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	font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	color:black;
	mso-ansi-language:EN-AU;}
p.MsoBodyText2, li.MsoBodyText2, div.MsoBodyText2
	{mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-link:"Body Text 2 Char";
	mso-style-next:Normal;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:0cm;
	line-height:200%;
	mso-pagination:none;
	background:white;
	mso-layout-grid-align:none;
	text-autospace:none;
	font-size:9.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	color:black;
	mso-ansi-language:EN-AU;}
p.MsoBodyText3, li.MsoBodyText3, div.MsoBodyText3
	{mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-link:"Body Text 3 Char";
	mso-style-next:Normal;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:0cm;
	mso-pagination:none;
	background:white;
	mso-layout-grid-align:none;
	text-autospace:none;
	font-size:8.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	color:black;
	mso-ansi-language:EN-AU;}
a:link, span.MsoHyperlink
	{mso-style-noshow:yes;
	mso-style-priority:99;
	color:blue;
	text-decoration:underline;
	text-underline:single;}
a:visited, span.MsoHyperlinkFollowed
	{mso-style-noshow:yes;
	mso-style-priority:99;
	color:purple;
	mso-themecolor:followedhyperlink;
	text-decoration:underline;
	text-underline:single;}
strong
	{mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-qformat:yes;
	mso-ansi-font-size:10.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:"Times New Roman","serif";
	mso-ascii-font-family:"Times New Roman";
	mso-hansi-font-family:"Times New Roman";
	mso-bidi-font-family:"Times New Roman";
	color:black;
	background:white;}
em
	{mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-qformat:yes;
	mso-ansi-font-size:10.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:"Times New Roman","serif";
	mso-ascii-font-family:"Times New Roman";
	mso-hansi-font-family:"Times New Roman";
	mso-bidi-font-family:"Times New Roman";
	color:black;
	background:white;}
p.MsoDocumentMap, li.MsoDocumentMap, div.MsoDocumentMap
	{mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-link:"Document Map Char";
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:0cm;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:8.0pt;
	font-family:"Tahoma","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
p.MsoPlainText, li.MsoPlainText, div.MsoPlainText
	{mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-link:"Plain Text Char";
	mso-style-next:Normal;
	margin:0cm;
	margin-bottom:.0001pt;
	mso-pagination:none;
	background:white;
	mso-layout-grid-align:none;
	text-autospace:none;
	font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	color:black;
	mso-ansi-language:EN-AU;}
p.MsoCommentSubject, li.MsoCommentSubject, div.MsoCommentSubject
	{mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-parent:"Comment Text";
	mso-style-link:"Comment Subject Char";
	mso-style-next:"Comment Text";
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:0cm;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;
	font-weight:bold;}
p.MsoAcetate, li.MsoAcetate, div.MsoAcetate
	{mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-link:"Balloon Text Char";
	margin:0cm;
	margin-bottom:.0001pt;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:8.0pt;
	font-family:"Tahoma","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
p.MsoListParagraph, li.MsoListParagraph, div.MsoListParagraph
	{mso-style-priority:34;
	mso-style-unhide:no;
	mso-style-qformat:yes;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:36.0pt;
	mso-add-space:auto;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:12.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
p.MsoListParagraphCxSpFirst, li.MsoListParagraphCxSpFirst, div.MsoListParag=
raphCxSpFirst
	{mso-style-priority:34;
	mso-style-unhide:no;
	mso-style-qformat:yes;
	mso-style-type:export-only;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:0cm;
	margin-left:36.0pt;
	margin-bottom:.0001pt;
	mso-add-space:auto;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:12.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
p.MsoListParagraphCxSpMiddle, li.MsoListParagraphCxSpMiddle, div.MsoListPar=
agraphCxSpMiddle
	{mso-style-priority:34;
	mso-style-unhide:no;
	mso-style-qformat:yes;
	mso-style-type:export-only;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:0cm;
	margin-left:36.0pt;
	margin-bottom:.0001pt;
	mso-add-space:auto;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:12.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
p.MsoListParagraphCxSpLast, li.MsoListParagraphCxSpLast, div.MsoListParagra=
phCxSpLast
	{mso-style-priority:34;
	mso-style-unhide:no;
	mso-style-qformat:yes;
	mso-style-type:export-only;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:36.0pt;
	mso-add-space:auto;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:12.0pt;
	mso-bidi-font-size:10.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:"Times New Roman";
	mso-fareast-language:EN-US;}
span.Heading1Char
	{mso-style-name:"Heading 1 Char";
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	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 1";
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	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	mso-font-kerning:16.0pt;
	font-weight:bold;}
span.Heading2Char
	{mso-style-name:"Heading 2 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 2";
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	mso-bidi-font-size:14.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	font-weight:bold;
	mso-bidi-font-style:italic;}
span.Heading3Char
	{mso-style-name:"Heading 3 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 3";
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	mso-bidi-font-size:13.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	font-weight:bold;}
span.Heading4Char
	{mso-style-name:"Heading 4 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 4";
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	mso-bidi-font-size:12.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:"Times New Roman";
	font-weight:bold;
	font-style:italic;
	mso-bidi-font-style:normal;}
span.Heading5Char
	{mso-style-name:"Heading 5 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 5";
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	mso-bidi-font-size:13.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	font-weight:bold;
	font-style:italic;}
span.Heading6Char
	{mso-style-name:"Heading 6 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 6";
	font-family:"Times New Roman","serif";
	mso-ascii-font-family:"Times New Roman";
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:"Times New Roman";
	mso-bidi-font-family:"Times New Roman";
	font-weight:bold;}
span.Heading7Char
	{mso-style-name:"Heading 7 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 7";
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	mso-bidi-font-size:12.0pt;
	font-family:"Times New Roman","serif";
	mso-ascii-font-family:"Times New Roman";
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:"Times New Roman";
	mso-bidi-font-family:"Times New Roman";}
span.Heading8Char
	{mso-style-name:"Heading 8 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 8";
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	mso-bidi-font-size:12.0pt;
	font-family:"Times New Roman","serif";
	mso-ascii-font-family:"Times New Roman";
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:"Times New Roman";
	mso-bidi-font-family:"Times New Roman";
	font-style:italic;}
span.Heading9Char
	{mso-style-name:"Heading 9 Char";
	mso-style-noshow:yes;
	mso-style-priority:9;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Heading 9";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;}
span.FootnoteTextChar
	{mso-style-name:"Footnote Text Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Footnote Text";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	mso-fareast-language:EN-US;}
span.CommentTextChar
	{mso-style-name:"Comment Text Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Comment Text";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	mso-fareast-language:EN-US;}
span.HeaderChar
	{mso-style-name:"Header Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:Header;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;}
span.FooterChar
	{mso-style-name:"Footer Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:Footer;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;}
span.EndnoteTextChar
	{mso-style-name:"Endnote Text Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Endnote Text";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:black;
	mso-ansi-language:EN-AU;}
span.TitleChar
	{mso-style-name:"Title Char";
	mso-style-priority:10;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:Title;
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	mso-bidi-font-size:16.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	mso-font-kerning:14.0pt;
	font-weight:bold;}
span.BodyTextChar
	{mso-style-name:"Body Text Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Body Text";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:black;
	mso-ansi-language:EN-AU;}
span.NoteHeadingChar
	{mso-style-name:"Note Heading Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Note Heading";
	font-family:"Arial","sans-serif";
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	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:black;
	mso-ansi-language:EN-AU;}
span.BodyText2Char
	{mso-style-name:"Body Text 2 Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Body Text 2";
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	font-family:"Arial","sans-serif";
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	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:black;
	mso-ansi-language:EN-AU;}
span.BodyText3Char
	{mso-style-name:"Body Text 3 Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Body Text 3";
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	font-family:"Arial","sans-serif";
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	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:black;
	mso-ansi-language:EN-AU;}
span.DocumentMapChar
	{mso-style-name:"Document Map Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Document Map";
	mso-ansi-font-size:8.0pt;
	mso-bidi-font-size:8.0pt;
	font-family:"Tahoma","sans-serif";
	mso-ascii-font-family:Tahoma;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Tahoma;
	mso-bidi-font-family:Tahoma;
	mso-fareast-language:EN-US;}
span.PlainTextChar
	{mso-style-name:"Plain Text Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Plain Text";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:black;
	mso-ansi-language:EN-AU;}
span.CommentSubjectChar
	{mso-style-name:"Comment Subject Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-parent:"Comment Text Char";
	mso-style-link:"Comment Subject";
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	mso-fareast-language:EN-US;
	font-weight:bold;}
span.BalloonTextChar
	{mso-style-name:"Balloon Text Char";
	mso-style-noshow:yes;
	mso-style-priority:99;
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Balloon Text";
	mso-ansi-font-size:8.0pt;
	mso-bidi-font-size:8.0pt;
	font-family:"Tahoma","sans-serif";
	mso-ascii-font-family:Tahoma;
	mso-fareast-font-family:"Times New Roman";
	mso-hansi-font-family:Tahoma;
	mso-bidi-font-family:Tahoma;}
span.NormalBoldChar
	{mso-style-name:"Normal Bold Char";
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Normal Bold";
	mso-ansi-font-size:12.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	font-weight:bold;
	mso-bidi-font-weight:normal;}
p.NormalBold, li.NormalBold, div.NormalBold
	{mso-style-name:"Normal Bold";
	mso-style-unhide:no;
	mso-style-link:"Normal Bold Char";
	mso-style-next:Normal;
	margin-top:6.0pt;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:0cm;
	mso-pagination:widow-orphan lines-together;
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	font-family:"Arial","sans-serif";
	mso-fareast-font-family:Calibri;
	mso-fareast-language:EN-US;
	font-weight:bold;
	mso-bidi-font-weight:normal;}
span.NormalBlueChar
	{mso-style-name:"Normal Blue Char";
	mso-style-unhide:no;
	mso-style-locked:yes;
	mso-style-link:"Normal Blue";
	mso-ansi-font-size:12.0pt;
	font-family:"Arial","sans-serif";
	mso-ascii-font-family:Arial;
	mso-hansi-font-family:Arial;
	mso-bidi-font-family:Arial;
	color:blue;}
p.NormalBlue, li.NormalBlue, div.NormalBlue
	{mso-style-name:"Normal Blue";
	mso-style-unhide:no;
	mso-style-link:"Normal Blue Char";
	mso-style-next:Normal;
	margin-top:0cm;
	margin-right:0cm;
	margin-bottom:6.0pt;
	margin-left:0cm;
	mso-pagination:widow-orphan;
	tab-stops:right 729.0pt;
	font-size:12.0pt;
	mso-bidi-font-size:11.0pt;
	font-family:"Arial","sans-serif";
	mso-fareast-font-family:Calibri;
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</head>

<body lang=3DEN-GB link=3Dblue vlink=3Dpurple style=3D'tab-interval:36.0pt'>

<div class=3DWordSection1>

<h1 style=3D'margin-left:0cm;text-indent:0cm;mso-list:none;tab-stops:36.0pt=
'><a
name=3D"_Toc295845634">Example Electronic Discharge Summary Illustration</a=
> </h1>

<p class=3DMsoNormal>This example has been provided to illustrate a data di=
splay realisation
of the detailed implementation requirements specification.<span
style=3D'mso-spacerun:yes'>&nbsp; </span>Local variation in user interface =
design
is expected &#8211; what appears in this document has been provided as an
illustrative example only.</p>

<p class=3DMsoNormal>A few items of note in understanding this example and
general issues of implementation:</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt;text-indent:-18.0pt;mso-li=
st:l0 level1 lfo4;
tab-stops:35.45pt right 729.0pt'><![if !supportLists]><span style=3D'font-f=
amily:
Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style=3D'mso-list:Ignore'>&middot;<span style=3D'font:7.0pt "Times New Roma=
n"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>This illustration is of a display of data wi=
thin
an example (completed) Discharge Summary.<span style=3D'mso-spacerun:yes'>&=
nbsp;
</span>Note that a screen designed for data input could look quite differen=
t to
this illustration, in order to support efficient and correct data confirmat=
ion
or entry (according to the guidelines for data meaning proposed in the deta=
iled
requirements).<span style=3D'mso-spacerun:yes'>&nbsp; </span>An example data
input user interface has <i style=3D'mso-bidi-font-style:normal'>not</i> be=
en
illustrated in this document.</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt;text-indent:-18.0pt;mso-li=
st:l0 level1 lfo4;
tab-stops:35.45pt right 729.0pt'><![if !supportLists]><span style=3D'font-f=
amily:
Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style=3D'mso-list:Ignore'>&middot;<span style=3D'font:7.0pt "Times New Roma=
n"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>It is not assumed that every Discharge Summa=
ry
will include data for every available section in this requirements
specification.<span style=3D'mso-spacerun:yes'>&nbsp; </span></p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt;text-indent:-18.0pt;mso-li=
st:l0 level1 lfo4;
tab-stops:35.45pt right 729.0pt'><![if !supportLists]><span style=3D'font-f=
amily:
Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style=3D'mso-list:Ignore'>&middot;<span style=3D'font:7.0pt "Times New Roma=
n"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Some sections that have no data in the examp=
le
illustration are included only to provide an overview summary of potential
content.<span style=3D'mso-spacerun:yes'>&nbsp; </span>Because of this, the
example Discharge Summary provided is greater in length than what would be
expected for the same data in implementations in general.</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt;text-indent:-18.0pt;mso-li=
st:l0 level1 lfo4;
tab-stops:35.45pt right 729.0pt'><![if !supportLists]><span style=3D'font-f=
amily:
Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style=3D'mso-list:Ignore'>&middot;<span style=3D'font:7.0pt "Times New Roma=
n"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>Whether particular data is mandatory or opti=
onal
to record or to communicate in the Discharge Summary is not determined with=
in
the LRA.<span style=3D'mso-spacerun:yes'>&nbsp; </span>The LRA focuses on e=
stablishing
common meaning and structure for data in order to support its purpose, where
data is intended to be shared (e.g. wherever this data exists or is shared,=
 it
should have the same meaning, etc.).<span style=3D'mso-spacerun:yes'>&nbsp;
</span>Issues related to standards &#8216;conformance criteria&#8217; are a
matter for standards development bodies, both professional and technical, to
address within their jurisdictions of authority.<span
style=3D'mso-spacerun:yes'>&nbsp; </span>For example, Discharge Summary con=
tent
may be mandated by professional regulatory bodies or via business contracts
related to information system development or communication.</p>

<p class=3DMsoNormal style=3D'margin-left:72.0pt;text-indent:-18.0pt;mso-li=
st:l0 level2 lfo4;
tab-stops:70.9pt right 729.0pt'><![if !supportLists]><span style=3D'font-fa=
mily:
"Courier New";mso-fareast-font-family:"Courier New"'><span style=3D'mso-lis=
t:
Ignore'>o<span style=3D'font:7.0pt "Times New Roman"'>&nbsp;&nbsp; </span><=
/span></span><![endif]>In
future, any data content that is mandated by various authorities may be
reflected as references within future versions of the LRA.<span
style=3D'mso-spacerun:yes'>&nbsp; </span>This may assist in preventing any
conflicts in conformance requirements between professional standards and
technical information system contracts in future.</p>

<p class=3DMsoNormal style=3D'margin-left:36.0pt;text-indent:-18.0pt;mso-li=
st:l0 level1 lfo4;
tab-stops:35.45pt right 729.0pt'><![if !supportLists]><span style=3D'font-f=
amily:
Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style=3D'mso-list:Ignore'>&middot;<span style=3D'font:7.0pt "Times New Roma=
n"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>It is expected that providing complete data
according to this requirements specification relies on &#8216;building
up&#8217; the Discharge Summary record content during the patient&#8217;s
hospital stay, starting with data available at admission (including,
potentially in future, data submitted to a Trust from a GP within referral
communications with respect to current diagnoses, problems, allergies, and
medications, in addition to reasons for referral).</p>

<ul style=3D'margin-top:0cm' type=3Ddisc>
 <li class=3DMsoNormal style=3D'mso-list:l0 level1 lfo4;tab-stops:36.0pt'>T=
his form
     design is an illustration only and has not been iterated and tested as=
 a
     display of data to users in its proposed context of use (e.g. for
     different Discharge Summary readers). Where possible in this illustrat=
ion,
     NHS Common User Interface (CUI) guidance has been applied to the patie=
nt
     identification, medications display and demographic information. In the
     case of medications, the format used focused on guidance that has been
     established for secondary care, and has not been validated fully as a
     display suitable for use between secondary care and other care setting=
s. </li>
</ul>

