiana State Department of Health Nurse Aide Curriculum Created: July 1998 Revised: March 21, 2014 Indiana Nurse Aide Training Requirements The Indiana Administrative Code (IAC 16.2-3.1-14CNA) requires a nurse aide working in a health facility to have successfully completed a nurse aide training program approved by the ISDH. The ISDH also serves as the State Survey Agency for the Centers for Medicare and Medicaid Services (CMS) Health Care Facility Survey and Certification Program. Federal regulations at 42 CFR 483 require the ISDH provide oversight for nurse aide training and competency programs. This Nurse Aide Curriculum was developed by the ISDH as the ISDH Approved Curriculum in compliance with state and federal regulations. In July 1998, the ISDH Division of Long Term Care created the Nurse Aide Curriculum. The curriculum was a product of the ISDH in conjunction with Professional Resources and input from the Indiana Health Facilities Council Advisory Sub-committee. The curriculum was based on the standards of practice for nurse aides at that time. The care provided today at Indiana nursing homes has a higher acuity level than in the past. Nurse aides play an increasing important role in the delivery of quality health care. In 2012 the ISDH began a project to update the nurse aide curriculum to better reflect current standards of care. The curriculum was reviewed by the ISDH Division of Long Term Care, ISDH Division of Healthcare Education and Training, academic institutions, nurse aide training programs, and long term care provider associations. The updated nurse aide curriculum was completed and released in September 2013. Nurse aide training programs were to implement by January 1, 2014. The ISDH will further update the curriculum as changes or corrections are identified. Nurse aide training programs should check the ISDH Web site periodically for any changes to the curriculum. Indiana Nurse Aide Curriculum The Indiana Nurse Aide Curriculum is organized into thirty (30) lessons. The curriculum establishes the minimum standards for an approved program. Each lesson provides objectives, terms, content, and review questions. Each nurse aide training program is expected to include this content as part of their course. The training entity shall utilize the lesson plans as a basis for training and may complement the lessons using a text of choice. It is the responsibility of the training entity to ensure that, if a text is utilized, any variance in the content of the text from the Indiana Nursing Assistant Scope of Practice shall be identified to prevent misinformation as to the duties of the nursing assistant. The nurse aide lesson plans serve as a guide for classroom lecture. Resident care procedures should be introduced and demonstrated during lecture and then reinforced during the clinical experience. Should a standard of practice, at any time, be revised by an applicable regulatory entity, the training entity shall be responsible to update the lesson plan accordingly without waiting for an update and/or revised curriculum to be distributed by the Indiana State Department of Health. Table of Contents Pages Lesson 1- Introduction to the Role of the Nurse Aide 1-9 Introduction to Long Term Care The Role of the Nurse Aide The Care Team and the Chain of Command Communication and Interpersonal Skills Resident-Centered Care (Person-Centered Care) Lesson 2 Resident Rights 10-14 Origin/Purpose List of Rights Protection of Resident Rights Abuse, Neglect, and Personal Possessions/Misappropriation Lesson 3 Infection Control 15-20 Introduction to Infection Control Hand Hygiene Personal Protective Equipment PPE Precautions Lesson 4 Infection Control, continued 21-25 Infectious Disease/Infectious Condition Infection Control Practices Review of Personal Infection Control Practices Lesson 5 Medical Concerns/Emergency Procedures 26-31 Accidents Falls Choking Burns/Scalds Poisoning Medical Emergency Safety Measures/Prevention Strategies Lesson 6 Fire Safety and Other Resident Safety Concerns 32-36 Fire Safety Side rails/Entrapment Resident Elopement Smoking Lesson 7 Basic Nursing Skills (Vital Signs, Height and Weight) 37-40 Initial Steps Final Steps Pages Vital Signs Measuring and Recording Height and Weight Lesson 8 Activities of Daily Living (Positioning/Turning, Transfers) 41-47 Proper Positioning and Body Alignment Commonly Used Positions Proper Transfer Lesson 9 Activities of Daily Living (Devices Used for Transfer) 48-50 Using Mechanical Lifts Transfer Resident to Stretcher/Shower Bed Transfer Two Person Lift Lesson 10 Activities of Daily Living (Bathing, Shampoo, Perineal Care) 51-53 Shower/Shampoo/Drape-Undrape/Bed Bath/Perineal Care/Back Rub/ Catheter Care/Whirlpool Lesson 11 Activities of Daily Living (Oral Care, Grooming, Nail Care) 54-57 Grooming/Personal Hygiene Lesson 12 Activities of Daily Living (Dressing, Toileting) 58-62 Dressing II. Toileting Lesson 13 Resident Environment 63-66 Unoccupied Bed Occupied Bed Resident Room/Environment/Fall Prevention Lesson 14 Activities of Daily Living Nutrition/Hydration 67-75 Promoting Proper Nutrition and Hydration Promoting the Use of Proper Feeding Technique/Assisting a Resident with Special Needs Caring for a Resident with a Tube Feeding and the Resident at Risk for Aspiration Lesson 15 Skin Care/Pressure Prevention 76-82 Understanding the Integumentary System and Basic Skin Care Risk Factors for Skin Breakdown Development Prevention Lesson 16 Restraints 83-86 Physical Restraint Pages Lesson 17 Rehabilitation/Restorative Services 87-90 Rehabilitation Restorative