<p class=3DMsoNormal style=3D'margin-left:36.0pt;text-indent:-18.0pt;mso-li=
st:l0 level1 lfo4;
tab-stops:35.45pt right 729.0pt'><![if !supportLists]><span style=3D'font-f=
amily:
Symbol;mso-fareast-font-family:Symbol;mso-bidi-font-family:Symbol'><span
style=3D'mso-list:Ignore'>&middot;<span style=3D'font:7.0pt "Times New Roma=
n"'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
</span></span></span><![endif]>At this time, national or international stan=
dards
for displaying clinical statements that contain a mix of both coded and non=
-coded
clinical data have not been established. An option that was explored by the=
 NHS
CFH CUI team in 2009<a style=3D'mso-footnote-id:ftn1' href=3D"#_ftn1"
name=3D"_ftnref1" title=3D""><span class=3DMsoFootnoteReference><span
style=3D'mso-special-character:footnote'><![if !supportFootnotes]><span
class=3DMsoFootnoteReference><span style=3D'font-size:12.0pt;mso-bidi-font-=
size:
10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New =
Roman";
mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'=
>[1]</span></span><![endif]></span></span></a>
has been adopted for the &#8216;mock-up&#8217; user interface in this secti=
on
&#8211; with bold text indicating encoded data, separated by a &#8216;|&#82=
17;
symbol from un-bolded text indicating non-coded (limited free text annotati=
ons)
data.<span style=3D'mso-spacerun:yes'>&nbsp; </span>This convention applies=
 to
Sections 6-24 of the illustration.</p>

<span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Aria=
l","sans-serif";
mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-GB;mso-farea=
st-language:
EN-US;mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-charact=
er:line-break;
page-break-before:always'>
</span>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt'><o:p=
>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt'><!--=
[if gte vml 1]><o:wrapblock><v:shapetype
  id=3D"_x0000_t202" coordsize=3D"21600,21600" o:spt=3D"202" path=3D"m,l,21=
600r21600,l21600,xe">
  <v:stroke joinstyle=3D"miter"/>
  <v:path gradientshapeok=3D"t" o:connecttype=3D"rect"/>
 </v:shapetype><v:shape id=3D"_x0000_s1028" type=3D"#_x0000_t202" style=3D'=
position:absolute;
  margin-left:22.2pt;margin-top:94pt;width:553.8pt;height:503.1pt;z-index:2=
'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1028'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D712 style=3D'width:534.0pt;border-collapse:collapse;mso-yfti-=
tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D318 colspan=3D4 valign=3Dtop style=3D'width:238.85pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>1. GP Details</span>=
<span
       style=3D'font-size:11.0pt;mso-bidi-font-size:14.0pt;color:white'><o:=
p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt'><o:p>&nbsp;</o:p=
></span></p>
       </td>
       <td width=3D370 colspan=3D6 valign=3Dtop style=3D'width:277.5pt;back=
ground:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>2. Patient Details<o=
:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D'>GP NAME:<o:p></o:p=
></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Dr. Ja=
ne
       Anderson<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Patient
       Surname, First Name:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>SMITH,
       William (Mr)<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D'>GP IDENTIFER:<o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>G33451=
22<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-top:0cm;margin-ri=
ght:5.05pt;
       margin-bottom:0cm;margin-left:0cm;margin-bottom:.0001pt;text-align:r=
ight;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Name
       Known as:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:-423.85pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Bill<o=
:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>GP
       Practice Code:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>12345<=
o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       of Birth:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>01-Jan=
-1946<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4;height:1.0pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>GP
       Practice Address:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;mso-b=
order-top-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Northf=
ield
       Surgery<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Gender:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Male<o=
:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:5;height:1.0pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><span
       style=3D'font-size:7.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>142 St.
       Heliers Road<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>NHS
       Number:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>123 72=
8 7652<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:6;height:1.0pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Northf=
ield<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Local
       Identifier:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>987 65=
4321<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:7;height:1.0pt'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Slough=
<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Patient
       Address:</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:re=
d'><o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;mso-=
border-top-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>196
       Middleton Hall Road<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:8;height:1.0pt'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>SL3 1D=
P<o:p></o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:red'><o:p>&nbsp;</o:p></spa=
n></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Kings =
Norton<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:9;height:1.0pt'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 rowspan=3D3 valign=3Dtop style=3D'width:=
141.8pt;
       border:none;mso-border-top-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt =
0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:red'><o:p>&nbsp;</o:p></spa=
n></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Slough=
<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:10;height:1.0pt'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:11.85pt 24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:red'><o:p>&nbsp;</o:p></spa=
n></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>SL10 9=
DY<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:11;height:11.35pt'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:11.35pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D24 colspan=3D2 valign=3Dtop style=3D'width:17.65pt;paddi=
ng:0cm 5.4pt 0cm 5.4pt;
       height:11.35pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D3 style=3D'width:131.95pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:11.35pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Patient
       Telephone Number(s):<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:11.35pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>0121 4=
59
       9123<span style=3D'mso-spacerun:yes'>&nbsp; </span>(home)<o:p></o:p>=
</span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>0121 6=
28
       1112<span style=3D'mso-spacerun:yes'>&nbsp; </span>(work)<o:p></o:p>=
</span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:12'>
       <td width=3D318 colspan=3D4 valign=3Dtop style=3D'width:238.85pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>3. Admission Details=
<o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt'><o:p>&nbsp;</o:p=
></span></p>
       </td>
       <td width=3D370 colspan=3D7 valign=3Dtop style=3D'width:277.85pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>4. Discharge Details=
<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:13'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Method
       of Admission:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Planne=
d<o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       of Discharge:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>13-Nov=
-2009<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:14'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Source
       of Admission:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Usual =
place
       of residence<o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Time
       of Discharge:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>13:22<=
o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:15'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Hospital
       Site:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Readin=
g Hospital<o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Discharge
       Method:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Discha=
rged
       upon clinical advice<b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'color:red'><o:p></o:p></span></b></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:16;height:1.0pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Responsible
       Trust:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;mso-b=
order-top-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>The Ro=
yal
       Berkshire NHS <o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:1.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Type
       of Destination:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:1.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Care H=
ome<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:17;height:5.65pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:5.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Founda=
tion
       Trust<o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Destination
       Address:<o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;mso-=
border-top-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:5.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:11.0pt;font-family:"Cal=
ibri","sans-serif"'>Slough
       Care Home<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:18;height:5.65pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       of Admission:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:5.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>06-Nov=
-2009<o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:11.0pt;font-family:"Cal=
ibri","sans-serif"'>24
       The Mount<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:19;height:5.65pt'>
       <td width=3D129 style=3D'width:97.05pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Time
       of Admission:<o:p></o:p></span></b></p>
       </td>
       <td width=3D189 colspan=3D3 style=3D'width:141.8pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:5.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>09:12<=
o:p></o:p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:11.0pt;font-family:"Cal=
ibri","sans-serif"'>Slough<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:20;height:5.65pt'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 valign=3Dtop style=3D'width:141.8pt;bord=
er:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:4.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p=
></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:5.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
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       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:11.0pt;font-family:"Cal=
ibri","sans-serif"'>SL6
       6UP<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:21'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 valign=3Dtop style=3D'width:141.8pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:4.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:p=
></span></p>
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       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
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       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-top:0cm;margin-ri=
ght:0cm;
       margin-bottom:0cm;margin-left:-10.75pt;margin-bottom:.0001pt;text-al=
ign:
       right;tab-stops:right dotted 450.0pt blank 729.0pt'><b style=3D'mso-=
bidi-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       color:#1F497D;text-transform:uppercase'>Discharging Consultant:<o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Mr Greg
       Cross<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:22'>
       <td width=3D129 valign=3Dtop style=3D'width:97.05pt;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:6.0pt;mso-bidi-font-size:8.0pt;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D189 colspan=3D3 valign=3Dtop style=3D'width:141.8pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D23 valign=3Dtop style=3D'width:17.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D176 colspan=3D4 style=3D'width:132.3pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Discharging
       Specialty / Department: <o:p></o:p></span></b></p>
       </td>
       <td width=3D194 colspan=3D3 style=3D'width:145.55pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Orthop=
aedic Surgery<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:23'>
       <td width=3D400 colspan=3D7 valign=3Dtop style=3D'width:300.25pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'mso-bidi-font-size:1=
2.0pt;
       color:white'>5. Hospital Stay Responsible Consultants List<o:p></o:p=
></span></p>
       </td>
       <td width=3D312 colspan=3D5 valign=3Dtop style=3D'width:233.75pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>(1 recorded)<b><o:p>=
</o:p></b></span></p>
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      </tr>
      <tr style=3D'mso-yfti-irow:24;height:16.15pt'>
       <td width=3D151 colspan=3D2 style=3D'width:4.0cm;padding:0cm 5.4pt 0=
cm 5.4pt;
       height:16.15pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Consultant Name<o:p></o:p></span></b></p>
       </td>
       <td width=3D159 style=3D'width:119.5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:16.15pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Consultant Specialty<o:p></o:p></span></b>=
</p>
       </td>
       <td width=3D153 colspan=3D5 style=3D'width:114.85pt;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:16.15pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Consultant Treatment Specialty<o:p></o:p><=
/span></b></p>
       </td>
       <td width=3D167 colspan=3D3 style=3D'width:125.0pt;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:16.15pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Responsibility Start Date<span
       style=3D'mso-bidi-font-weight:bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D82 style=3D'width:61.25pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:16.15pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Responsibility
       End Date<span style=3D'mso-bidi-font-weight:bold'><o:p></o:p></span>=
</span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:25;mso-yfti-lastrow:yes'>
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9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Mr Greg Cross<o:p></o:p></span><=
/p>
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 #D9D9D9 1.0pt;
       border-left:none;border-bottom:solid #D9D9D9 1.0pt;border-right:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
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       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Orthopaedic Surgery<o:p></o:p></=
span></p>
       </td>
       <td width=3D153 colspan=3D5 valign=3Dtop style=3D'width:114.85pt;bor=
der-top:
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pt;
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ottom-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Orthopaedics<o:p></o:p></span></=
p>
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       <td width=3D154 colspan=3D2 valign=3Dtop style=3D'width:115.8pt;bord=
er-top:solid #D9D9D9 1.0pt;
       border-left:none;border-bottom:solid #D9D9D9 1.0pt;border-right:none;
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9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>06-Nov=
-2009<o:p></o:p></span></p>
       </td>
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r-top:solid #D9D9D9 1.0pt;
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9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>13-Nov=
-2009<o:p></o:p></span></p>
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       <td width=3D23 style=3D'border:none'></td>
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ze:16.0pt;
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der-bottom:
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ze:16.0pt;
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dowtext .5pt;
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bri","sans-serif"'>Another
       Hospital, The Royal Another NHS Foundation Trust<o:p></o:p></span></=
p>
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0pt;
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r-top-alt:
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4pt;
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idi-font-weight:
       normal'><span style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;
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<b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>SMITH,
       William<span style=3D'mso-spacerun:yes'>&nbsp; </span>(Mr)</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border:none;bor=
der-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:3.0pt'><b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D'>BORN</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>01-Jan-1946
       (63yr)</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:77.95pt;border:none;bord=
er-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:3.0pt'><b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D'>GENDER</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>Male</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D189 valign=3Dtop style=3D'width:5.0cm;border-top:none;bo=
rder-left:
       none;border-bottom:solid windowtext 1.0pt;border-right:solid windowt=
ext 1.0pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid wi=
ndowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:sol=
id windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:3.0pt'><b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D'>NHS No.</span></b>=
<b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>123
       728 7652</span><span style=3D'font-size:14.0pt;font-family:"Calibri"=
,"sans-serif"'><o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:3.0pt'><b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'font-size:9.0pt;font-family:"Calibri","sans-s=
erif";
       color:#17365D'>HOSPITAL No.</span></b><b style=3D'mso-bidi-font-weig=
ht:
       normal'><span style=3D'font-size:9.0pt;font-family:"Calibri","sans-s=
erif"'>
       </span></b><span style=3D'mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'>ABC12345</span><span
       style=3D'font-size:14.0pt;mso-bidi-font-size:9.0pt;font-family:"Cali=
bri","sans-serif"'>
       <o:p></o:p></span></p>
       </td>
      </tr>
     </table>
     <p class=3DMsoNormal><span style=3D'font-size:11.0pt;mso-bidi-font-siz=
e:10.0pt'><o:p>&nbsp;</o:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><![endif]--><![if !vml]><span style=3D'mso-ignore:vglayout;posit=
ion:
 relative;z-index:2'><span style=3D'position:absolute;left:29px;top:-15px;
 width:744px;height:816px'><img width=3D744 height=3D816
 src=3D"v0-4-1Mockup3_files/image002.gif" v:shapes=3D"_x0000_s1028 _x0000_s=
1046"></span></span><![endif]><!--[if gte vml 1]></o:wrapblock><![endif]-->=
<o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><o:p>&nbsp;<=
/o:p></p>