Services Devices which May be Applied per Restorative Nursing Program Lesson 18 Oxygen Use 91-94 Oxygen Use Lesson 19 Devices/Interventions Prosthetics, Hearing Aids, Artificial, 95-98 Eye, Eyeglasses, Dentures, and Compression Stockings Purpose of a Prosthetic Device Types of Prosthetic Devices Role of CNA regarding Amputations and Prosthetic Care Role of CNA regarding Hearing Aids Role of CNA regarding Artificial Eye and Eyeglasses Role of CNA regarding Dentures Role of CNA regarding Elastic/Compression Stockings Lesson 20 Special Care Needs Intravenous Fluids, Non-Pharmacologic 99-102 Pain Interventions Purpose of IV or PICC II. Role of CNA in caring for IV/PICC Infection Control IV. Pain Factors Role of CNA related to Pain Lesson 21 Cognitive Impairment/Dementia/Alzheimers 103-113 Conditions Behaviors, Causes and Interventions Methods/Therapies to Reduce Behaviors Tips to Remember when Dealing with Cognitively Impaired Residents Communication Strategies Techniques to Handle Difficult Behaviors Behavior Interventions Lesson 22 Mental Health, Depression and Social Needs 114-120 Causes of Mental Illness Response to Behaviors Use of Defense Mechanisms Types of Mental Illness Behaviors Associated with Mental Disorders Actions and Interventions Treatment for Mental Illness Special Considerations Mental Illness and Intellectual Disability Mental Retardation Pages: Lesson 23 Common Diseases and Disorders Nervous, Circulatory & 121-127 Musculo-Skeletal Systems Nervous System Nervous System Conditions that Affect Nervous System Normal Nervous System Changes with Age Role of the CNA Circulatory System Circulatory System Conditions that Affect the Circulatory System Normal Circulatory Changes with Age Role of the CNA Musculo-Skeletal System Musculo-Skeletal System Conditions that Affect the Musculo-Skeletal System Importance of Exercise and Range of Motion (ROM) Normal Musculo-Skeletal Changes with Age Role of CNA Lesson 24 Common Diseases and Disorders Respiratory and Urinary 128-131 Respiratory System Respiratory System Common Conditions of the Respiratory System Normal Changes with Age Role of CNA Urinary System Urinary System Common Conditions of the Urinary System Normal Changes with Age Role of the CNA Lesson 25 Common Diseases and Disorders Gastrointestinal, Endocrine 132-135 Gastrointestinal Systems Gastrointestinal System Common Conditions of the Gastrointestinal System Normal Changes with Age Role of the CNA Endocrine System Endocrine System Common Conditions that Affect the Endocrine System Normal Changes with Age Role of the CNA Pages Lesson 26 Common Diseases and Disorders Reproductive, Immune/ 136-138 Lymphatic Systems Common Conditions of the Reproductive System Normal Changes with Age Role of the CNA Common Conditions of the Immune and Lymphatic Systems