<p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><o:p>&nbsp;<=
/o:p></p>

<p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><o:p>&nbsp;<=
/o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;mso-p=
agination:
none;tab-stops:36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Aria=
l","sans-serif";
mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-GB;mso-farea=
st-language:
EN-US;mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-charact=
er:line-break;
page-break-before:always'>
</span>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><!--[if gte vml 1]><o:wrapblock><v:shape id=3D"_x0000=
_s1036"
  type=3D"#_x0000_t202" style=3D'position:absolute;margin-left:15.95pt;
  margin-top:-11.75pt;width:546pt;height:104.3pt;z-index:1'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1036'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D690 style=3D'width:517.4pt;margin-left:-1.7pt;border-collapse=
:collapse;
      mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D217 valign=3Dtop style=3D'width:163.05pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:18.0pt;font-family:"Ca=
libri","sans-serif"'>Discharge
       Summary<o:p></o:p></span></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D293 colspan=3D2 valign=3Dtop style=3D'width:219.7pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB;mso-no-proof:yes'><v:shape id=3D"Picture_x0020_4" o:spid=3D"_x=
0000_i1029"
        type=3D"#_x0000_t75" alt=3D"nhs_logo_transparent.png" style=3D'widt=
h:70.5pt;
        height:27.75pt;visibility:visible;mso-wrap-style:square'>
        <v:imagedata src=3D"v0-4-1Mockup3_files/image001.png" o:title=3D"nh=
s_logo_transparent"/>
       </v:shape></span><span style=3D'mso-bidi-font-size:16.0pt;font-famil=
y:
       "Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:15.4pt'>
       <td width=3D217 valign=3Dtop style=3D'width:163.05pt;border:none;bor=
der-bottom:
       solid windowtext 1.0pt;mso-border-bottom-alt:solid windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:5.0pt;mso-bidi-font-si=
ze:16.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border:none;bor=
der-bottom:
       solid windowtext 1.0pt;mso-border-bottom-alt:solid windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:5.0pt;mso-bidi-font-si=
ze:16.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D293 colspan=3D2 valign=3Dtop style=3D'width:219.7pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><span style=3D'font-size:8.0pt;mso-bidi-fo=
nt-size:
       10.0pt;font-family:"Calibri","sans-serif"'>Another Hospital, The Roy=
al
       Another NHS Foundation Trust<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:44.25pt'>
       <td width=3D217 valign=3Dtop style=3D'width:163.05pt;border-top:none;
       border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.=
0pt;
       border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-borde=
r-top-alt:
       solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.=
4pt;
       height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>PATIENT</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>SMITH,
       William<span style=3D'mso-spacerun:yes'>&nbsp; </span>(Mr)</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border:none;bor=
der-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>BORN</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>01-Jan-1946
       (63yr)</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
       <td width=3D113 valign=3Dtop style=3D'width:3.0cm;border:none;border=
-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>GENDER</span></b><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>Male</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border-top:none;
       border-left:none;border-bottom:solid windowtext 1.0pt;border-right:s=
olid windowtext 1.0pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid wi=
ndowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:sol=
id windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>NHS No.</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>123
       728 7652</span><span style=3D'font-size:14.0pt;font-family:"Calibri"=
,"sans-serif"'><o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif";color:#1=
7365D'>HOSPITAL
       No.</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif"'> </span=
></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>ABC12345</span><span
       style=3D'font-size:14.0pt;mso-bidi-font-size:9.0pt;font-family:"Cali=
bri","sans-serif"'>
       </span><b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-=
size:
       9.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
      </tr>
     </table>
     <p class=3DMsoNormal><span style=3D'font-size:3.0pt;mso-bidi-font-size=
:10.0pt'><o:p>&nbsp;</o:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><v:shape id=3D"_x0000_s1058" type=3D"#_x0000_t202" style=3D'posi=
tion:absolute;
  margin-left:15.95pt;margin-top:94.3pt;width:546pt;height:647.1pt;z-index:=
10'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1058'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D688 style=3D'width:515.7pt;border-collapse:collapse;mso-yfti-=
tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.35pt'>
       <td width=3D489 colspan=3D4 valign=3Dtop style=3D'width:366.85pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.35pt'>
       <p class=3DMsoNormal style=3D'margin-top:0cm;margin-right:11.05pt;
       margin-bottom:0cm;margin-left:0cm;margin-bottom:.0001pt;tab-stops:71=
.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>6. All Current Diagn=
oses
       at Discharge<span style=3D'mso-spacerun:yes'>&nbsp; </span><o:p></o:=
p></span></p>
       </td>
       <td width=3D198 colspan=3D2 valign=3Dtop style=3D'width:148.85pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.35pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:44.2pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>(6 recorded)<o:p></o=
:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:29.55pt'>
       <td width=3D234 style=3D'width:175.5pt;border:none;border-bottom:sol=
id #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Diagnosis<span style=3D'mso-bidi-font-weig=
ht:
       bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D104 style=3D'width:78.0pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Date Diagnosis Made<o:p></o:p></span></b><=
/p>
       </td>
       <td width=3D132 style=3D'width:99.2pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Person Responsible <o:p></o:p></span></b><=
/p>
       </td>
       <td width=3D123 colspan=3D2 style=3D'width:92.15pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Treatment Specialty<o:p></o:p></span></b><=
/p>
       </td>
       <td width=3D94 style=3D'width:70.85pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       of first Presentation<o:p></o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'>Ost=
eoarthritis
       of knee - right</span></b><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:78.0pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>10-Sep-2009<o:p></o:p></span></p>
       </td>
       <td width=3D132 valign=3Dtop style=3D'width:99.2pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Mr Greg
       Cross<o:p></o:p></span></p>
       </td>
       <td width=3D123 colspan=3D2 valign=3Dtop style=3D'width:92.15pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Orthop=
aedics<o:p></o:p></span></p>
       </td>
       <td width=3D94 valign=3Dtop style=3D'width:70.85pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>May-20=
09<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><span style=3D'mso-spacerun:yes'>&nbsp; </span></span></i><b
       style=3D'mso-bidi-font-weight:normal'><i style=3D'mso-bidi-font-styl=
e:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       mso-bidi-font-family:Calibri'>A complication of<o:p></o:p></span></i=
></b></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
       </span><b style=3D'mso-bidi-font-weight:normal'>Fractured knee-cap &=
#8211;
       right <o:p></o:p></b></span></i></p>
       </td>
       <td width=3D104 style=3D'width:78.0pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><i style=3D'mso-bidi-font-style:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>17-Jun-2006<o:p></o:p></span></i></p>
       </td>
       <td width=3D132 style=3D'width:99.2pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'>Mr. Gr=
eg
       Cross<o:p></o:p></span></i></p>
       </td>
       <td width=3D123 colspan=3D2 style=3D'width:92.15pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><i style=3D'mso-bidi-font-style:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>Orthopaedics<o:p></o:p></span></i></p>
       </td>
       <td width=3D94 style=3D'width:70.85pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'>16-Jun=
-2006<o:p></o:p></span></i></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'>Ana=
emia</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:78.0pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>02-Oct-2008<o:p></o:p></span></p>
       </td>
       <td width=3D132 valign=3Dtop style=3D'width:99.2pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Dr. Ja=
ne
       Anderson<o:p></o:p></span></p>
       </td>
       <td width=3D123 colspan=3D2 valign=3Dtop style=3D'width:92.15pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>General
       Practice<o:p></o:p></span></p>
       </td>
       <td width=3D94 valign=3Dtop style=3D'width:70.85pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>25-Sep=
-2008<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:5;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'>COP=
D-Chronic
       obstructive pulmonary disease<o:p></o:p></span></b></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:78.0pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>07-Aug-2006<o:p></o:p></span></p>
       </td>
       <td width=3D132 valign=3Dtop style=3D'width:99.2pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Dr. Ja=
ne
       Anderson<o:p></o:p></span></p>
       </td>
       <td width=3D123 colspan=3D2 valign=3Dtop style=3D'width:92.15pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>General
       Practice<o:p></o:p></span></p>
       </td>
       <td width=3D94 valign=3Dtop style=3D'width:70.85pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Jun-20=
06<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:6;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'>Pos=
t-operative
       pneumonia<o:p></o:p></span></b></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:78.0pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>08-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D132 valign=3Dtop style=3D'width:99.2pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Mr. Je=
remy
       Jones<o:p></o:p></span></p>
       </td>
       <td width=3D123 colspan=3D2 valign=3Dtop style=3D'width:92.15pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>Respiratory
       Medicine<o:p></o:p></span></p>
       </td>
       <td width=3D94 valign=3Dtop style=3D'width:70.85pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>08-Nov=
-2009<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:7;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><span style=3D'mso-spacerun:yes'>&nbsp; </span></span></i><b
       style=3D'mso-bidi-font-weight:normal'><i style=3D'mso-bidi-font-styl=
e:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       mso-bidi-font-family:Calibri'>A complication of<o:p></o:p></span></i=
></b></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><i style=3D'mso-bidi-font-styl=
e:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif";
       mso-bidi-font-family:Calibri'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
       </span>Primary cemented total knee<o:p></o:p></span></i></b></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><i style=3D'mso-bidi-font-styl=
e:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif";
       mso-bidi-font-family:Calibri'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;
       </span>replacement &#8211; right<o:p></o:p></span></i></b></p>
       </td>
       <td width=3D104 style=3D'width:78.0pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><i style=3D'mso-bidi-font-style:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>06-Nov-2006<o:p></o:p></span></i></p>
       </td>
       <td width=3D132 style=3D'width:99.2pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'>Mr. Gr=
eg
       Cross<o:p></o:p></span></i></p>
       </td>
       <td width=3D123 colspan=3D2 style=3D'width:92.15pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;text-align:justify'><i style=3D'mso-bidi-font-=
style:
       normal'><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;
       font-family:"Calibri","sans-serif"'>Orthopaedics<o:p></o:p></span></=
i></p>
       </td>
       <td width=3D94 style=3D'width:70.85pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><i
       style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></i></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:8;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'>Hyp=
otension<o:p></o:p></span></b></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:78.0pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>09-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D132 valign=3Dtop style=3D'width:99.2pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Mr. Gr=
eg
       Cross<o:p></o:p></span></p>
       </td>
       <td width=3D123 colspan=3D2 valign=3Dtop style=3D'width:92.15pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>Orthopaedics<o:p></o:p></span></p>
       </td>
       <td width=3D94 valign=3Dtop style=3D'width:70.85pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>09-Nov=
-2009<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:9;mso-yfti-lastrow:yes;height:12.25pt'>
       <td width=3D234 valign=3Dtop style=3D'width:175.5pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'>Sen=
sorineural
       hearing loss &#8211; left <o:p></o:p></span></b></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:78.0pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center;tab-stops:
       71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>Jun-2002<o:p></o:p></span></p>
       </td>
       <td width=3D132 valign=3Dtop style=3D'width:99.2pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Dr. An=
ne
       Bond<o:p></o:p></span></p>
       </td>
       <td width=3D123 colspan=3D2 valign=3Dtop style=3D'width:92.15pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>Otolaryngology<o:p></o:p></span></p>
       </td>
       <td width=3D94 valign=3Dtop style=3D'width:70.85pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-top:3.0pt;margin=
-right:
       0cm;margin-bottom:3.0pt;margin-left:0cm;text-align:center'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Jan-20=
02<o:p></o:p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D234 style=3D'border:none'></td>
       <td width=3D104 style=3D'border:none'></td>
       <td width=3D132 style=3D'border:none'></td>
       <td width=3D19 style=3D'border:none'></td>
       <td width=3D104 style=3D'border:none'></td>
       <td width=3D94 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt'=
><span
     style=3D'font-size:5.0pt;mso-bidi-font-size:6.0pt;font-family:"Calibri=
","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt'=
><span
     style=3D'font-size:5.0pt;mso-bidi-font-size:6.0pt;font-family:"Calibri=
","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D688 style=3D'width:515.7pt;border-collapse:collapse;mso-yfti-=
tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D430 colspan=3D7 valign=3Dtop style=3D'width:322.15pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>7. Other Significant
       Problems at Discharge</span><b style=3D'mso-bidi-font-weight:normal'=
><span
       style=3D'mso-bidi-font-size:12.0pt'><o:p></o:p></span></b></p>
       </td>
       <td width=3D143 colspan=3D2 valign=3Dtop style=3D'width:107.4pt;back=
ground:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D115 colspan=3D2 valign=3Dtop style=3D'width:86.15pt;back=
ground:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><span style=3D'font-size:11.0pt;mso-bidi-f=
ont-size:
       14.0pt;font-family:"Calibri","sans-serif";color:white'><o:p>&nbsp;</=
o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:29.55pt'>
       <td width=3D187 colspan=3D2 style=3D'width:140.1pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-top:6.0pt;tab-stops:71.35pt rig=
ht 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Problem<span
       style=3D'mso-bidi-font-weight:bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D123 colspan=3D2 style=3D'width:92.1pt;border:none;border=
-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:29.55pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       problem Recorded<o:p></o:p></span></b></p>
       </td>
       <td width=3D180 colspan=3D4 style=3D'width:134.7pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:29.55pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Person
       Responsible for Recording<o:p></o:p></span></b></p>
       </td>
       <td width=3D113 colspan=3D2 style=3D'width:3.0cm;border:none;border-=
bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:29.55pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Treatment
       Specialty<o:p></o:p></span></b></p>
       </td>
       <td width=3D85 style=3D'width:63.75pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-left:-5.4pt;tab-stops:71.35pt r=
ight 729.0pt'><b><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Date of first Presentation<o:p></o:p></spa=
n></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;height:12.25pt'>
       <td width=3D234 colspan=3D3 valign=3Dtop style=3D'width:175.5pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D113 colspan=3D3 valign=3Dtop style=3D'width:3.0cm;border=
:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D142 colspan=3D2 valign=3Dtop style=3D'width:106.35pt;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D113 colspan=3D2 valign=3Dtop style=3D'width:3.0cm;border=
:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 valign=3Dtop style=3D'width:63.75pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3'>
       <td width=3D573 colspan=3D9 valign=3Dtop style=3D'width:429.55pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>8. Operations and
       Significant Procedures</span><b style=3D'mso-bidi-font-weight:normal=
'><span
       style=3D'mso-bidi-font-size:12.0pt'><o:p></o:p></span></b></p>
       </td>
       <td width=3D115 colspan=3D2 valign=3Dtop style=3D'width:86.15pt;back=
ground:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><span style=3D'mso-bidi-font-size:12.0pt;
       color:white'>(1 recorded)<b style=3D'mso-bidi-font-weight:normal'><o=
:p></o:p></b></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4'>
       <td width=3D158 style=3D'width:118.75pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Procedure Description:<o:p></o:p></span></=
b></p>
       </td>
       <td width=3D529 colspan=3D10 valign=3Dtop style=3D'width:396.95pt;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Primary
       cemented total knee replacement &#8211; right<o:p></o:p></span></b><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:5'>
       <td width=3D158 style=3D'width:118.75pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Reason for Procedure:<o:p></o:p></span></b=
></p>
       </td>
       <td width=3D529 colspan=3D10 valign=3Dtop style=3D'width:396.95pt;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Osteoa=
rthritis
       of knee &#8211; right<o:p></o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:6'>
       <td width=3D158 style=3D'width:118.75pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Procedure Comments:<o:p></o:p></span></b><=
/p>
       </td>
       <td width=3D529 colspan=3D10 valign=3Dtop style=3D'width:396.95pt;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>Due
       to mild anaemia prior to surgery and subsequent operative blood loss,
       required a blood transfusion of three units<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:7'>
       <td width=3D158 style=3D'width:118.75pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Procedure Complications:<o:p></o:p></span>=
</b></p>
       </td>
       <td width=3D529 colspan=3D10 style=3D'width:396.95pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Intrao=
perative
       haemorrhage<o:p></o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:8'>
       <td width=3D158 style=3D'width:118.75pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Date Performed:<o:p></o:p></span></b></p>
       </td>
       <td width=3D529 colspan=3D10 valign=3Dtop style=3D'width:396.95pt;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>06-Nov-2009<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:9;mso-yfti-lastrow:yes'>
       <td width=3D158 style=3D'width:118.75pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Consultant Responsible:<o:p></o:p></span><=
/b></p>
       </td>
       <td width=3D170 colspan=3D4 valign=3Dtop style=3D'width:127.6pt;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'>Mr.
       Greg Cross<o:p></o:p></span></p>
       </td>
       <td width=3D19 valign=3Dtop style=3D'width:14.2pt;border-top:solid #=
D9D9D9 1.0pt;
       border-left:none;border-bottom:solid #D9D9D9 1.0pt;border-right:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D142 colspan=3D2 valign=3Dtop style=3D'width:106.35pt;bor=
der-top:
       solid #D9D9D9 1.0pt;border-left:none;border-bottom:solid #D9D9D9 1.0=
pt;
       border-right:none;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-b=
ottom-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D198 colspan=3D3 valign=3Dtop style=3D'width:148.8pt;bord=
er-top:solid #D9D9D9 1.0pt;
       border-left:none;border-bottom:solid #D9D9D9 1.0pt;border-right:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:8.0pt;mso-bidi-font-si=
ze:10.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D158 style=3D'border:none'></td>
       <td width=3D28 style=3D'border:none'></td>
       <td width=3D47 style=3D'border:none'></td>
       <td width=3D76 style=3D'border:none'></td>
       <td width=3D19 style=3D'border:none'></td>
       <td width=3D19 style=3D'border:none'></td>
       <td width=3D82 style=3D'border:none'></td>
       <td width=3D60 style=3D'border:none'></td>
       <td width=3D84 style=3D'border:none'></td>
       <td width=3D30 style=3D'border:none'></td>
       <td width=3D85 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
     line-height:150%'><span style=3D'font-size:7.0pt;mso-bidi-font-size:8.=
0pt;
     line-height:150%;font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p>=
</span></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D678 style=3D'width:508.65pt;border-collapse:collapse;mso-yfti=
-tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:17.25pt'>
       <td width=3D347 colspan=3D2 valign=3Dtop style=3D'width:260.55pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:17.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>9. Reason for Admiss=
ion
       and Presenting Complaints<o:p></o:p></span></p>
       </td>
       <td width=3D28 rowspan=3D2 valign=3Dtop style=3D'width:21.3pt;paddin=
g:0cm 5.4pt 0cm 5.4pt;
       height:17.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif";
       color:white'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D302 colspan=3D2 valign=3Dtop style=3D'width:8.0cm;backgr=
ound:black;
       padding:0cm 5.4pt 0cm 5.4pt;height:17.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>10. Mental Capacity =
and
       Advance Decisions<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:17.25pt'>
       <td width=3D140 style=3D'width:104.65pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:17.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Reasons
       for Admission:<o:p></o:p></span></b></p>
       </td>
       <td width=3D208 style=3D'width:155.9pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:17.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:24.0pt right dotted 450.0pt blank 72=
9.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif"'>Elective - total replacement of
       right knee joint<o:p></o:p></span></b></p>
       </td>
       <td width=3D208 style=3D'width:155.9pt;background:white;padding:0cm =
5.4pt 0cm 5.4pt;
       height:17.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Mental
       Capacity:<o:p></o:p></span></b></p>
       </td>
       <td width=3D95 valign=3Dtop style=3D'width:70.9pt;border:none;border=
-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;backgro=
und:
       white;padding:0cm 5.4pt 0cm 5.4pt;height:17.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2'>
       <td width=3D140 style=3D'width:104.65pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Presenting
       Complaints:<o:p></o:p></span></b></p>
       </td>
       <td width=3D208 valign=3Dtop style=3D'width:155.9pt;border-top:solid=
 #D9D9D9 1.0pt;
       border-left:none;border-bottom:solid #D9D9D9 1.0pt;border-right:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td width=3D28 valign=3Dtop style=3D'width:21.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:24.0pt right dotted 450.0pt =
blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D208 style=3D'width:155.9pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Advance
       Decisions to Refuse Treatment (including resuscitation status:<o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D95 valign=3Dtop style=3D'width:70.9pt;border:none;border=
-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif"'>None<o:p></o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3;mso-yfti-lastrow:yes'>
       <td width=3D140 style=3D'width:104.65pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>DATE
       of onset for presenting complaint:</span></b><b style=3D'mso-bidi-fo=
nt-weight:
       normal'><span style=3D'font-size:7.0pt;mso-bidi-font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D208 valign=3Dtop style=3D'width:155.9pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td width=3D28 valign=3Dtop style=3D'width:21.3pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D208 style=3D'width:155.9pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:24.0pt right dotted 450.0pt blank=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Link
       to ADRT document<o:p></o:p></span></b></p>
       </td>
       <td width=3D95 valign=3Dtop style=3D'width:70.9pt;border:none;border=
-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:24.0pt right dotted 450.0pt blank 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
      </tr>
     </table>
     <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin-b=
ottom:
     .0001pt;text-align:right'><span style=3D'font-size:9.0pt;mso-bidi-font=
-size:
     10.0pt;font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin-b=
ottom:
     .0001pt;text-align:right'><span style=3D'font-size:9.0pt;mso-bidi-font=
-size:
     10.0pt;font-family:"Calibri","sans-serif"'>Screen <b style=3D'mso-bidi=
-font-weight:
     normal'>2</b> of <b style=3D'mso-bidi-font-weight:normal'>6<span
     style=3D'color:white;mso-themecolor:background1'>..</span></b><o:p></o=
:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><![endif]--><![if !vml]><span style=3D'mso-ignore:vglayout;posit=
ion:
 relative;z-index:1'><span style=3D'position:absolute;left:20px;top:-17px;
 width:734px;height:1011px'><img width=3D734 height=3D1011
 src=3D"v0-4-1Mockup3_files/image003.gif" v:shapes=3D"_x0000_s1036 _x0000_s=
1058"></span></span><![endif]><!--[if gte vml 1]></o:wrapblock><![endif]-->=
<o:p>&nbsp;</o:p></p>

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<span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Aria=
l","sans-serif";
mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-GB;mso-farea=
st-language:
EN-US;mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-charact=
er:line-break;
page-break-before:always'>
</span>