Normal Changes with Age Role of the CNA Lesson 27 Admission/Transfer/Discharge 139-141 Admitting a New Resident to the Facility Assisting to Transfer a Resident to a Hospital (i.e., Care Transition) Assisting a Resident to Discharge Home or to Another Facility Lesson 28 End of Life 142-145 Advance Directives Role of Hospice Care of the Dying Resident Signs/Symptoms of Impending Death Post Mortem Care Disposition of Personal Belongings Lesson 29 Daily Responsibilities 146-148 Day to Day Time Management/Resident Care Interdisciplinary Care Plan Meetings Lesson 30 Protecting Your Profession 149-153 Reducing Stress/Burnout Abuse/Neglect/Misappropriation Nurse Aide Testing/Certification AppendiX A 154 Resident Care Procedures Initial Steps Final Steps Hand washing/Hand rub* Gloves* Gown* Mask* Falling or Fainting* Choking* Seizures* Fire* Fire Extinguisher* Oral Temperature (Electronic) Axillary Temperature Pulse and Respiration Blood Pressure Height Weight Assist Resident to Move to Head of Bed Supine Position Lateral Position Fowlers Position Semi-Fowlers Position Sit on Edge of Bed Using a Gait Belt to Assist with Ambulation Transfer to Chair Transfer to Wheelchair Walking Assist with Walker Assist with Cane Transfer to Stretcher/Shower Bed* Transfer: Two Person Lift* Shower/Shampoo Bed Bath/Perineal Care Back Rub Bed Shampoo* Oral Care Oral Care for Unconscious Denture Care Electric Razor Safety Razor Comb/Brush Hair Fingernail Care Foot Care Change Gown Dressing a Dependent Resident Assist to Bathroom Bedside Commode* Bedpan/Fracture Pan Urinal Empty Urinary Drainage Bag* Urine Specimen Collection* Stool Specimen Collection* Application of Incontinent Brief Unoccupied Bed* Occupied Bed Thickened Liquids* Passing Fresh Ice Water Feeding Assist to Eat Inspecting Skin Float Heels Bed Cradle* Passive Range of Motion Splint Application* Abdominal Binder* Abduction Pillow* Knee Immobilizer* Palm Cones Nasal Cannula Care Assisting with Hearing Aids Elastic/Compression Stocking Application Post Mortem Care* * May be simulated in lab if clinical experience is not available *** Please note bolded steps in the RCPs indicate Critical Steps Updated: January 15, 2014 (>A_mnos 5 J {ճՖsdTdIh5Gh+eOJQJh5Gh+e6CJOJQJaJh5Gh+eCJOJQJaJh5Gh+e5CJOJQJaJh5Gh+e6h+e h5Gh+eh5Gh+e5CJOJQJaJh+e5CJ$OJQJaJ$h5Gh+e5CJ$OJQJaJ$"h5Gh+e5>*CJ,OJQJaJ,h5Gh+e5CJ,OJQJaJ,3jh+eh+e5CJ,OJQJUaJ,mHnHu(>?@AUn E XYUdgd+e d7$8$H$gd+egd+e$a$gd+eUyz{|}~ $da$gd+egd+e$a$gd+edgd+e}=} Ku.y@aV~3I^ t !L!!!!!!! "#"?"B"m""""&#)#r#дддддддh+e5CJOJQJaJh+eCJOJQJaJh5Gh+e5CJOJQJaJh5Gh+eCJOJQJaJ"h5Gh+e5;CJOJQJaJh+e5;CJOJQJaJB2Mt"@z}  & Fdgd+e hd^hgd+e  & Fdgd+e$ & Fda$gd+edgd+e & Fd^`gd+e & F d^`gd+e $da$gd+e X%-:DV|} pd^pgd+e & F*>d^*`>gd+e  & Fdgd+e $da$gd+e  & Fdgd+edgd+e  & Fdgd+e  ao{$Jctu  & Fdgd+e$hd^ha$gd+e hd^hgd+e  & Fdgd+e $da$gd+edgd+e  & Fdgd+e-.F`a  hd`hgd+e & F!dgd+ed^`gd+e & F d^`gd+edgd+e  & F dgd+e $da$gd+edgd+e  & F dgd+e )SV*}~'23p  & Fdgd+e  & F dgd+edgd+e  & Fdgd+e $da$gd+ed^`gd+e & F d^gd+e  ] ^ O!n!!!!"7"  & Fdgd+ed^`gd+e  & Fdgd+e & F!d^`gd+e $da$gd+edgd+e d^gd+e7"l"m"""#@#R#j#####$6$y$$$$$)% & F>d`>gd+e  & Fdgd+e d^gd+e  & F!dgd+edgd+e & F>d`>gd+er#u###$ %&&D&E&F&M&N&&&&&&Z']'''(((()))))J***V+Y+\+f+l+m++++,,--}../;///C055ƹ姗h5Gh+eOJQJh5Gh+e;CJOJQJaJ"h5Gh+e5;CJOJQJaJh+e5CJOJQJaJh1Eh+eCJOJQJaJh5Gh+e5CJOJQJaJh5Gh+eCJOJQJaJh+eCJOJQJaJ7)%B%Y%s%%%%&E&F&N&&&&'&'N'^'q'''  & Fdgd+e  & Fdgd+edgd+e $da$gd+edgd+e & Fd`gd+e  & Fdgd+e''''(J({(((()#)6)b)z))))))))S*  & Fdgd+e  & Fdgd+e d^gd+e  & Fdgd+edgd+e  & Fdgd+eS*l*******2+J+Z+[+\+l+m+++',?,O,,  & Fdgd+e d^ `gd+e$ d^ `a$gd+e  & Fdgd+e  & Fdgd+edgd+e,,,,,"-i----- .%.G.Y.|.}...//^/v/  & Fdgd+e  & Fdgd+e  & Fdgd+e  & Fdgd+edgd+e  & Fdgd+ev////C0b0p0|00000000001131B1I1Q1y111 & F 8d^8gd+edgd+e  & Fdgd+e111122/282L2^222222222 33&363F3Q3]3{3333 & F 8d^8gd+e3333 4/4?4M4`4y44444444455%585T5~5555gd+edgd+e & F 8d^8gd+e556656667686gd+e5566$64656667686h[Nh@th5Gh+eOJQJhhl4h+e5OJQJh+eOJQJ 21h:p[N/ =!"#$% 5 01h:p[N/ =!"#$% 21h:p@t/ =!"#$% oDd 9 r  NA?indiana-sealPicture 2C:\Users\twhitson\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DYZUAHZ1\indiana-seal.jpgRn.95C!;ʳפ{mDFm.95C!;ʳפ{JFIFmICC_PROFILE]LinomntrRGB XYZ  1acspMSFTIEC sRGB-HP cprtP3desclwtptbkptrXYZgXYZ+bXYZ?dmndSpdmddvuedKview$lumimeas $tech- rTRC9 gTRC E bTRCQ textCopyright (c) 1998 Hewlett-Packard CompanydescsRGB IEC61966-2.1sRGB IEC61966-2.1XYZ QXYZ XYZ o8XYZ bXYZ $descIEC http://www.iec.chIEC http://www.iec.chdesc.IEC 61966-2.1 Default RGB colour space - sRGB.IEC 61966-2.1 Default RGB colour space - sRGBdesc,Reference Viewing Condition in IEC61966-2.1,Reference Viewing Condition in IEC61966-2.1view_. \XYZ L VPWmeassig CRT curv #(-27;@EJOTY^chmrw| %+28>ELRY`gnu| &/8AKT]gqz !-8COZfr~ -;HUcq~ +:IXgw'7HYj{+=Oat 2FZn  % : O d y  ' = T j " 9 Q i  * C \ u & @ Z t .Id %A^z &Ca~1Om&Ed#Cc'Ij4Vx&IlAe@e Ek*Qw;c*R{Gp@j>i  A l !!H!u!!!"'"U"""# #8#f###$$M$|$$% %8%h%%%&'&W&&&''I'z''( (?(q(())8)k))**5*h**++6+i++,,9,n,,- -A-v--..L.../$/Z///050l0011J1112*2c223 3F3334+4e4455M555676r667$7`7788P8899B999:6:t::;-;k;;<' >`>>?!?a??@#@d@@A)AjAAB0BrBBC:C}CDDGDDEEUEEF"FgFFG5G{GHHKHHIIcIIJ7J}JK KSKKL*LrLMMJMMN%NnNOOIOOP'PqPQQPQQR1R|RSS_SSTBTTU(UuUVV\VVWDWWX/X}XYYiYZZVZZ[E[[\5\\]']x]^^l^__a_``W``aOaabIbbcCccd@dde=eef=ffg=ggh?hhiCiijHjjkOkklWlmm`mnnknooxop+ppq:qqrKrss]sttptu(uuv>vvwVwxxnxy*yyzFz{{c{|!||}A}~~b~#G k͂0WGrׇ;iΉ3dʋ0cʍ1fΏ6n֑?zM _ɖ4 uL$h՛BdҞ@iءG&vVǥ8nRĩ7u\ЭD-u`ֲK³8%yhYѹJº;.! zpg_XQKFAǿ=ȼ:ɹ8ʷ6˶5̵5͵6ζ7ϸ9к<Ѿ?DINU\dlvۀ܊ݖޢ)߯6DScs 2F[p(@Xr4Pm8Ww)Kmcurv #(-27;@EJOTY^chmrw| %+28>ELRY`gnu| &/8AKT]gqz !