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tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><!--[if gte vml 1]><o:wrapblock><v:shape id=3D"_x0000=
_s1050"
  type=3D"#_x0000_t202" style=3D'position:absolute;margin-left:14.4pt;margi=
n-top:-3.45pt;
  width:545.55pt;height:99pt;z-index:9'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1050'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D699 style=3D'width:524.5pt;margin-left:-1.7pt;border-collapse=
:collapse;
      mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:18.0pt;font-family:"Ca=
libri","sans-serif"'>Discharge
       Summary<o:p></o:p></span></p>
       </td>
       <td width=3D133 valign=3Dtop style=3D'width:100.1pt;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D293 colspan=3D2 valign=3Dtop style=3D'width:219.7pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB;mso-no-proof:yes'><v:shape id=3D"Picture_x0020_6" o:spid=3D"_x=
0000_i1028"
        type=3D"#_x0000_t75" alt=3D"nhs_logo_transparent.png" style=3D'widt=
h:70.5pt;
        height:27.75pt;visibility:visible;mso-wrap-style:square'>
        <v:imagedata src=3D"v0-4-1Mockup3_files/image001.png" o:title=3D"nh=
s_logo_transparent"/>
       </v:shape></span><span style=3D'mso-bidi-font-size:16.0pt;font-famil=
y:
       "Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:8.5pt'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.5pt'>
       <p class=3DMsoNormal><span style=3D'font-size:2.0pt;mso-bidi-font-si=
ze:16.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D133 valign=3Dtop style=3D'width:100.1pt;border:none;bord=
er-bottom:
       solid windowtext 1.0pt;mso-border-bottom-alt:solid windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.5pt'>
       <p class=3DMsoNormal><span style=3D'font-size:2.0pt;mso-bidi-font-si=
ze:16.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D293 colspan=3D2 valign=3Dtop style=3D'width:219.7pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>Another
       Hospital, The Royal Another NHS Foundation Trust<o:p></o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:39.15pt'>
       <td width=3D208 valign=3Dtop style=3D'width:155.95pt;border-top:none;
       border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.=
0pt;
       border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-borde=
r-top-alt:
       solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.=
4pt;
       height:39.15pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>PATIENT</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>SMITH,
       William<span style=3D'mso-spacerun:yes'>&nbsp; </span>(Mr)</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D198 colspan=3D2 valign=3Dtop style=3D'width:148.85pt;bor=
der:none;
       border-bottom:solid windowtext 1.0pt;mso-border-top-alt:solid window=
text .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:39.15pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>BORN</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>01-Jan-1946
       (63yr)</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
       <td width=3D123 valign=3Dtop style=3D'width:92.15pt;border:none;bord=
er-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:39.15pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>GENDER</span></b><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>Male</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border-top:none;
       border-left:none;border-bottom:solid windowtext 1.0pt;border-right:s=
olid windowtext 1.0pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid wi=
ndowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:sol=
id windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:39.15pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>NHS No.</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>123
       728 7652</span><span style=3D'font-size:14.0pt;font-family:"Calibri"=
,"sans-serif"'><o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       0cm;margin-left:0cm;margin-bottom:.0001pt'><b style=3D'mso-bidi-font=
-weight:
       normal'><span style=3D'font-size:9.0pt;font-family:"Calibri","sans-s=
erif";
       color:#17365D'>HOSPITAL No.</span></b><b style=3D'mso-bidi-font-weig=
ht:
       normal'><span style=3D'font-size:9.0pt;font-family:"Calibri","sans-s=
erif"'>
       </span></b><span style=3D'mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'>ABC12345</span><span
       style=3D'font-size:14.0pt;mso-bidi-font-size:9.0pt;font-family:"Cali=
bri","sans-serif"'>
       </span><b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-=
size:
       9.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D208 style=3D'border:none'></td>
       <td width=3D65 style=3D'border:none'></td>
       <td width=3D133 style=3D'border:none'></td>
       <td width=3D123 style=3D'border:none'></td>
       <td width=3D170 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal><span style=3D'font-size:11.0pt;mso-bidi-font-siz=
e:10.0pt'><o:p>&nbsp;</o:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
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tion:absolute;
  margin-left:14.4pt;margin-top:92.15pt;width:545.55pt;height:594.6pt;
  z-index:11'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1056'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D"102%" style=3D'width:102.34%;border-collapse:collapse;mso-yf=
ti-tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.95pt;
       mso-row-margin-right:2.18%'>
       <td width=3D"34%" colspan=3D3 valign=3Dtop style=3D'width:34.16%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'mso-bidi-font-size:1=
2.0pt;
       color:white'>11. Allergies<span style=3D'mso-spacerun:yes'>&nbsp; </=
span><o:p></o:p></span></p>
       </td>
       <td width=3D"3%" valign=3Dtop style=3D'width:3.54%;background:black;
       padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'><o:p>&nbsp;</o:p></s=
pan></p>
       </td>
       <td width=3D"60%" colspan=3D5 valign=3Dtop style=3D'width:60.12%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>(2 recorded)<o:p></o=
:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"2%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:29.55pt;mso-row-margin-right:2.36=
%'>
       <td width=3D"12%" style=3D'width:12.94%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Causative Agent<span style=3D'mso-bidi-fon=
t-weight:
       bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"9%" style=3D'width:9.26%;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Type of Causative Agent<o:p></o:p></span><=
/b></p>
       </td>
       <td width=3D"11%" style=3D'width:11.96%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Probability of Causation<o:p></o:p></span>=
</b></p>
       </td>
       <td width=3D"10%" colspan=3D2 style=3D'width:10.6%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>New Propensity Flag<o:p></o:p></span></b><=
/p>
       </td>
       <td width=3D"29%" style=3D'width:29.18%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><b><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>New Reaction Description<o:p></o:p></span>=
</b></p>
       </td>
       <td width=3D"13%" style=3D'width:13.26%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       of Identification<span style=3D'mso-bidi-font-weight:bold'><o:p></o:=
p></span></span></b></p>
       </td>
       <td width=3D"10%" style=3D'width:10.42%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:29.55pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Clinical
       Notes<o:p></o:p></span></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;border-bottom:=
solid #D9D9D9 1.0pt'
       width=3D"2%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;height:12.25pt'>
       <td width=3D"12%" style=3D'width:12.94%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>penicillin</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"9%" style=3D'width:9.26%;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Drug<o=
:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" style=3D'width:11.96%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"10%" colspan=3D2 style=3D'width:10.6%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"29%" style=3D'width:29.18%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td width=3D"13%" style=3D'width:13.26%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>11-Jan=
-2001<o:p></o:p></span></p>
       </td>
       <td width=3D"10%" colspan=3D2 style=3D'width:10.6%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td width=3D"2%" valign=3Dtop style=3D'width:2.18%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3;mso-yfti-lastrow:yes;height:12.25pt'>
       <td width=3D"12%" style=3D'width:12.94%;border:none;mso-border-top-a=
lt:solid #D9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>metoprolol</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"9%" style=3D'width:9.26%;border:none;mso-border-top-alt=
:solid #D9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Drug<o=
:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" style=3D'width:11.96%;border:none;mso-border-top-a=
lt:solid #D9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Probab=
ly
       present<o:p></o:p></span></b></p>
       </td>
       <td width=3D"10%" colspan=3D2 style=3D'width:10.6%;border:none;mso-b=
order-top-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>New<o:=
p></o:p></span></p>
       </td>
       <td width=3D"29%" style=3D'width:29.18%;border:none;mso-border-top-a=
lt:solid #D9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif"'>Acute exacerbation of chronic
       obstructive airways disease<o:p></o:p></span></b></p>
       </td>
       <td width=3D"13%" style=3D'width:13.26%;border:none;mso-border-top-a=
lt:solid #D9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>08-Nov=
-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"10%" colspan=3D2 valign=3Dtop style=3D'width:10.6%;bord=
er:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center'><span style=3D'font-size:11.0pt;font-fami=
ly:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"2%" valign=3Dtop style=3D'width:2.18%;border:none;mso-b=
order-top-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D94 style=3D'border:none'></td>
       <td width=3D67 style=3D'border:none'></td>
       <td width=3D87 style=3D'border:none'></td>
       <td width=3D26 style=3D'border:none'></td>
       <td width=3D51 style=3D'border:none'></td>
       <td width=3D211 style=3D'border:none'></td>
       <td width=3D96 style=3D'border:none'></td>
       <td width=3D76 style=3D'border:none'></td>
       <td width=3D1 style=3D'border:none'></td>
       <td width=3D16 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
     line-height:150%'><span style=3D'font-size:4.0pt;line-height:150%;
     font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D"102%" style=3D'width:102.28%;margin-left:-1.05pt;border-coll=
apse:
      collapse;mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.95pt;
       mso-row-margin-left:.2%;mso-row-margin-right:2.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"42%" colspan=3D9 valign=3Dtop style=3D'width:42.42%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'mso-bidi-font-size:1=
2.0pt;
       color:white'>12. Risks and Warnings<span style=3D'mso-spacerun:yes'>=
&nbsp;
       </span><o:p></o:p></span></p>
       </td>
       <td width=3D"55%" colspan=3D16 valign=3Dtop style=3D'width:55.36%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>(1 recorded)<o:p></o=
:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"2%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:16.05pt;mso-row-margin-left:.2%;
       mso-row-margin-right:2.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"52%" colspan=3D12 style=3D'width:52.76%;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Risk Description<span style=3D'mso-bidi-fo=
nt-weight:
       bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"14%" colspan=3D3 style=3D'width:14.58%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Risk Category<o:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" colspan=3D4 style=3D'width:11.9%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Risk Probability<o:p></o:p></span></b></p>
       </td>
       <td width=3D"18%" colspan=3D6 style=3D'width:18.52%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Other Risk Information<o:p></o:p></span></=
b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"2%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;height:12.25pt;mso-row-margin-left:.2%;
       mso-row-margin-right:2.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"52%" colspan=3D12 valign=3Dtop style=3D'width:52.76%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif"'>Risk of &#8211; pressure sores</=
span></b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'> | due=
 to
       easily damaged skin<o:p></o:p></span></p>
       </td>
       <td width=3D"14%" colspan=3D3 valign=3Dtop style=3D'width:14.58%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Risk to
       patient<o:p></o:p></span></p>
       </td>
       <td width=3D"11%" colspan=3D4 valign=3Dtop style=3D'width:11.9%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td width=3D"18%" colspan=3D6 valign=3Dtop style=3D'width:18.52%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"2%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:3;mso-row-margin-left:.2%;mso-row-margin-r=
ight:
       3.58%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"96%" colspan=3D23 valign=3Dtop style=3D'width:96.22%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>13. Clinical Narrati=
ve or
       Other Significant Information</span><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;color:white'><o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D4><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:4;mso-row-margin-left:.2%;mso-row-margin-r=
ight:
       3.58%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"12%" valign=3Dtop style=3D'width:12.46%;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'><o:p>&nbsp;</o:p></s=
pan></b></p>
       <p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Description:</span><=
/b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:7.0pt;
       mso-bidi-font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'><o:p></o:p></span></=
b></p>
       </td>
       <td width=3D"83%" colspan=3D22 valign=3Dtop style=3D'width:83.78%;pa=
dding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><span style=3D'font-size:11.0pt;font-family:"=
Calibri","sans-serif";
       mso-bidi-font-family:Calibri'>Admitted for elective, right Total Knee
       Replacement. Day 3, developed bilateral basal atelectasis. The FBC s=
howed
       high WCC and high neutrophils. Commenced on doxycycline and chest
       physio. Due to mild anaemia prior to surgery and subsequent operative
       blood loss, required a blood transfusion of three units. Subsequently
       made steady progress, regaining good mobility in his knee and is abl=
e to
       mobilise with the aid of a stick. Right knee Xray showed no fracture=
 or
       dislocation, with the total knee prosthesis well positioned post
       surgery.<span style=3D'mso-bidi-font-weight:bold'><o:p></o:p></span>=
</span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D4><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:5;height:14.95pt;mso-row-margin-left:.22%;
       mso-row-margin-right:1.78%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"98%" colspan=3D26 valign=3Dtop style=3D'width:98.02%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'mso-bidi-font-size:1=
4.0pt;
       color:white'>14. Significant Investigations and Results<span
       style=3D'mso-spacerun:yes'>&nbsp; </span><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span>(3
       recorded)<o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"1%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:6;height:19.8pt;mso-row-margin-left:.22%;
       mso-row-margin-right:1.78%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"14%" colspan=3D2 style=3D'width:14.28%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Department<span style=3D'mso-bidi-font-wei=
ght:
       bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D3 style=3D'width:12.06%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Investigation<o:p></o:p></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Reason for investigation<o:p></o:p></span>=
</b></p>
       </td>
       <td width=3D"13%" colspan=3D3 style=3D'width:13.24%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Date Performed<o:p></o:p></span></b></p>
       </td>
       <td width=3D"13%" colspan=3D3 style=3D'width:13.28%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>RESULT<o:p></o:p></span></b></p>
       </td>
       <td width=3D"13%" colspan=3D4 style=3D'width:13.22%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Clinical
       Interpretation<o:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" colspan=3D4 valign=3Dtop style=3D'width:11.88%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>reference range<span style=3D'mso-bidi-fon=
t-weight:
       bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"7%" colspan=3D4 style=3D'width:7.98%;border:none;border=
-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.8pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Result
       STATUS<o:p></o:p></span></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;border-bottom:=
solid #D9D9D9 1.0pt'
       width=3D"1%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:7;height:12.25pt;mso-row-margin-left:.22%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"14%" colspan=3D2 valign=3Dtop style=3D'width:14.28%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Haematology <o:p></o:p></span></=
p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>White =
cell
       count<o:p></o:p></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 valign=3Dtop style=3D'width:13.24%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>10-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 valign=3Dtop style=3D'width:13.28%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>20.0 x
       10^9/L<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D4 valign=3Dtop style=3D'width:13.22%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>HIGH<o=
:p></o:p></span></p>
       </td>
       <td width=3D"11%" colspan=3D4 valign=3Dtop style=3D'width:11.88%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>3.8 to=
 10.8
       x 10^9/L,<o:p></o:p></span></p>
       </td>
       <td width=3D"9%" colspan=3D5 valign=3Dtop style=3D'width:9.76%;borde=
r:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Final<=
o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:8;height:12.25pt;mso-row-margin-left:.22%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"14%" colspan=3D2 valign=3Dtop style=3D'width:14.28%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Haematology<o:p></o:p></span></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Neutro=
phil
       cell count<o:p></o:p></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 valign=3Dtop style=3D'width:13.24%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>10-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 valign=3Dtop style=3D'width:13.28%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>14.7x1=
0^9/L<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D4 valign=3Dtop style=3D'width:13.22%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>HIGH<i
       style=3D'mso-bidi-font-style:normal'><o:p></o:p></i></span></p>
       </td>
       <td width=3D"11%" colspan=3D4 valign=3Dtop style=3D'width:11.88%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>2.0 to=
 7.5 x
       10^9/L<o:p></o:p></span></p>
       </td>
       <td width=3D"9%" colspan=3D5 valign=3Dtop style=3D'width:9.76%;borde=
r:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Final<=
o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:9;height:12.25pt;mso-row-margin-left:.22%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"14%" colspan=3D2 valign=3Dtop style=3D'width:14.28%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Radiology<o:p></o:p></span></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Right =
knee
       x-ray<o:p></o:p></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.06%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 valign=3Dtop style=3D'width:13.24%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>07-Nov-2001<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 valign=3Dtop style=3D'width:13.28%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>No fra=
cture
       or dislocation, prosthesis well positioned.<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D4 valign=3Dtop style=3D'width:13.22%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>No obv=
ious
       problems with prosthesis<o:p></o:p></span></p>
       </td>
       <td width=3D"11%" colspan=3D4 valign=3Dtop style=3D'width:11.88%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>N/A<o:=
p></o:p></span></p>
       </td>
       <td width=3D"9%" colspan=3D5 valign=3Dtop style=3D'width:9.76%;borde=
r:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Final<=
o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:10;height:14.95pt;mso-row-margin-right:2.0=
2%'>
       <td width=3D"82%" colspan=3D21 valign=3Dtop style=3D'width:82.62%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'mso-bidi-font-size:1=
4.0pt;
       color:white'>15. Significant Treatments and Changes Made to Treatmen=
ts
       (Non-Procedural)<o:p></o:p></span></p>
       </td>
       <td width=3D"15%" colspan=3D5 valign=3Dtop style=3D'width:15.36%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>(1 recorded)<o:p></o=
:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"2%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:11;height:8.9pt;mso-row-margin-right:3.04%=
'>
       <td width=3D"14%" colspan=3D4 rowspan=3D2 style=3D'width:14.7%;borde=
r:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Treatment<span style=3D'mso-bidi-font-weig=
ht:
       bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"10%" rowspan=3D2 style=3D'width:10.62%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:8.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Reason for Treatment<o:p></o:p></span></b>=
</p>
       </td>
       <td width=3D"13%" colspan=3D3 rowspan=3D2 style=3D'width:13.18%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Start Time <o:p></o:p></span></b></p>
       </td>
       <td width=3D"13%" colspan=3D3 rowspan=3D2 style=3D'width:13.18%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>End Time<o:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" colspan=3D3 rowspan=3D2 style=3D'width:11.94%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:8.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Treatment
       Comments<o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D11 style=3D'width:33.34%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:8.9pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><b><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Medication Treatment<o:p></o:p></span></b>=
</p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:12;height:19.2pt;mso-row-margin-right:3.04=
%'>
       <td width=3D"10%" colspan=3D4 style=3D'width:10.58%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Dose
       Quantity<o:p></o:p></span></b></p>
       </td>
       <td width=3D"10%" colspan=3D4 style=3D'width:10.56%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Dose
       Frequency<o:p></o:p></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D3 style=3D'width:12.2%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Administered
       method<o:p></o:p></span></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:13;height:19.75pt;mso-row-margin-right:3.0=
4%'>
       <td width=3D"14%" colspan=3D4 style=3D'width:14.7%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Physio=
therapy<o:p></o:p></span></b></p>
       </td>
       <td width=3D"10%" style=3D'width:10.62%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 style=3D'width:13.18%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>10-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"13%" colspan=3D3 style=3D'width:13.18%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>13-Nov=
-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"11%" colspan=3D3 valign=3Dtop style=3D'width:11.94%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center'><span style=3D'font-size:10.0pt;font-fami=
ly:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"10%" colspan=3D4 valign=3Dtop style=3D'width:10.58%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"10%" colspan=3D4 valign=3Dtop style=3D'width:10.56%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"12%" colspan=3D3 valign=3Dtop style=3D'width:12.2%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:19.75pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:14;mso-row-margin-left:.22%;mso-row-margin=
-right:
       3.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"67%" colspan=3D16 valign=3Dtop style=3D'width:67.4%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:12.0pt;color:white'>16. Measures of Phys=
ical
       Ability and Cognitive Function<b style=3D'mso-bidi-font-weight:norma=
l'><o:p></o:p></b></span></p>
       </td>
       <td width=3D"29%" colspan=3D8 valign=3Dtop style=3D'width:29.34%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><span style=3D'mso-bidi-font-size:12.0pt;
       color:white'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:15;height:15.3pt;mso-row-margin-left:.22%;
       mso-row-margin-right:3.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"30%" colspan=3D6 style=3D'width:30.3%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:15.3pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Physical Ability at =
Time
       of Discharge:<o:p></o:p></span></b></p>
       </td>
       <td width=3D"66%" colspan=3D18 valign=3Dtop style=3D'width:66.44%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.3pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><span style=3D'font-size:11.0pt;font-famil=
y:
       "Calibri","sans-serif";mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:16;height:20.65pt;mso-row-margin-left:.22%;
       mso-row-margin-right:3.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"30%" colspan=3D6 style=3D'width:30.3%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:20.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Cognitive Function at
       Time of Discharge:<o:p></o:p></span></b></p>
       </td>
       <td width=3D"66%" colspan=3D18 style=3D'width:66.44%;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:20.65pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>No problems<o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"3%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:17;mso-yfti-lastrow:yes;height:20.65pt;
       mso-row-margin-left:.22%;mso-row-margin-right:3.04%'>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
       <td width=3D"96%" colspan=3D24 style=3D'width:96.76%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:20.65pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt'>Screen 3 of 6</s=
pan></b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
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       <td width=3D2 style=3D'border:none'></td>
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 </v:shape><![endif]--><![if !vml]><span style=3D'mso-ignore:vglayout;posit=
ion:
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tops:
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<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
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tops:
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tops:
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<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Aria=
l","sans-serif";
mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-GB;mso-farea=
st-language:
EN-US;mso-bidi-language:AR-SA'><br clear=3Dall style=3D'page-break-before:a=
lways'>
</span>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><!--[if gte vml 1]><o:wrapblock><v:shape id=3D"_x0000=
_s1031"
  type=3D"#_x0000_t202" style=3D'position:absolute;margin-left:18.9pt;margi=
n-top:110.6pt;
  width:541.9pt;height:668.75pt;z-index:3'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1031'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D"100%" style=3D'width:100.0%;border-collapse:collapse;mso-yft=
i-tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.95pt'>
       <td width=3D"63%" colspan=3D3 style=3D'width:63.84%;background:black;
       padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-top:0cm;margin-right:0cm;margin=
-bottom:
       0cm;margin-left:17.85pt;margin-bottom:.0001pt;text-indent:-17.85pt;
       tab-stops:36.0pt right 729.0pt'><span style=3D'mso-bidi-font-size:12=
.0pt;
       mso-fareast-font-family:Calibri;color:white'>17. Current Medications=
<o:p></o:p></span></p>
       </td>
       <td width=3D"36%" colspan=3D4 style=3D'width:36.16%;background:black;
       padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-top:0cm;margin-ri=
ght:0cm;
       margin-bottom:0cm;margin-left:17.85pt;margin-bottom:.0001pt;text-ali=
gn:
       right;text-indent:-17.85pt;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;mso-fareast-font-family:Calibri;
       color:white'>(5 recorded)<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:13.5pt'>
       <td width=3D"11%" valign=3Dbottom style=3D'width:11.94%;padding:0cm =
5.4pt 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D;text-tr=
ansform:
       uppercase'>Status</span></b><b style=3D'mso-bidi-font-weight:normal'=
><span
       style=3D'font-size:7.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D;text-transform:uppercase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" valign=3Dbottom style=3D'width:33.98%;padding:0cm =
5.4pt 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D;text-tr=
ansform:
       uppercase'>DRUG DETAILS</span></b><b style=3D'mso-bidi-font-weight:n=
ormal'><span
       style=3D'font-size:7.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
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1F497D;
       text-transform:uppercase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"25%" colspan=3D3 valign=3Dbottom style=3D'width:25.86%;=
padding:
       0cm 5.4pt 0cm 5.4pt;height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D;text-transform:
       uppercase'>DRUG MANAGEMENT</span></b><b style=3D'mso-bidi-font-weigh=
t:
       normal'><span style=3D'font-size:7.0pt;mso-bidi-font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D;text-transform:
       uppercase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"28%" colspan=3D2 valign=3Dtop style=3D'width:28.22%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D;text-tr=
ansform:
       uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;height:3.7pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;bor=
der-bottom:
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t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;bor=
der-bottom:
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.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
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-family:
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n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
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       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
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       </td>
      </tr>
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-border-top-alt:
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       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:4.45pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:4.45pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:4.45pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>New</span></b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Dispensed</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><o:p></o:p></span></=
p>
       </td>
       <td width=3D"33%" rowspan=3D7 valign=3Dtop style=3D'width:33.98%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>doxycycline</span></=
b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> &#8211; 100 mg &#82=
11; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>dispersible tablet sugar free
       &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Courier New";mso-fareast-font-family:Calibri;color:#1F4=
97D'>DOSE</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> <b style=3D'mso-bid=
i-font-weight:
       normal'>1 tablet</b> &#8211; oral &#8211; once a day<o:p></o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>13-Nov-2009 <b style=3D'mso-=
bidi-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:5;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>END DATE:</spa=
n></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>15-Nov-2009<b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:6;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW DATE:</=
span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span><b style=3D'ms=
o-bidi-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:7;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW
       RESPONSIBILITY:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span>=
</span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;</span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:8;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>QUANTITY
       DISPENSED:</span></b><span style=3D'font-size:10.0pt;font-family:"Ca=
libri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span><b style=3D'ms=
o-bidi-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>2 tablets<b style=3D'mso-bid=
i-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:9;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INSTRUCTIONS:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:10;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp; </span><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Pneumonia<b style=3D'mso-bid=
i-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:11;height:3.7pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:12;height:3.2pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:13;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>New</span></b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Dispensed</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><o:p></o:p></span></=
p>
       </td>
       <td width=3D"33%" rowspan=3D6 valign=3Dtop style=3D'width:33.98%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>co-codamol</span></b><span style=3D'font-size:11.0pt;font-fam=
ily:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'> </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>&#8211; </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>30 and 500 mg &#8211; tablet &#8211; </span><span
       style=3D'font-size:11.0pt;font-family:"Courier New";mso-fareast-font=
-family:
       Calibri;color:#1F497D'>DOSE</span><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'> </span><span style=3D'font-=
size:
       11.0pt;font-family:"Calibri","sans-serif";mso-fareast-font-family:Ca=
libri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'><=
span
       style=3D'mso-spacerun:yes'>&nbsp;</span><b style=3D'mso-bidi-font-we=
ight:
       normal'>2 tablets</b> &#8211; oral &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'>as
       required maximum 8 per day<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>13-Nov-2009<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><o:=
p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:14;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>END DATE:</spa=
n></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>NA<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span><b style=3D'mso=
-bidi-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:15;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW DATE:</=
span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:16;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW
       RESPONSIBILITY:<span style=3D'mso-spacerun:yes'>&nbsp; </span><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:17;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>QUANTITY
       DISPENSED:</span></b><span style=3D'font-size:10.0pt;font-family:"Ca=
libri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span><b style=3D'ms=
o-bidi-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>20 tablets<b style=3D'mso-bi=
di-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:18;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INSTRUCTIONS:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:19;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'><=
o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp; </span><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Pain Management<b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'color:#1F497D'>=
<o:p></o:p></span></b></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:20;height:3.7pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:21;height:3.6pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:3.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:3.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:3.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:3.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:22;height:12.6pt'>
       <td width=3D"11%" rowspan=3D2 valign=3Dtop style=3D'width:11.94%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:12.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Changed</span></b><s=
pan
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Dispensed</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><o:p></o:p></span></=
p>
       </td>
       <td width=3D"33%" rowspan=3D8 valign=3Dtop style=3D'width:33.98%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:12.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>furosemide</span></b><span style=3D'font-size:11.0pt;font-fam=
ily:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'> </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>&#8211; </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>40 mg &#8211; tablet &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Courier New";mso-fareast-font-family:Calibri;color:#1F4=
97D'>DOSE</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'><span style=3D'mso-spacerun:yes'>&nbsp;</span><b style=3D'mso=
-bidi-font-weight:
       normal'>1 tablet</b> &#8211; oral &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'>o=
nce
       a day<o:p></o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.6pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> <o:p></o:p></span><=
/p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.6pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:23;height:14.2pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>END DATE:</spa=
n></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span><o:p></o:p></sp=
an></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<span
       style=3D'mso-spacerun:yes'>&nbsp; </span><b style=3D'mso-bidi-font-w=
eight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:24;height:14.2pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW DATE:</=
span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:25;height:14.2pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW
       RESPONSIBILITY:<span style=3D'mso-spacerun:yes'>&nbsp; </span><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>---- <b style=3D'mso-bidi-fo=
nt-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:26;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>QUANTITY
       DISPENSED:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>100 tablets<b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:27;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INSTRUCTIONS:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:28;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><o:p></o:p></span></b=
></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Fluid Retention<o:p></o:p></=
span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:29;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REASON FOR
       CHANGE:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp; </s=
pan><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Hypotension<o:p></o:p></span=
></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:30;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'><=
o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;padd=
ing:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>CHANGE
       DESCRIPTION:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </sp=
an><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>dose decreased from tablet t=
wice
       a day<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:31;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'><=
o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>DATE OF LAST
       CHANGE:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span><o=
:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>08-Nov-2009<o:p></o:p></span=
></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:32;height:3.7pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:3.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:33;height:3.2pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:3.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:34;height:14.2pt'>
       <td width=3D"11%" rowspan=3D2 valign=3Dtop style=3D'width:11.94%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Continued<o:p></o:p>=
</span></b></p>
       </td>
       <td width=3D"33%" rowspan=3D7 valign=3Dtop style=3D'width:33.98%;pad=
ding:0cm 5.4pt 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>tiotropium</span></b><span style=3D'font-size:11.0pt;font-fam=
ily:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'> &#8211; 18 microgram
       &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'>d=
ry-powder
       inhaler &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Courier New";mso-fareast-font-family:Calibri;color:#1F4=
97D'>DOSE</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'><span style=3D'mso-spacerun:yes'>&nbsp;</span><b style=3D'mso=
-bidi-font-weight:
       normal'>1 capsule</b> &#8211; inhalation &#8211; <o:p></o:p></span><=
/p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'>o=
nce
       a day<o:p></o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> <o:p></o:p></span><=
/p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.2pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:35;height:13.35pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>END DATE:</spa=
n></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span><o:p></o:p></sp=
an></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </sp=
an><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'color:#1F497D'>=
<o:p></o:p></span></b></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:36;height:13.35pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW DATE:</=
span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><b style=3D'mso-bidi-=
font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:37;height:13.35pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW
       RESPONSIBILITY:<span style=3D'mso-spacerun:yes'>&nbsp; </span><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.35pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><b style=3D'mso-bidi-=
font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:38;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>QUANTITY
       DISPENSED:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Patient&#8217;s own supply<b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'color:#1F497D'>=
<o:p></o:p></span></b></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:39;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INSTRUCTIONS:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:40;height:12.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;padding:0cm 5.4=
pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><o:p></o:p></span></b=
></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>COPD<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:41;height:5.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:5.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:5.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:5.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:5.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:42;height:6.25pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:6.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;mso=
-border-top-alt:
       solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:6.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:6.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 valign=3Dtop style=3D'width:33.7%;bord=
er:none;
       mso-border-top-alt:solid gray .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:6.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:43;height:15.9pt'>
       <td width=3D"11%" rowspan=3D10 valign=3Dtop style=3D'width:11.94%;pa=
dding:0cm 5.4pt 0cm 5.4pt;
       height:15.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Changed</span></b><s=
pan
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>Dispensed</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><o:p></o:p></span></=
p>
       </td>
       <td width=3D"33%" rowspan=3D10 valign=3Dtop style=3D'width:33.98%;pa=
dding:0cm 5.4pt 0cm 5.4pt;
       height:15.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>aspirin</span></b><span style=3D'font-size:11.0pt;font-family=
:"Calibri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       mso-fareast-language:EN-GB'> </span><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>&#8211; </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>75 mg &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'>d=
ispersible
       tablet &#8211; <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Courier New";mso-fareast-font-family:Calibri;color:#1F4=
97D'>DOSE</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> </span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'><span style=3D'mso-spacerun:yes'>&nbsp;</span><b style=3D'mso=
-bidi-font-weight:
       normal'>1 tablet</b> &#8211; oral <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:15.9pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> <o:p></o:p></span><=
/p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:15.9pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:44;height:14.0pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>END DATE:</spa=
n></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span><o:p></o:p></sp=
an></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </sp=
an><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'color:#1F497D'>=
<o:p></o:p></span></b></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:45;height:14.0pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW DATE:</=
span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><b style=3D'mso-bidi-=
font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:46;height:14.0pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.0pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REVIEW
       RESPONSIBILITY:<span style=3D'mso-spacerun:yes'>&nbsp; </span><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:14.0pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>GP<b style=3D'mso-bidi-font-=
weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:47;height:13.5pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>QUANTITY
       DISPENSED:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>30 tablets<b style=3D'mso-bi=
di-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:48;height:13.5pt'>
       <td width=3D"20%" colspan=3D2 valign=3Dtop style=3D'width:20.4%;padd=
ing:0cm 5.4pt 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INSTRUCTIONS:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Please recommence 1 tablet o=
nce
       daily by mouth, 3 days after discharge<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:49;height:13.5pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span><o:p></o:p></span></b=
></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Anticoagulant prophylaxis<o:=
p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:50;height:13.5pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REASON FOR
       CHANGE:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp; </s=
pan><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Surgery<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:51;height:13.5pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>CHANGE
       DESCRIPTION:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </sp=
an><o:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>Withheld<o:p></o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:52;height:13.5pt'>
       <td width=3D"20%" colspan=3D2 style=3D'width:20.4%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>DATE OF LAST
       CHANGE:<span style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span><o=
:p></o:p></span></b></p>
       </td>
       <td width=3D"33%" colspan=3D3 style=3D'width:33.7%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:13.5pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>06-Nov-2009<o:p></o:p></span=
></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:53;mso-yfti-lastrow:yes;height:5.7pt'>
       <td width=3D"11%" valign=3Dtop style=3D'width:11.94%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:5.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:2.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"33%" valign=3Dtop style=3D'width:33.98%;border:none;bor=
der-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:5.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><span style=3D'font-size:2.0pt;font-=
family:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'><o:p>&nbsp;</o:p></spa=
n></p>
       </td>
       <td width=3D"28%" colspan=3D4 valign=3Dtop style=3D'width:28.48%;bor=
der:none;
       border-bottom:solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:5.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"25%" valign=3Dtop style=3D'width:25.6%;border:none;bord=
er-bottom:
       solid gray 1.0pt;mso-border-bottom-alt:solid gray .5pt;padding:0cm 5=
.4pt 0cm 5.4pt;
       height:5.7pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:2.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D84 style=3D'border:none'></td>
       <td width=3D239 style=3D'border:none'></td>
       <td width=3D126 style=3D'border:none'></td>
       <td width=3D17 style=3D'border:none'></td>
       <td width=3D38 style=3D'border:none'></td>
       <td width=3D18 style=3D'border:none'></td>
       <td width=3D180 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
     style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
     mso-bidi-font-size:10.0pt'>Screen 4 of 6</span></b></p>
     <p class=3DMsoNormal><o:p>&nbsp;</o:p></p>
     <p class=3DMsoNormal><o:p>&nbsp;</o:p></p>
     <p class=3DMsoNormal><o:p>&nbsp;</o:p></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D"101%" style=3D'width:101.34%;margin-left:-4.25pt;border-coll=
apse:
      collapse;mso-yfti-tbllook:1184;mso-padding-alt:0cm 2.85pt 0cm 2.85pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:12.25pt'>
       <td width=3D"100%" colspan=3D9 style=3D'width:100.0%;border:none;bor=
der-top:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;background:
       black;padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:14.0pt;color:=
white;
       mso-bidi-font-weight:bold'>18. Medications-Related Recommendations<s=
pan
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
       </span></span><span style=3D'mso-bidi-font-size:14.0pt;color:white'>=
(0
       recorded)</span><span style=3D'font-size:10.0pt;mso-bidi-font-size:1=
2.0pt;
       font-family:"Calibri","sans-serif";color:white'><o:p></o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:12.25pt'>
       <td width=3D"30%" colspan=3D2 style=3D'width:30.1%;border-top:solid =
#A6A6A6 1.0pt;
       border-left:none;border-bottom:solid #A6A6A6 1.0pt;border-right:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A=
6A6A6 .5pt;
       padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase;mso-bidi-font-weight:bold'>REcommendation</=
span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"20%" style=3D'width:20.64%;border-top:solid #A6A6A6 1.0=
pt;
       border-left:none;border-bottom:solid #A6A6A6 1.0pt;border-right:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A=
6A6A6 .5pt;
       padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'font-size:8.0pt;font-family:"Cal=
ibri","sans-serif";
       color:#1F497D;text-transform:uppercase'>Date for Action</span><span
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bri","sans-serif"'><o:p></o:p></span></p>
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6A6A6 .5pt;
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ibri","sans-serif";
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tended
       Recipient</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:12=
.0pt;
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er-bottom:
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-top-alt:
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       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></b></p>
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r:none;
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5pt;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A=
6A6A6 .5pt;
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ze:12.0pt;
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er-bottom:
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ibri","sans-serif";
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ntact
       Address<b>:</b></span><span style=3D'font-size:9.0pt;mso-bidi-font-s=
ize:
       12.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
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d #A6A6A6 1.0pt;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-top-alt:solid #A6A6=
A6 .5pt;
       mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:0cm 2.85pt 0cm 2.85=
pt;
       height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:12.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"8%" valign=3Dtop style=3D'width:8.2%;padding:0cm 2.85pt=
 0cm 2.85pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt;font-family:"Cali=
bri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
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r-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;mso-border=
-top-alt:
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       style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt;font-family:"Cali=
bri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
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       <p class=3DMsoNormal><span style=3D'font-size:8.0pt;font-family:"Cal=
ibri","sans-serif";
       color:#1F497D;text-transform:uppercase'>Telephone Numbers:</span><sp=
an
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><o:p></o:p></span></p>
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er-bottom:
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ze:12.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
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lid #A6A6A6 1.0pt;
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A6 .5pt;
       mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:0cm 2.85pt 0cm 2.85=
pt;
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       <p class=3DMsoNormal><span style=3D'font-size:8.0pt;mso-bidi-font-si=
ze:10.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
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er-bottom:
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       solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;font-family:"Cal=
ibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
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       <td width=3D9 style=3D'border:none'></td>
       <td width=3D147 style=3D'border:none'></td>
       <td width=3D88 style=3D'border:none'></td>
       <td width=3D11 style=3D'border:none'></td>
       <td width=3D68 style=3D'border:none'></td>
       <td width=3D59 style=3D'border:none'></td>
       <td width=3D58 style=3D'border:none'></td>
       <td width=3D67 style=3D'border:none'></td>
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     <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stops=
:71.35pt right 729.0pt'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Calibr=
i","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stops=
:71.35pt right 729.0pt'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Calibr=
i","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stops=
:71.35pt right 729.0pt'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Calibr=
i","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stops=
:71.35pt right 729.0pt'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Calibr=
i","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stops=
:71.35pt right 729.0pt'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Calibr=
i","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stops=
:71.35pt right 729.0pt'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Calibr=
i","sans-serif"'>Screen
     <b style=3D'mso-bidi-font-weight:normal'>4</b> of <b style=3D'mso-bidi=
-font-weight:
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x:6'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1043'>
   <![if !mso]>
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     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D690 style=3D'width:517.4pt;margin-left:-1.7pt;border-collapse=
:collapse;
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       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:18.0pt;font-family:"Ca=
libri","sans-serif"'>Discharge
       Summary<o:p></o:p></span></p>
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       <td width=3D126 valign=3Dtop style=3D'width:94.7pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D291 colspan=3D2 valign=3Dtop style=3D'width:218.0pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
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0000_i1027"
        type=3D"#_x0000_t75" alt=3D"nhs_logo_transparent.png" style=3D'widt=
h:70.5pt;
        height:27.75pt;visibility:visible;mso-wrap-style:square'>
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s_logo_transparent"/>
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y:
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      <tr style=3D'mso-yfti-irow:1;height:15.4pt'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:6.0pt;mso-bidi-font-si=
ze:16.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D126 valign=3Dtop style=3D'width:94.7pt;border:none;borde=
r-bottom:
       solid windowtext 1.0pt;mso-border-bottom-alt:solid windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:6.0pt;mso-bidi-font-si=
ze:16.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D291 colspan=3D2 valign=3Dtop style=3D'width:218.0pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>Another
       Hospital, The Royal Another NHS Foundation Trust<o:p></o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:35.5pt'>
       <td width=3D208 valign=3Dtop style=3D'width:155.95pt;border-top:none;
       border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.=
0pt;
       border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-borde=
r-top-alt:
       solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.=
4pt;
       height:35.5pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>PATIENT</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>SMITH,
       William<span style=3D'mso-spacerun:yes'>&nbsp; </span>(Mr)</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D191 colspan=3D2 valign=3Dtop style=3D'width:143.45pt;bor=
der:none;
       border-bottom:solid windowtext 1.0pt;mso-border-top-alt:solid window=
text .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:35.5pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>BORN</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>01-Jan-1946
       (63yr)</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
       <td width=3D121 valign=3Dtop style=3D'width:90.45pt;border:none;bord=
er-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:35.5pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>GENDER</span></b><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>Male</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border-top:none;
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olid windowtext 1.0pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid wi=
ndowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:sol=
id windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:35.5pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>NHS No.</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>123
       728 7652</span><span style=3D'font-size:14.0pt;font-family:"Calibri"=
,"sans-serif"'><o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif";color:#1=
7365D'>HOSPITAL
       No.</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif"'> </span=
></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>ABC12345</span><span
       style=3D'font-size:14.0pt;mso-bidi-font-size:9.0pt;font-family:"Cali=
bri","sans-serif"'>
       </span><b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-=
size:
       9.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></b></p>
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       <td width=3D126 style=3D'border:none'></td>
       <td width=3D121 style=3D'border:none'></td>
       <td width=3D170 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal><span style=3D'font-size:1.0pt;mso-bidi-font-size=
:10.0pt'><o:p>&nbsp;</o:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><![endif]--><![if !vml]><span style=3D'mso-ignore:vglayout'>
 <table cellpadding=3D0 cellspacing=3D0 align=3Dleft>
  <tr>
   <td width=3D24 height=3D6></td>
  </tr>
  <tr>
   <td></td>
   <td><img width=3D729 height=3D1038 src=3D"v0-4-1Mockup3_files/image005.g=
if"
   v:shapes=3D"_x0000_s1031 _x0000_s1043"></td>
  </tr>
 </table>
 </span><![endif]><!--[if gte vml 1]></o:wrapblock><![endif]--><o:p>&nbsp;<=
/o:p></p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto'><o:p>&nbsp;</o:p>=
</p>