-8COZfr~ -;HUcq~ +:IXgw'7HYj{+=Oat 2FZn  % : O d y  ' = T j " 9 Q i  * C \ u & @ Z t .Id %A^z &Ca~1Om&Ed#Cc'Ij4Vx&IlAe@e Ek*Qw;c*R{Gp@j>i  A l !!H!u!!!"'"U"""# #8#f###$$M$|$$% %8%h%%%&'&W&&&''I'z''( (?(q(())8)k))**5*h**++6+i++,,9,n,,- -A-v--..L.../$/Z///050l0011J1112*2c223 3F3334+4e4455M555676r667$7`7788P8899B999:6:t::;-;k;;<' >`>>?!?a??@#@d@@A)AjAAB0BrBBC:C}CDDGDDEEUEEF"FgFFG5G{GHHKHHIIcIIJ7J}JK KSKKL*LrLMMJMMN%NnNOOIOOP'PqPQQPQQR1R|RSS_SSTBTTU(UuUVV\VVWDWWX/X}XYYiYZZVZZ[E[[\5\\]']x]^^l^__a_``W``aOaabIbbcCccd@dde=eef=ffg=ggh?hhiCiijHjjkOkklWlmm`mnnknooxop+ppq:qqrKrss]sttptu(uuv>vvwVwxxnxy*yyzFz{{c{|!||}A}~~b~#G k͂0WGrׇ;iΉ3dʋ0cʍ1fΏ6n֑?zM _ɖ4 uL$h՛BdҞ@iءG&vVǥ8nRĩ7u\ЭD-u`ֲK³8%yhYѹJº;.! zpg_XQKFAǿ=ȼ:ɹ8ʷ6˶5̵5͵6ζ7ϸ9к<Ѿ?DINU\dlvۀ܊ݖޢ)߯6DScs 2F[p(@Xr4Pm8Ww)Kmcurv #(-27;@EJOTY^chmrw| %+28>ELRY`gnu| &/8AKT]gqz !-8COZfr~ -;HUcq~ +:IXgw'7HYj{+=Oat 2FZn  % : O d y  ' = T j " 9 Q i  * C \ u & @ Z t .Id %A^z &Ca~1Om&Ed#Cc'Ij4Vx&IlAe@e Ek*Qw;c*R{Gp@j>i  A l !!H!u!!!"'"U"""# #8#f###$$M$|$$% %8%h%%%&'&W&&&''I'z''( (?(q(())8)k))**5*h**++6+i++,,9,n,,- -A-v--..L.../$/Z///050l0011J1112*2c223 3F3334+4e4455M555676r667$7`7788P8899B999:6:t::;-;k;;<' >`>>?!?a??@#@d@@A)AjAAB0BrBBC:C}CDDGDDEEUEEF"FgFFG5G{GHHKHHIIcIIJ7J}JK KSKKL*LrLMMJMMN%NnNOOIOOP'PqPQQPQQR1R|RSS_SSTBTTU(UuUVV\VVWDWWX/X}XYYiYZZVZZ[E[[\5\\]']x]^^l^__a_``W``aOaabIbbcCccd@dde=eef=ffg=ggh?hhiCiijHjjkOkklWlmm`mnnknooxop+ppq:qqrKrss]sttptu(uuv>vvwVwxxnxy*yyzFz{{c{|!||}A}~~b~#G k͂0WGrׇ;iΉ3dʋ0cʍ1fΏ6n֑?zM _ɖ4 uL$h՛BdҞ@iءG&vVǥ8nRĩ7u\ЭD-u`ֲK³8%yhYѹJº;.! zpg_XQKFAǿ=ȼ:ɹ8ʷ6˶5̵5͵6ζ7ϸ9к<Ѿ?DINU\dlvۀ܊ݖޢ)߯6DScs 2F[p(@Xr4Pm8Ww)Km   (!%"/#%)*,-,!140+4(+,+  ++++++++++++++++++++++++++++++++++++++++++++++++++ }!1AQa"q2#BR$3br %&'()*456789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz w!1AQaq"2B #3Rbr $4%&'()*56789:CDEFGHIJSTUVWXYZcdefghijstuvwxyz ? ( ( 7]O+#DB iz sỦ]HmJ#y5S5Cz帩m~eVRU+\A_le}4=MR\El?1_z&z F}$觜`Ỏex?kYvwӓ9Wmk7wZwBGcn7(WB *z[y9+g4|YƼȥ8G8+Zz9_J5?;K#JkOK>X6yJ?*7nmQ̃úfm5m\&IR+T!.U&iK;R\sk+h)5}Rs%Ș[pn::yvLˮ|k=Gy?i`5m/QbvQoGzg.GOlhG ŴǕ_l-V}vj,.R\}_SQGyh;T`P@P@P@9 sQD[ȷS/;E__7 /Oޗ**._x\|ט?rvŸ/~5yo.z?ξ]6gj7xo%, Fsꦴ僪OerkC~X~-ikw$h |菱aJ%V?ziz]q:B<6W<5^tpi.HΫMhgǚoxOXE[ !}{MTURN2"khF54 Kw1MkIdrc={^+rLd.喫Uc jZli5ҧ">:WbxtCޡѬ%=QwB諫Zq/̿veO{,Z^2wFw0ۤʺ_aNjEJ(IJՐP@P@6v\]HC;R47dNU$v5EuH-hd;c1۟s:հkOL <2瞲]z"tkmcZ!64V8-';׷#.j?Qۿ_sxw~״-T\\t,ڰ\Osӕ9F˿ZJiݔ~/ KtBLg}ue&D s|^랄_5Q= LJ,55xS`VV!`~fwd;S(VVNQNW;sI^H1Io$NH:aj.IJ['V/MtmF=~RּA7 i5-GJDW5_xU/T5Q\ n:qQTНN'783~i.᨟3ˤݱq# t5É?nQz¾1%>Uq~G\ca~ֳR'RN\2dLUfZdޠO9>ӌa1ԝXhGU/eWUmرm>MD/l7cM|5OMO^E?[xL[u8ڑ'8xHǯu&eԦs MZ+cúéH 7GZ]9iD$d1WspQ9~'W|-iBi yjf{vv3t:t$71}8ՋyFpht? hum}^7CNP,Ur?x8sMQ\a^MN-6ovhkMBX@? Tqs-9ӳM#g:4dߥQfm=sv-]NOP3 ]>NԣwOg-7cA9YEWW;9eH >Ri+eLr}F]&kRԃ F+egY13I,+:|_(_W8y>*|[ngԾèw n\'nͻ s۽y')b$_K5w~_$3eR;#cW[.ԛ8߭O.UZ?<7t"eM?s` LyocO RջmmΉbaS>SaO(~)4zE )-&rWgĚ}hܫp1y G^0>cZ8Q]z3˻6ںemR][ˣhZ]Are|ܝR@TMaɽEܽHV_xGkɌp38ssqܫ VmV?k͢zEH'@22?W؜6+!kPNGx{YZB6LlбoO)*ؼ,sRNP (2zPxY}r` -Rl5}~_51 p OzI|oڍt+kv7SQտad_xXjE{A])~ YI2]GG?CsL 4u}T' Z5^L:\q ~d py>#0L<}n)i䢔޲W)ᘛMeCl>PqgF TRo;wg͒!$cYiO%d.3nqv4~1*_Եn1Wn{tQoī(me/~߀@'m%vsF.N\Zb $A niFKQp{#%ʟۃo^GŚxT7 z$#=Jט޻)EiZ旋."Zv7J4nNF8xhb(7k?-e׭ΫɴAus?9;°TSMXkR?JLd=ՔּbpsԼoўY~KGKM;oeZy&M4&Y?M{voB)3ag/ibioR.dGIP,란6:beR)Ij3%jhxza1#?÷ba#%{4qT?WiQCnC^@{_ZCv>{,m'=CMQ*O>ЭRF|jR7 Qf3 (9(Jd g\]>|UKO_*KIh ^aK#- b9 bR1gǷ>3 X9_l]߰S=7> xWVsA i1܏\g8S\c̒NUG,yh%r}nvTqE4&՗X#hmblcC-FD EI#qV\z~dnUGW׌}C'5L$ʰ=BGWs'ui'*qkfc%ݡ^kCHWhI9I;o7[zLPjj˭_/$\+1OC]R(ԧe][+k}\=zuFU^oEweؗvfn>uNW=_G/u/E3RN7eGoի/˱"QoMJ30WjOZ/Fڬu i̎{ ˃\.)Zsu}{Y>XԿA`ֹWSxךV<`4W`<;y9sߠC_a̓9i{Z>eEsg \T67TJ>kleykqqІ'*>f$I=CGwpxXu8Μlob39]% -ny|Yx_kD$$#(*{ǯ5m< vzJ4[&Acge6ҏ*-Um%/>]gƗmC[iŶO/-Z+Z.O*c g$4NX&^y[yJzdOG:s.sm6DS$9]#sXI`9GIY>)sA{oN6B|eXՋFyyP 8߈׿b>dy~USt0/Y_ס}V}-|?tq5o# kp+ M-LZ}?S ֿ6]nЮekc-gR<'F.̓¯u}jb0Q{*~Ҽl5 Q7ʹu}zcjaxS[2iN)K.7G>0lɰ.(ƬV1渽\`4?6f3l@aN b:IrĞPOUxG,ױ8~v֦&>&d˩|CO3 NO91yuqQkvӯC%~[1 @q+i׫*|K_ B4#U1/&KJS3ֺGCqغε_â^=&u#]@~Lc\>!җ50Vu")6Nuußߘ򮷙JDÖ Gs:Ūx\4 M9LkeRNv=L<97_~JθeaE1k#Sg+4tҼ%'"i3.!d L H G U>{Kx7bPأ`yG9{68=tMF->կnCVDm# rq~)JңιG wswȬbb15%t)jY%BϞ=+(ɶ(G~5蚎 9e?5M]X}>I_QR.QyFq95KIJss=[xUX JDuK hW i-<2*O _a?a3j{Ly@헆!j~ fM-n}1_W.cIcO.Wħg^)eɜ"?*߆ UU(sG^!w ͱӭٚOr*V6uiVUmwՏ(ٽo|srwҼ (ۏ83}TPOCMն3j22G^}srK:4$JW*wOQV% .MJ # Z Shdl|ySI r Xq~o|N,H<ʍÓ.fRo&RɴQ@Irx{JJ*G'ZQ{EQfA-{&L 4IESw|v;p8$񇄭zWz)< pܲlwN~"2j뾧^߽n)_SwW1x2XxQ>8kUIj] a8C՝/Ukkyg=B8۬R nS\AI(b!_}YQVè˧6W wgrhFkMT|H8Mddζs?݆6s5&7\ps6 ]k֒r.Ows|Su }.k5 +KJ<7G%BNOM{~T_b'|5u kG 6c1QbkRK.׻vW*[=] q5ϔ`ՙ,HaӪ-_.M5̫F)A98#q#zzM.HIALe+DK8)6qۗ/:(2MoC$qIrm&&2J2ܪ$_:o E ?CEvXmgC$Β0u1Z)h kjra*?/C-6* ? Ěto1ډb=~. :rmgfvw<> _tY^ S q2k8֚egIpA[izg-K ۂq#C;:.K~0..jQ..G3YdMO's tJds,L5eYYZDPj>xqVc`P2M[#ؠu1-/CF'@`ٹT*?yTu9PYpUq̪(Ⓛҁ$v".">9'\~P4%.g2uM-ŽђcD#'}-rՖ+ 7=~lE׉g4{hIr;pFk ).ob.%e8FXsMxJGJ-Zv#/t%>ju+W3 pv$_FyUNpo>rf$>ZG@(8['fˬC!Y/ !J,t VKH -#,7zyм3"\(09JMb*wL 8?OMh>o}6L=tHѠ tn8e5uh Cg#iZOc V ]:8Xxq7{Suc u2DGO8Ee.4}Hj'yA2;=8/`k{OpفW74cYUMQ9}11cJx.{m!=_Zݼ}Q0$W؞c:^XSW>+mOK*rӡ aEI'wօ9#O|4r{_h-%Qv'48 8=ѱy&e`8nѤW•J9mЧqL$VpCSVta?A@&^vQ' ?^ٯ?gC]g~]9>ށ $1gv $|HC8]Οqq]Hq!%R}8$SغzXMsr_->OVm~yJ5xm8<KZ<[@dX?3ӜNǷoiST%ɘYzI4V0I%m{% l5&\-O܄Agal6s]HYbcVBbxltTetã9P>SMv:ɪΏI#cXt2i3 5+l#IuH 3ҀI +2Ur;q@m7%w,Q6$Ú\WdjTFA"#(-Au5Qϓs{!vb3{œ9V* _.DZlG<,A_@~ {p:?j0rS_ևw7 cy}}{XZ[7 eTd9ݫʣJLNTʢھ~}?3ܜ:|M[OߎuO YGmh6vHwWӄRQsQwp_gEqNo_;LN$P`J*)+$I%ӦxWnw'P?Ҽʊto%Q;\/9aƹmEdA?̟gbi0&J{馧wBI6֩O3Oilp^6U{3^UQZ` )X䩆'imD78֩jg/I.PƳT$sSZkty24eV1@MQkV[a'=8GCQmirƇ4o۟ҝyZkjžnf\ZˡOEM,\+ii~;ٔ0d 3ZHEkvI۸ɗi3RTx/cBJ˦\) 0p'SF\[q̯$dr)NMiVJ֑p#.&{;zwkJM+=gNZ&ѼF~ n[fnXE EG# \U4%*q9M[='_>(Bt(O}>Jj}tHmc<.\#dӓ^E Rq\窗o=c&KQB ^rfMz{$@ǻ=l)砿!ۡKrG}\ >ּ7C`c~z?_<(aF?,vORuUO I⾳Ko=\WGp|?/|%/s 񁴣܃=@ؚpUgGS^m)Z_/:1Vb~g^&Bͻc608{`e? 3xgz9'OQFjϩ}CJ/LL :ҕzXoeW2"JBg|֥yz %:߿F-#Vvq ioqR<*ܝ1=A+kxmbX;T`PT)ݍKXRKLM"fpP{"Y\Fǰ@gb%HC)PSrRVgi2.wkӥZh*}Qc0/Unwpn>Z[rGT,~DQ]ܩGOq5yzhsW67Fe8${Tzq ir;.Q<,3jN ~]a$slrRF}o䯖S'cR 4[@xїW'26>]V0Ngdon@rGcAfba5B~Ð޼SO烻j4q,Ȓz29eSv$v3JWBR0Aj qqmW×%ߧOKOQ֞ G-S91ڭbK(`lSK7%|9񭎁Q! 