<span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Aria=
l","sans-serif";
mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-GB;mso-farea=
st-language:
EN-US;mso-bidi-language:AR-SA'><br clear=3Dall style=3D'mso-special-charact=
er:line-break;
page-break-before:always'>
</span>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto;tab-stops:36.0pt r=
ight 729.0pt'><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal style=3D'mso-margin-bottom-alt:auto;tab-stops:36.0pt r=
ight 729.0pt'><!--[if gte vml 1]><o:wrapblock><v:shape
  id=3D"_x0000_s1054" type=3D"#_x0000_t202" style=3D'position:absolute;marg=
in-left:18.4pt;
  margin-top:92.85pt;width:531pt;height:636.15pt;z-index:12'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1054'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D"100%" style=3D'width:100.5%;border-collapse:collapse;mso-yft=
i-tbllook:
      1184;mso-padding-alt:0cm 2.85pt 0cm 2.85pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:12.25pt'>
       <td width=3D"100%" colspan=3D27 style=3D'width:100.0%;border:none;bo=
rder-top:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;background:
       black;padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white;mso-bidi-font-weight:=
bold'>18.
       Medications-Related Recommendations<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
       </span></span><span style=3D'mso-bidi-font-size:14.0pt;font-family:"=
Calibri","sans-serif";
       mso-ascii-theme-font:minor-latin;mso-hansi-theme-font:minor-latin;
       color:white'>(0 recorded)</span><span style=3D'font-size:10.0pt;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif";color:w=
hite'><o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:12.25pt'>
       <td width=3D"29%" colspan=3D3 style=3D'width:29.88%;border-top:solid=
 #A6A6A6 1.0pt;
       border-left:none;border-bottom:solid #A6A6A6 1.0pt;border-right:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A=
6A6A6 .5pt;
       padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>REcommendation</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"20%" colspan=3D8 style=3D'width:20.44%;border-top:solid=
 #A6A6A6 1.0pt;
       border-left:none;border-bottom:solid #A6A6A6 1.0pt;border-right:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A=
6A6A6 .5pt;
       padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       for Action</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:12.0pt;font-family:"Cali=
bri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"49%" colspan=3D16 style=3D'width:49.68%;border-top:soli=
d #A6A6A6 1.0pt;
       border-left:none;border-bottom:solid #A6A6A6 1.0pt;border-right:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A=
6A6A6 .5pt;
       padding:0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Intended Recipient</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;height:12.25pt'>
       <td width=3D"29%" colspan=3D4 rowspan=3D2 style=3D'width:29.94%;bord=
er:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;padding:0cm 2.85pt 0cm 2.85pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></b></p>
       </td>
       <td width=3D"20%" colspan=3D7 rowspan=3D2 style=3D'width:20.38%;bord=
er:none;
       mso-border-top-alt:solid #A6A6A6 .5pt;padding:0cm 2.85pt 0cm 2.85pt;
       height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:12.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"23%" colspan=3D8 style=3D'width:23.38%;border:none;bord=
er-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;mso-border=
-top-alt:
       solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Contact Address:</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D"26%" colspan=3D8 style=3D'width:26.3%;border:none;borde=
r-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;mso-border=
-top-alt:
       solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:3.0pt;mso-bidi-font-size:12.0pt;font-family:"Cali=
bri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3;height:12.25pt'>
       <td width=3D"23%" colspan=3D9 style=3D'width:23.48%;border:none;bord=
er-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;mso-border=
-top-alt:
       solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Telephone
       Numbers:</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"26%" colspan=3D7 style=3D'width:26.2%;border:none;borde=
r-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #A6A6A6 .5pt;mso-border=
-top-alt:
       solid #A6A6A6 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 2.85pt 0cm 2.85pt;height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'font-size:5.0pt;mso-bidi-font-si=
ze:12.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4;height:14.95pt;mso-row-margin-right:.22%=
'>
       <td width=3D"55%" colspan=3D13 valign=3Dtop style=3D'width:55.46%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:-17.4pt right 729.0pt'><span style=3D'mso-bidi-font-size:1=
4.0pt;
       color:white;mso-bidi-font-weight:bold'>19. Stopped Medications<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&n=
bsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
       </span></span><span style=3D'mso-bidi-font-size:12.0pt;font-family:"=
Calibri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:white'><o:p></o:p></span></p>
       </td>
       <td width=3D"44%" colspan=3D13 valign=3Dtop style=3D'width:44.32%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-top:0cm;margin-ri=
ght:0cm;
       margin-bottom:0cm;margin-left:17.85pt;margin-bottom:.0001pt;text-ali=
gn:
       right;text-indent:-17.85pt;tab-stops:-17.4pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:white'>(2 recorded)<o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:5;height:11.45pt;mso-row-margin-right:.72%=
'>
       <td width=3D"46%" colspan=3D7 valign=3Dbottom style=3D'width:46.38%;=
border:none;
       border-bottom:solid #A6A6A6 1.0pt;mso-border-bottom-themecolor:backg=
round1;
       mso-border-bottom-themeshade:166;mso-border-bottom-alt:solid #A6A6A6=
 .5pt;
       mso-border-bottom-themecolor:background1;mso-border-bottom-themeshad=
e:
       166;padding:0cm 5.4pt 0cm 5.4pt;height:11.45pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D;text-transform:uppercase'>DRUG DETAILS</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:Calibri;color:#1F497D;text-transform:up=
percase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"21%" colspan=3D9 valign=3Dbottom style=3D'width:21.68%;=
border:none;
       border-bottom:solid #A6A6A6 1.0pt;mso-border-bottom-themecolor:backg=
round1;
       mso-border-bottom-themeshade:166;mso-border-bottom-alt:solid #A6A6A6=
 .5pt;
       mso-border-bottom-themecolor:background1;mso-border-bottom-themeshad=
e:
       166;padding:0cm 5.4pt 0cm 5.4pt;height:11.45pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:8.0pt;font-family:"Calibri","sans-serif";mso-fare=
ast-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";color:#1F497D;text-tr=
ansform:
       uppercase'>STOPPED DETAILS<o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;border:none;bord=
er-bottom:
       solid #A6A6A6 1.0pt;mso-border-bottom-themecolor:background1;mso-bor=
der-bottom-themeshade:
       166;mso-border-bottom-alt:solid #A6A6A6 .5pt;mso-border-bottom-theme=
color:
       background1;mso-border-bottom-themeshade:166;padding:0cm 5.4pt 0cm 5=
.4pt;
       height:11.45pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:4.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D;text-transform:uppercase'><o:p>&nbsp;</o:p></span></b>=
</p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:6;height:12.25pt;mso-row-margin-right:.72%=
'>
       <td width=3D"46%" colspan=3D7 rowspan=3D4 valign=3Dtop style=3D'widt=
h:46.38%;
       border:none;border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-them=
ecolor:
       background1;mso-border-bottom-themeshade:217;mso-border-top-alt:soli=
d #A6A6A6 .5pt;
       mso-border-top-themecolor:background1;mso-border-top-themeshade:166;
       mso-border-top-alt:solid #A6A6A6 .5pt;mso-border-top-themecolor:back=
ground1;
       mso-border-top-themeshade:166;mso-border-bottom-alt:solid #D9D9D9 .5=
pt;
       mso-border-bottom-themecolor:background1;mso-border-bottom-themeshad=
e:
       217;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>oxycodone hydrochloride</span></b><span style=3D'font-size:11=
.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";mso-fareast-language:EN-GB'>
       &#8211; 5 mg &#8211; capsule &#8211; </span><span style=3D'font-size=
:11.0pt;
       font-family:"Courier New";mso-fareast-font-family:Calibri;color:#1F4=
97D'>DOSE</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> <b style=3D'mso-bid=
i-font-weight:
       normal'>1 capsule</b></span><span style=3D'font-size:11.0pt;font-fam=
ily:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'> &#8211; oral &#8211; =
as
       required<o:p></o:p></span></p>
       </td>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;border:none;mso-=
border-top-alt:
       solid #A6A6A6 .5pt;mso-border-top-themecolor:background1;mso-border-=
top-themeshade:
       166;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;border:none;mso-=
border-top-alt:
       solid #A6A6A6 .5pt;mso-border-top-themecolor:background1;mso-border-=
top-themeshade:
       166;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:7;height:12.25pt;mso-row-margin-right:.72%=
'>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>STOPPED DATE:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>06-Nov-2009<b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:8;height:12.25pt;mso-row-margin-right:.72%=
'>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REASON FOR
       STOPPING:</span></b><span style=3D'font-size:10.0pt;font-family:"Cal=
ibri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span><b style=3D'ms=
o-bidi-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif"'>No longer required</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:9;height:12.25pt;mso-row-margin-right:.72%=
'>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-themecolor:background1;mso-bor=
der-bottom-themeshade:
       217;mso-border-bottom-alt:solid #D9D9D9 .5pt;mso-border-bottom-theme=
color:
       background1;mso-border-bottom-themeshade:217;padding:0cm 5.4pt 0cm 5=
.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp; </span><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-themecolor:background1;mso-bor=
der-bottom-themeshade:
       217;mso-border-bottom-alt:solid #D9D9D9 .5pt;mso-border-bottom-theme=
color:
       background1;mso-border-bottom-themeshade:217;padding:0cm 5.4pt 0cm 5=
.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:10;height:12.25pt;mso-row-margin-right:.72=
%'>
       <td width=3D"46%" colspan=3D7 rowspan=3D4 valign=3Dtop style=3D'widt=
h:46.38%;
       border:none;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-the=
mecolor:
       background1;mso-border-top-themeshade:217;padding:0cm 5.4pt 0cm 5.4p=
t;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:36.0pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB'>celecoxib</span></b><span style=3D'font-size:11.0pt;font-fami=
ly:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'> &#8211; 200 mg &#8211;
       capsule &#8211; </span><span style=3D'font-size:11.0pt;font-family:"=
Courier New";
       mso-fareast-font-family:Calibri;color:#1F497D'>DOSE</span><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'> <b style=3D'mso-bid=
i-font-weight:
       normal'>1 capsule</b></span><span style=3D'font-size:11.0pt;font-fam=
ily:
       "Calibri","sans-serif";mso-fareast-font-family:Calibri;mso-bidi-font=
-family:
       "Times New Roman";mso-fareast-language:EN-GB'> &#8211; oral &#8211; =
as
       required<o:p></o:p></span></p>
       </td>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;border:none;mso-=
border-top-alt:
       solid #D9D9D9 .5pt;mso-border-top-themecolor:background1;mso-border-=
top-themeshade:
       217;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>START DATE:</s=
pan></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;border:none;mso-=
border-top-alt:
       solid #D9D9D9 .5pt;mso-border-top-themecolor:background1;mso-border-=
top-themeshade:
       217;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>----<b style=3D'mso-bidi-fon=
t-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:11;height:12.25pt;mso-row-margin-right:.72=
%'>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>STOPPED DATE:<=
/span></b><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span><b style=3D'mso-bidi=
-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman"'>06-Nov-2009<b style=3D'mso-b=
idi-font-weight:
       normal'><span style=3D'color:#1F497D'><o:p></o:p></span></b></span><=
/p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:12;height:12.25pt;mso-row-margin-right:.72=
%'>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>REASON FOR
       STOPPING:</span></b><span style=3D'font-size:10.0pt;font-family:"Cal=
ibri","sans-serif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span><b style=3D'ms=
o-bidi-font-weight:
       normal'><span style=3D'font-size:8.0pt;font-family:"Calibri","sans-s=
erif";
       mso-fareast-font-family:Calibri;mso-bidi-font-family:"Times New Roma=
n";
       color:#1F497D'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:10.0pt;
       font-family:"Calibri","sans-serif"'>Ceased due to scheduled surgery<=
/span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:10.0p=
t;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'><o:p></o:p></s=
pan></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:13;height:12.25pt;mso-row-margin-right:.72=
%'>
       <td width=3D"21%" colspan=3D9 style=3D'width:21.68%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;mso-pagination:none;tab-stops:71.35pt right=
 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-fareast-font-family:Calibri;
       mso-bidi-font-family:"Times New Roman";color:#1F497D'>INDICATION:<sp=
an
       style=3D'mso-spacerun:yes'>&nbsp; </span><o:p></o:p></span></b></p>
       </td>
       <td width=3D"31%" colspan=3D9 style=3D'width:31.22%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       mso-pagination:none;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman"'>----</span><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:14;height:14.95pt;mso-row-margin-right:.22=
%'>
       <td width=3D"57%" colspan=3D15 valign=3Dtop style=3D'width:57.06%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>20. Actions to be ta=
ken by
       Hospital after discharge<o:p></o:p></span></p>
       </td>
       <td width=3D"42%" colspan=3D11 valign=3Dtop style=3D'width:42.72%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>(1 recorded)<o:p></o=
:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:15;height:16.05pt;mso-row-margin-right:.22=
%'>
       <td width=3D"37%" colspan=3D6 style=3D'width:37.08%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Action<span style=3D'mso-bidi-font-weight:=
bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"14%" colspan=3D6 style=3D'width:14.34%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Contact Person <o:p></o:p></span></b></p>
       </td>
       <td width=3D"16%" colspan=3D4 style=3D'width:16.64%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Specialty / Department Responsible<o:p></o=
:p></span></b></p>
       </td>
       <td width=3D"14%" colspan=3D7 style=3D'width:14.98%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Date for Action</spa=
n></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"16%" colspan=3D3 style=3D'width:16.74%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Status
       or Other Comments<o:p></o:p></span></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:16;height:12.25pt;mso-row-margin-right:.22=
%'>
       <td width=3D"37%" colspan=3D6 valign=3Dtop style=3D'width:37.08%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Post-d=
ischarge
       follow-up &#8211; hospital-based outpatient orthopaedics clinic</spa=
n></b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'> <o:p>=
</o:p></span></p>
       </td>
       <td width=3D"14%" colspan=3D6 valign=3Dtop style=3D'width:14.34%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"16%" colspan=3D4 valign=3Dtop style=3D'width:16.64%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Orthopaedic Surgery<o:p></o:p></=
span></p>
       </td>
       <td width=3D"14%" colspan=3D7 style=3D'width:14.98%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>15-Dec=
-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"16%" colspan=3D3 style=3D'width:16.74%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'margin-bottom:0cm;margi=
n-bottom:
       .0001pt;text-align:center;tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Booked=
<o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:17;height:14.95pt;mso-row-margin-right:.22=
%'>
       <td width=3D"57%" colspan=3D15 valign=3Dtop style=3D'width:57.06%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>21. Recommended GP A=
ctions<o:p></o:p></span></p>
       </td>
       <td width=3D"42%" colspan=3D11 valign=3Dtop style=3D'width:42.72%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right;tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>(3 recorded)<o:p></o=
:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:18;height:16.05pt;mso-row-margin-right:.22=
%'>
       <td width=3D"56%" colspan=3D14 style=3D'width:56.18%;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Action<o:p></o:p></span></b></p>
       </td>
       <td width=3D"16%" colspan=3D4 style=3D'width:16.62%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Date for Action</spa=