'ރZ7jkkkm5+o9B Ls^ ⽭*Tc2og8TeWwq;$.dTa9lPcgxv 5[5? /0%_}F2k j=Wz~|P@u:=[I_Ða㈣*R IlGwo\)/ G+8,2X:&3 hkmW=:5}.mFJk (hU_}r=E:Ѽ]ׯq)-gA#H@[\d'Mxy<5PG][~x:gվrxR98 ׺|HuSgjH2Yۦ?>J)ߡbyԤ`bxNv#ߚ uwvs8VEg+I S4JWOcIZ.O65; ֓Ip-Uu ",a[taWi@{ iXU9Ջ:^qe}0hk'мmb8rlu([CN 5މxF %1ܲš18h\Gmk4Cx)Xqi\ jOUr <{r=v1M'3hQ---Ďƅ,P$1N D=_5ܳ KD#ss 3,dUnp^ҢQڎ2kJI;tgO,BRo{+&n'R2<Zq%'O |fƂH;hK{>U}s_` Z8ϩ׼ya@4EEw@  Oʾ3i[_}Sr{W j:4W8 SrF C^GR< g[O6 ׶vӗ̹qw?oi% [_%v<P{ƅ%ι[\k?u&IDYw g#pڄҚNFjWZ\~"6z\62ctHQSG#^FRI{Y6Ֆ3\VM{>[&ykRi^ 5ݱRw8܍Hl'AHldT+ @ꤝ!ԴIu9rmxIoɂYF$]`r?|H?LcÚ Ճ)`\g@>4w9%.H{vʂܯ :yK,q wG5f$a̅X֝%S6BoHA;sBaK9ϕZ;+GNgt1]J|m2n9*9Ohg]F%–G$65!e+$3OM|Z˓(u=ߞ2@^~?1KnA>Wm6X=G=N_N*xQ_޶{Nc>'#X֜ZIk6ֱi\arx}kpP%yuiJٝ{6o;KFGy2'*TuZf~c?['#_/5[By=*)_W՞B@~G7qh +YmPI U8ԋ.NJQvhۈ/<1"ťvqt> ~yW#X|Ꮹh;;[ _lK!ktr @+g۽~GBϗaeF,֨/V>9`1zG<潚u!V pwOV89†8;Ν.l-i=%Te6 A?=EJH7O hC=rcYA'~2i9HduVr9 w)--`qp$fF~n#I(:]Js,;RzFxh9T}_(I0*\~"u_y[h݊C ۩?Tqek':~j.I8b!#xHҦ{YI6i6S]B>`AFOBNOAyJ2>qMv[{VvKi%į,ykVx5πb=j䖍f`؟gF5%*nFTd3zĺ ٣I}pkOOA3|t\Ja <,pۛھ˱kGEVdw/w~}_1OSeyrP@fG֬ GS)WF݈Ln .Q8\Tw<zԨ/'g_QdXNgUKE4>k_hze3ϦG-v~TbyB_q414 TcT*НbaF?Jr{IOsLq|j0MӨ=Gs:K)2Zh*Xו,|5Ok4Ѿ 'Y[|#𷈦 |;܂(疌ӡ.jTq15{v˩l f(Mgt&נL巜F3xcԥZhSk`\gk:]cC-P0jN`kS게tE;JR2#xp2sxG5Zݢ"xT&vӿPs =%moh*-b`>p$2W.,Z}O`],NHAuPTg v:5)U~)/V_Nޚq-J+Tp {::Χ06}v=_ON+j209G5<047fl?~>gM^P@P_4[mjE8)2s>ڸXnDuaqsϚ;u]<Sέ+ ?svWVX?}ciw_N݆#Fвo0y8Ziz>wzz'P2+YA `*eݡEcgb$7?u,O49!JpQ5ݝ?\ܧgumF۵՝晨su!.{x2*)?u5%IgOXi15jY\95޷-jZ-*Hh4. m+S6x5%ڮ]*]4 AQSݻO_CXf'-֭C2Aӯ֔*W(+_R^28$gOigog%D-ֺ*XrQ"Yw=uPl,^MQ8ݼ{ƾ*Ҥh^\W<^5넵Xd~>^_BӾ:zd=NZOލg|iOO9 c{ے!"4Oׇ)=]Ս鵍o{Dhd?hm1< Vx^WU;k^:עwi^7ڞ!pպ.9jk2ܚrZv9)eKiqj}&TkGkÔ\[Oޝ\Ck Ms,pĽ]?YNqy싄%7vrc[X Ê(Q(.i(wgo%ӴSw_iVy܏GkWG-h_\E y?U4 Eu/;w?^ھÒ=T?{n5k ( ( (15 iګ^3k{ƼnUŧ#s Vw]xOU΅'ݚݼ*7˟ 3ڣШe=Q]:O"[Ic?jib!ʩ.hyTG{OukhĻ mh+ٺus)Vտ.HnIgCgZ Z+jfگ4NXFr:d ҽL}q答Z忣L=ax>%<7"hqA9q=YfIuݣed='ږx{T]WO]Z \e}4&-tl8&73 xgZVj]QͩiTČ`g1 9Egt.WI;]ouK|B:[:6 rwr2y?+a(%55A9;J):K^vN"$yE`:~u]_ZQF:_̂Dui-cQru:Sf+/.TפY[ͩ;j FD澓\"\kgWJ@ ;W-P@P@P@P@ZA0j'J\*Nv0nLŠkF=MNG^V#"V;bcFtqk&d _ GLs榾NTonGW5Y/x}DnƏ>)+1xX zEl$?;^R#iom1H7R]*7-# ”} <egQ8pUUɲnbP@P@P@P@P@P@P@P@P@j 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ OJPJQJ_HmH nH sH tH V`V +eNormaldh(CJOJPJQJ^J_HaJmH sH tH DA D Default Paragraph FontRiR 0 Table Normal4 l4a (k ( 0No List \^`\ +e0 Normal (Web)ddd[$\$CJOJPJQJaJD`D +e List Paragraph ^m$NN +e0 Balloon TextdCJOJQJ^JaJR/!R +e0Balloon Text CharCJOJPJQJ^JaJPK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] -5.8.b4bkbr#586'0U 7")%'S*,v/13586 !"#$%&()*+,-./8@0(  B S  ?jr 1 8 ))**+-2-0.4.9.U x .5.9.33.4.5.9.!KbX R\$nL8W.M,H.>6J0%EmB&N")$f *QM* ,#.2R[w2y"9 3 8?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghiklmnopqrstuvwxyz{|}~Root Entry F\4bGData 2o1TablejybWordDocumentbSummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q