n></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"26%" colspan=3D8 style=3D'width:26.98%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Status or Other Comments<o:p></o:p></span>=
</b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:19;height:12.25pt;mso-row-margin-right:.22=
%'>
       <td width=3D"56%" colspan=3D14 valign=3Dtop style=3D'width:56.18%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Please remove the staples.<o:p><=
/o:p></span></p>
       </td>
       <td width=3D"16%" colspan=3D4 valign=3Dtop style=3D'width:16.62%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>18-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"26%" colspan=3D8 valign=3Dtop style=3D'width:26.98%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:20;height:12.25pt;mso-row-margin-right:.22=
%'>
       <td width=3D"56%" colspan=3D14 valign=3Dtop style=3D'width:56.18%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Please ensure aspirin is recomme=
nced
       3 days post-discharge.<o:p></o:p></span></p>
       </td>
       <td width=3D"16%" colspan=3D4 valign=3Dtop style=3D'width:16.62%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>16-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"26%" colspan=3D8 valign=3Dtop style=3D'width:26.98%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:21;height:12.25pt;mso-row-margin-right:.22=
%'>
       <td width=3D"56%" colspan=3D14 valign=3Dtop style=3D'width:56.18%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Please follow-up anaemia.<o:p></=
o:p></span></p>
       </td>
       <td width=3D"16%" colspan=3D4 valign=3Dtop style=3D'width:16.62%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"26%" colspan=3D8 valign=3Dtop style=3D'width:26.98%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%"><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:22;height:14.95pt;mso-row-margin-right:.72=
%'>
       <td width=3D"99%" colspan=3D25 valign=3Dtop style=3D'width:99.28%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       background:black'><span style=3D'mso-bidi-font-size:14.0pt;color:whi=
te'>22.
       Recommended or planned Community and Specialist Services Actions<span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp=
;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
       </span>(1 recorded)<o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:23;height:16.05pt;mso-row-margin-right:.72=
%'>
       <td width=3D"22%" style=3D'width:22.92%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Action<span style=3D'mso-bidi-font-weight:=
bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"12%" colspan=3D4 style=3D'width:12.8%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri;
       color:#1F497D;text-transform:uppercase'>Service Organisation Respons=
ible<o:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" colspan=3D4 style=3D'width:11.9%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'>Contact Person<o:p></o:p></span></b></p>
       </td>
       <td width=3D"27%" colspan=3D12 style=3D'width:27.4%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Contact Person Addre=
ss<o:p></o:p></span></b></p>
       </td>
       <td width=3D"15%" colspan=3D3 style=3D'width:15.04%;padding:0cm 5.4p=
t 0cm 5.4pt;
       height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Contact Person Telep=
hone
       Number(s)</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1=
F497D;
       text-transform:uppercase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D"9%" valign=3Dtop style=3D'width:9.24%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:16.05pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Date for Action (sta=
tus)</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p></o:p></span></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:24;height:12.25pt;mso-row-margin-right:.72=
%'>
       <td width=3D"22%" valign=3Dtop style=3D'width:22.92%;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:11.0p=
t;
       font-family:"Calibri","sans-serif"'>Mobility therapy</span></b><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'> | con=
tinue<o:p></o:p></span></p>
       </td>
       <td width=3D"12%" colspan=3D4 valign=3Dtop style=3D'width:12.8%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Physio=
Care
       Limited<o:p></o:p></span></p>
       </td>
       <td width=3D"11%" colspan=3D4 valign=3Dtop style=3D'width:11.9%;bord=
er:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Mr Pet=
er
       Owen<o:p></o:p></span></p>
       </td>
       <td width=3D"27%" colspan=3D12 valign=3Dtop style=3D'width:27.4%;bor=
der:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal><span style=3D'font-size:11.0pt;font-family:"Ca=
libri","sans-serif"'>20
       Chapel Street, SomePlace, Slough, SL4 2XA<o:p></o:p></span></p>
       </td>
       <td width=3D"15%" colspan=3D3 valign=3Dtop style=3D'width:15.04%;bor=
der-top:
       solid #D9D9D9 1.0pt;border-left:none;border-bottom:solid #D9D9D9 1.0=
pt;
       border-right:none;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-b=
ottom-alt:
       solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>0191 5=
67
       8991<o:p></o:p></span></p>
       </td>
       <td width=3D"9%" valign=3Dtop style=3D'width:9.24%;border-top:solid =
#D9D9D9 1.0pt;
       border-left:none;border-bottom:solid #D9D9D9 1.0pt;border-right:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>As boo=
ked<o:p></o:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"0%" colspan=3D2><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:25'>
       <td width=3D"71%" colspan=3D17 valign=3Dtop style=3D'width:71.92%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>23. Information Give=
n To
       Patient and/or Authorised Representative </span><span style=3D'font-=
size:
       9.0pt;mso-bidi-font-size:10.0pt;color:white'><o:p></o:p></span></p>
       </td>
       <td width=3D"28%" colspan=3D10 valign=3Dtop style=3D'width:28.08%;ba=
ckground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><span style=3D'mso-bidi-font-size:12.0pt;
       color:white'>(1 recipient recorded)<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:26'>
       <td width=3D"25%" colspan=3D2 style=3D'width:25.58%;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Recipient Name:<o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D"21%" colspan=3D6 style=3D'width:21.8%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif";
       mso-bidi-font-family:Calibri'>William Smith</span><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif";
       mso-bidi-font-family:Calibri'><o:p></o:p></span></p>
       </td>
       <td width=3D"2%" colspan=3D2 valign=3Dtop style=3D'width:2.72%;borde=
r:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif";
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D"25%" colspan=3D12 style=3D'width:25.9%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Relationship to Pati=
ent:</span></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'><o:=
p></o:p></span></b></p>
       </td>
       <td width=3D"23%" colspan=3D5 style=3D'width:23.98%;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:10.0pt;mso-bidi-font-size:12.0pt;font-family:"Cal=
ibri","sans-serif";
       mso-bidi-font-family:Calibri'>Self</span><span style=3D'font-size:11=
.0pt;
       mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:27'>
       <td width=3D"25%" colspan=3D2 style=3D'width:25.58%;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Verbal Information
       Given:<o:p></o:p></span></b></p>
       </td>
       <td width=3D"74%" colspan=3D25 valign=3Dtop style=3D'width:74.42%;bo=
rder:none;
       mso-border-top-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>The good prognosis for return to activity was discussed with
       the patient.<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:28'>
       <td width=3D"25%" colspan=3D2 style=3D'width:25.58%;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Written Information
       Given:<o:p></o:p></span></b></p>
       </td>
       <td width=3D"74%" colspan=3D25 valign=3Dtop style=3D'width:74.42%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D=
9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>Patient was given a brochure explaining the expected post-o=
p recovery
       following a total knee replacement. <o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:29;mso-yfti-lastrow:yes'>
       <td width=3D"25%" colspan=3D2 style=3D'width:25.58%;padding:0cm 5.4p=
t 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Other Advice for
       Patient:<o:p></o:p></span></b></p>
       </td>
       <td width=3D"74%" colspan=3D25 valign=3Dtop style=3D'width:74.42%;bo=
rder:none;
       border-bottom:solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .=
5pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D=
9D9D9 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>Return to GP on 18 November 2009 to have the staples remove=
d.
       Keep up regular mobility routine as guided by physiotherapist. <o:p>=
</o:p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D159 style=3D'border:none'></td>
       <td width=3D18 style=3D'border:none'></td>
       <td width=3D30 style=3D'border:none'></td>
       <td width=3D0 style=3D'border:none'></td>
       <td width=3D40 style=3D'border:none'></td>
       <td width=3D9 style=3D'border:none'></td>
       <td width=3D64 style=3D'border:none'></td>
       <td width=3D7 style=3D'border:none'></td>
       <td width=3D2 style=3D'border:none'></td>
       <td width=3D17 style=3D'border:none'></td>
       <td width=3D2 style=3D'border:none'></td>
       <td width=3D8 style=3D'border:none'></td>
       <td width=3D28 style=3D'border:none'></td>
       <td width=3D5 style=3D'border:none'></td>
       <td width=3D6 style=3D'border:none'></td>
       <td width=3D76 style=3D'border:none'></td>
       <td width=3D27 style=3D'border:none'></td>
       <td width=3D6 style=3D'border:none'></td>
       <td width=3D6 style=3D'border:none'></td>
       <td width=3D1 style=3D'border:none'></td>
       <td width=3D8 style=3D'border:none'></td>
       <td width=3D7 style=3D'border:none'></td>
       <td width=3D49 style=3D'border:none'></td>
       <td width=3D49 style=3D'border:none'></td>
       <td width=3D64 style=3D'border:none'></td>
       <td width=3D3 style=3D'border:none'></td>
       <td width=3D2 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal align=3Dright style=3D'margin-top:6.0pt;margin-ri=
ght:0cm;
     margin-bottom:0cm;margin-left:0cm;margin-bottom:.0001pt;text-align:rig=
ht'><span
     style=3D'font-size:9.0pt;mso-bidi-font-size:11.0pt;font-family:"Calibr=
i","sans-serif"'>Screen
     <b style=3D'mso-bidi-font-weight:normal'>5</b> of <b style=3D'mso-bidi=
-font-weight:
     normal'>6<span style=3D'color:white;mso-themecolor:background1'>...</s=
pan></b></span><span
     style=3D'font-size:11.0pt;mso-bidi-font-size:10.0pt;color:white;mso-th=
emecolor:
     background1'><o:p></o:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><v:shape id=3D"_x0000_s1052" type=3D"#_x0000_t202" style=3D'posi=
tion:absolute;
  margin-left:18.4pt;margin-top:-19.4pt;width:531pt;height:110.1pt;z-index:=
13'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1052'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D690 style=3D'width:517.4pt;margin-left:-1.7pt;border-collapse=
:collapse;
      mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:18.0pt;font-family:"Ca=
libri","sans-serif"'>Discharge
       Summary<o:p></o:p></span></p>
       </td>
       <td width=3D143 colspan=3D2 valign=3Dtop style=3D'width:107.2pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D274 colspan=3D2 valign=3Dtop style=3D'width:205.5pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB;mso-no-proof:yes'><v:shape id=3D"Picture_x0020_10" o:spid=3D"_=
x0000_i1026"
        type=3D"#_x0000_t75" alt=3D"nhs_logo_transparent.png" style=3D'widt=
h:70.5pt;
        height:27.75pt;visibility:visible;mso-wrap-style:square'>
        <v:imagedata src=3D"v0-4-1Mockup3_files/image001.png" o:title=3D"nh=
s_logo_transparent"/>
       </v:shape></span><span style=3D'mso-bidi-font-size:16.0pt;font-famil=
y:
       "Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:15.4pt'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D126 valign=3Dtop style=3D'width:94.7pt;border:none;borde=
r-bottom:
       solid windowtext 1.0pt;mso-border-bottom-alt:solid windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D291 colspan=3D3 valign=3Dtop style=3D'width:218.0pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>Another
       Hospital, The Royal Another NHS Foundation Trust<o:p></o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:44.25pt'>
       <td width=3D208 valign=3Dtop style=3D'width:155.95pt;border-top:none;
       border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.=
0pt;
       border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-borde=
r-top-alt:
       solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.=
4pt;
       height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>PATIENT</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>SMITH,
       William<span style=3D'mso-spacerun:yes'>&nbsp; </span>(Mr)</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D208 colspan=3D3 valign=3Dtop style=3D'width:155.95pt;bor=
der:none;
       border-bottom:solid windowtext 1.0pt;mso-border-top-alt:solid window=
text .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>BORN</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>01-Jan-1946
       (63yr)</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
       <td width=3D104 valign=3Dtop style=3D'width:77.95pt;border:none;bord=
er-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>GENDER</span></b><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>Male</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border-top:none;
       border-left:none;border-bottom:solid windowtext 1.0pt;border-right:s=
olid windowtext 1.0pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid wi=
ndowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:sol=
id windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>NHS No.</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>123
       728 7652</span><span style=3D'font-size:14.0pt;font-family:"Calibri"=
,"sans-serif"'><o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif";color:#1=
7365D'>HOSPITAL
       No.</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif"'> </span=
></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>ABC12345</span><span
       style=3D'font-size:14.0pt;mso-bidi-font-size:9.0pt;font-family:"Cali=
bri","sans-serif"'>
       </span><b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-=
size:
       9.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
      </tr>
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       <td width=3D17 style=3D'border:none'></td>
       <td width=3D104 style=3D'border:none'></td>
       <td width=3D170 style=3D'border:none'></td>
      </tr>
      <![endif]>
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     <p class=3DMsoNormal><span style=3D'font-size:6.0pt;mso-bidi-font-size=
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     </div>
     <![if !mso]></td>
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   <![endif]></v:textbox>
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ion:
 relative;z-index:12'><span style=3D'position:absolute;left:24px;top:-27px;
 width:714px;height:1004px'><img width=3D714 height=3D1004
 src=3D"v0-4-1Mockup3_files/image006.gif" v:shapes=3D"_x0000_s1054 _x0000_s=
1052"></span></span><![endif]><!--[if gte vml 1]></o:wrapblock><![endif]-->=
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tops:
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<span style=3D'font-size:12.0pt;mso-bidi-font-size:10.0pt;font-family:"Aria=
l","sans-serif";
mso-fareast-font-family:"Times New Roman";mso-ansi-language:EN-GB;mso-farea=
st-language:
EN-US;mso-bidi-language:AR-SA'><br clear=3Dall style=3D'page-break-before:a=
lways'>
</span>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><!--[if gte vml 1]><o:wrapblock><v:shape id=3D"_x0000=
_s1033"
  type=3D"#_x0000_t202" style=3D'position:absolute;margin-left:32.55pt;
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   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D688 style=3D'width:515.7pt;border-collapse:collapse;mso-yfti-=
tbllook:
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       <td width=3D504 colspan=3D4 valign=3Dtop style=3D'width:378.35pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:14.0pt;mso-bi=
di-font-family:
       Calibri;color:white'>24. Patient&#8217;s Concerns, Expectations and
       Wishes <b style=3D'mso-bidi-font-weight:normal'><o:p></o:p></b></spa=
n></p>
       </td>
       <td width=3D183 valign=3Dtop style=3D'width:137.35pt;background:blac=
k;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri;color:white'><o:p>&nbsp;</o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;mso-yfti-lastrow:yes'>
       <td width=3D90 style=3D'width:67.7pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri;
       color:#1F497D;text-transform:uppercase'>Description:<o:p></o:p></spa=
n></b></p>
       </td>
       <td width=3D248 style=3D'width:186.15pt;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri'><o:=
p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D19 valign=3Dtop style=3D'width:14.05pt;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:11.0pt;mso-bidi-font-s=
ize:
       12.0pt;mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D147 valign=3Dtop style=3D'width:110.45pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt;mso-bidi-font-fa=
mily:
       Calibri'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D183 valign=3Dtop style=3D'width:137.35pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:11.0pt;mso-bidi-font-s=
ize:
       12.0pt;mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D90 style=3D'border:none'></td>
       <td width=3D248 style=3D'border:none'></td>
       <td width=3D19 style=3D'border:none'></td>
       <td width=3D147 style=3D'border:none'></td>
       <td width=3D183 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
     line-height:150%'><span style=3D'font-size:7.0pt;mso-bidi-font-size:10=
.0pt;
     line-height:150%'><o:p>&nbsp;</o:p></span></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D"137%" style=3D'width:137.72%;border-collapse:collapse;mso-yf=
ti-tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes;height:14.95pt;
       mso-row-margin-right:27.54%'>
       <td width=3D"41%" colspan=3D3 valign=3Dtop style=3D'width:41.58%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:14.0pt;mso-bi=
di-font-family:
       Calibri;color:white'>25. Results Awaited<o:p></o:p></span></p>
       </td>
       <td width=3D"30%" colspan=3D2 valign=3Dtop style=3D'width:30.88%;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt;height:14.95pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>(1 recorded)<o:p></o=
:p></span></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"27%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:16.05pt;mso-row-margin-right:27.5=
4%'>
       <td width=3D"21%" style=3D'width:21.92%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:16.05pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Investigation<span
       style=3D'mso-bidi-font-weight:bold'><o:p></o:p></span></span></b></p>
       </td>
       <td width=3D"11%" style=3D'width:11.58%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:16.05pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       Investigation Peformed or Requested<o:p></o:p></span></b></p>
       </td>
       <td width=3D"10%" colspan=3D2 style=3D'width:10.6%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:16.05pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Date
       of Expected Result<o:p></o:p></span></b></p>
       </td>
       <td width=3D"28%" style=3D'width:28.36%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:16.05pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Comments
       on Result Awaited<o:p></o:p></span></b></p>
       </td>
       <td style=3D'mso-cell-special:placeholder;border:none;padding:0cm 0c=
m 0cm 0cm'
       width=3D"27%" colspan=3D3><p class=3D'MsoNormal'>&nbsp;</td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:12.25pt'>
       <td width=3D"21%" style=3D'width:21.92%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Hepatic
       Function Panel<o:p></o:p></span></b></p>
       </td>
       <td width=3D"11%" style=3D'width:11.58%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>10-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"10%" colspan=3D2 style=3D'width:10.6%;border:none;borde=
r-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt;height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>24-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D"28%" style=3D'width:28.36%;border:none;border-bottom:so=
lid #D9D9D9 1.0pt;
       mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9=
D9 .5pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'><o:p>&=
nbsp;</o:p></span></p>
       </td>
       <td width=3D"9%" valign=3Dtop style=3D'width:9.2%;padding:0cm 5.4pt =
0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D"9%" valign=3Dtop style=3D'width:9.2%;padding:0cm 5.4pt =
0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
       <td width=3D"9%" valign=3Dtop style=3D'width:9.14%;padding:0cm 5.4pt=
 0cm 5.4pt;
       height:12.25pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><span
       style=3D'font-size:11.0pt;mso-bidi-font-size:12.0pt'><o:p>&nbsp;</o:=
p></span></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D207 style=3D'border:none'></td>
       <td width=3D109 style=3D'border:none'></td>
       <td width=3D76 style=3D'border:none'></td>
       <td width=3D24 style=3D'border:none'></td>
       <td width=3D268 style=3D'border:none'></td>
       <td width=3D87 style=3D'border:none'></td>
       <td width=3D87 style=3D'border:none'></td>
       <td width=3D86 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
     line-height:150%'><span style=3D'font-size:7.0pt;mso-bidi-font-size:10=
.0pt;
     line-height:150%'><o:p>&nbsp;</o:p></span></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D688 style=3D'width:515.7pt;border-collapse:collapse;mso-yfti-=
tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D347 colspan=3D2 valign=3Dtop style=3D'width:260.55pt;bac=
kground:
       black;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:14.0pt;mso-bi=
di-font-family:
       Calibri;color:white'>26. Persons Completing Summary<o:p></o:p></span=
></p>
       </td>
       <td width=3D85 valign=3Dtop style=3D'width:63.8pt;background:black;p=
adding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'mso-bidi-font-size:14.0pt;mso-bidi-font-family:Calibri;
       color:white'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 valign=3Dtop style=3D'width:2.0cm;background:black;pa=
dding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'mso-bidi-font-size:14.0pt;mso-bidi-font-family:Calibri;
       color:white'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;background:blac=
k;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'mso-bidi-font-size:14.0pt;mso-bidi-font-family:Calibri;
       color:white'>(1 recorded)<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>AUTHOR Name:<o:p></o=
:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>Jonathan Thomas<o:p></o:p></span></p>
       </td>
       <td width=3D161 colspan=3D2 style=3D'width:120.5pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Version Number:<o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>1.0<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Author Grade:<o:p></=
o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>FY1<o:p></o:p></span></p>
       </td>
       <td width=3D161 colspan=3D2 style=3D'width:120.5pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:7.0pt;
       mso-bidi-font-size:8.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Author Specialty:<o:=
p></o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>Orthopaedics<o:p></o:p></span></p>
       </td>
       <td width=3D161 colspan=3D2 style=3D'width:120.5pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:7.0pt;
       mso-bidi-font-size:8.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Treatment Specialty:=
<o:p></o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D161 colspan=3D2 style=3D'width:120.5pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:7.0pt;
       mso-bidi-font-size:8.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:5'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Date of Authoring:<o=
:p></o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'>14-Nov-2009<o:p></o:p></span></p>
       </td>
       <td width=3D161 colspan=3D2 style=3D'width:120.5pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:7.0pt;
       mso-bidi-font-size:8.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:6'>
       <td width=3D130 style=3D'width:97.55pt;border:none;border-bottom:sol=
id #A6A6A6 1.0pt;
       mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'><o:p>&nbsp;</o:p></s=
pan></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif";mso-bid=
i-font-family:
       Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 style=3D'width:63.8pt;border:none;border-bottom:solid=
 #A6A6A6 1.0pt;
       mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:3.0pt;
       mso-bidi-font-size:4.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 style=3D'width:2.0cm;border:none;border-bottom:solid =
#A6A6A6 1.0pt;
       mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:3.0pt;
       mso-bidi-font-size:4.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border:none;bor=
der-bottom:
       solid #A6A6A6 1.0pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:3.0pt;mso-bidi-font-si=
ze:4.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:7'>
       <td width=3D130 style=3D'width:97.55pt;border:none;mso-border-top-al=
t:solid #A6A6A6 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'><o:p>&nbsp;</o:p></s=
pan></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;mso-=
border-top-alt:
       solid #A6A6A6 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:3.0pt;mso-bidi-font-si=
ze:4.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 style=3D'width:63.8pt;border:none;mso-border-top-alt:=
solid #A6A6A6 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:3.0pt;
       mso-bidi-font-size:4.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 style=3D'width:2.0cm;border:none;mso-border-top-alt:s=
olid #A6A6A6 .5pt;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:3.0pt;
       mso-bidi-font-size:4.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border:none;mso=
-border-top-alt:
       solid #A6A6A6 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:3.0pt;mso-bidi-font-si=
ze:4.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:8'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>VERIFIER Name:<o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 style=3D'width:63.8pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dcenter style=3D'text-align:center'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 valign=3Dtop style=3D'width:2.0cm;padding:0cm 5.4pt 0=
cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:9'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Verifier Grade:<o:p>=
</o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 valign=3Dtop style=3D'width:63.8pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 valign=3Dtop style=3D'width:2.0cm;padding:0cm 5.4pt 0=
cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:10'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Verifier Specialty:<=
o:p></o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 valign=3Dtop style=3D'width:63.8pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 valign=3Dtop style=3D'width:2.0cm;padding:0cm 5.4pt 0=
cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:11'>
       <td width=3D130 style=3D'width:97.55pt;padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Treatment Specialty:=
<o:p></o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 valign=3Dtop style=3D'width:63.8pt;padding:0cm 5.4pt =
0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 valign=3Dtop style=3D'width:2.0cm;padding:0cm 5.4pt 0=
cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;padding:0cm 5.4=
pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:12;mso-yfti-lastrow:yes'>
       <td width=3D130 style=3D'width:97.55pt;border:none;border-bottom:sol=
id #A6A6A6 1.0pt;
       mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin=
-bottom:
       .0001pt;text-align:right'><b style=3D'mso-bidi-font-weight:normal'><=
span
       style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi=
-font-family:
       Calibri;color:#1F497D;text-transform:uppercase'>Date of Verifying:<o=
:p></o:p></span></b></p>
       </td>
       <td width=3D217 valign=3Dtop style=3D'width:163.0pt;border:none;bord=
er-bottom:
       solid #A6A6A6 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D85 valign=3Dtop style=3D'width:63.8pt;border:none;border=
-bottom:
       solid #A6A6A6 1.0pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D76 valign=3Dtop style=3D'width:2.0cm;border:none;border-=
bottom:
       solid #A6A6A6 1.0pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;mso-bidi-font-family:Calibri;color:#1F497D;
       text-transform:uppercase'><o:p>&nbsp;</o:p></span></b></p>
       </td>
       <td width=3D180 valign=3Dtop style=3D'width:134.65pt;border:none;bor=
der-bottom:
       solid #A6A6A6 1.0pt;mso-border-bottom-alt:solid #A6A6A6 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:9.0pt;mso-bidi-font-si=
ze:10.0pt;
       mso-bidi-font-family:Calibri'><o:p>&nbsp;</o:p></span></p>
       </td>
      </tr>
     </table>
     <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
     style=3D'font-size:6.0pt'><o:p>&nbsp;</o:p></span></p>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D688 style=3D'width:515.7pt;border-collapse:collapse;mso-yfti-=
tbllook:
      1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D310 colspan=3D2 valign=3Dtop style=3D'width:232.2pt;back=
ground:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>27. Distribution Lis=
t<o:p></o:p></span></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.6pt;background:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'><o:p>&nbsp;</o:p></s=
pan></p>
       </td>
       <td width=3D208 valign=3Dtop style=3D'width:155.9pt;background:black;
       padding:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-sto=
ps:71.35pt right 729.0pt'><span
       style=3D'mso-bidi-font-size:14.0pt;color:white'>(3 recorded)<o:p></o=
:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1'>
       <td width=3D140 valign=3Dtop style=3D'width:104.65pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Recipient
       Name<o:p></o:p></span></b></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Recipient
       Organisation<o:p></o:p></span></b></p>
       </td>
       <td width=3D170 style=3D'width:127.6pt;border:none;border-bottom:sol=
id #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";mso-bidi-font-family:Calibri;
       color:#1F497D;text-transform:uppercase'>Relationship to Patient</spa=
n></b><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'><o:p></o:p></span></b></p>
       </td>
       <td width=3D208 style=3D'width:155.9pt;border:none;border-bottom:sol=
id #D9D9D9 1.0pt;
       mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt=
'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm;tab-stops:71.35pt right 729.0pt'><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
       font-family:"Calibri","sans-serif";color:#1F497D;text-transform:uppe=
rcase'>Recipient
       Address<o:p></o:p></span></b></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2'>
       <td width=3D140 valign=3Dtop style=3D'width:104.65pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Mr. William Smith<b
       style=3D'mso-bidi-font-weight:normal'><o:p></o:p></b></span></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.6pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Self<o:p></o:p></span></p>
       </td>
       <td width=3D208 valign=3Dtop style=3D'width:155.9pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>196 Middleton Hall Road<o:p></o:=
p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Kings Norton<o:p></o:p></span></=
p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Slough<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>SL10 9DY<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:3'>
       <td width=3D140 valign=3Dtop style=3D'width:104.65pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Dr. Jane Anderson<b
       style=3D'mso-bidi-font-weight:normal'><o:p></o:p></b></span></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.6pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>GP<o:p></o:p></span></p>
       </td>
       <td width=3D208 valign=3Dtop style=3D'width:155.9pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>142 St.
       Heliers Road<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Northf=
ield<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Slough=
<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>SL3 1D=
P<o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:4;mso-yfti-lastrow:yes'>
       <td width=3D140 valign=3Dtop style=3D'width:104.65pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Mr. Peter Owen<b style=3D'mso-bi=
di-font-weight:
       normal'><o:p></o:p></b></span></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border:none;bor=
der-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>PhysioCare Limited<o:p></o:p></s=
pan></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.6pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t;
       tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
       font-family:"Calibri","sans-serif"'>Community physiotherapist<o:p></=
o:p></span></p>
       </td>
       <td width=3D208 valign=3Dtop style=3D'width:155.9pt;border:none;bord=
er-bottom:
       solid #D9D9D9 1.0pt;mso-border-top-alt:solid #D9D9D9 .5pt;mso-border=
-top-alt:
       solid #D9D9D9 .5pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
       0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>20 Cha=
pel
       Street<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>SomePl=
ace<o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>Slough=
 <o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001p=
t'><span
       style=3D'font-size:11.0pt;font-family:"Calibri","sans-serif"'>SL4 2X=
A<o:p></o:p></span></p>
       </td>
      </tr>
     </table>
     <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin-b=
ottom:
     .0001pt;text-align:right'><span style=3D'font-size:10.0pt;font-family:=
"Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
     <p class=3DMsoNormal align=3Dright style=3D'margin-bottom:0cm;margin-b=
ottom:
     .0001pt;text-align:right'><span style=3D'font-size:10.0pt;font-family:=
"Calibri","sans-serif"'>Screen
     <b style=3D'mso-bidi-font-weight:normal'>6 </b>of <b style=3D'mso-bidi=
-font-weight:
     normal'>6<span style=3D'color:white;mso-themecolor:background1'>...</s=
pan><span
     style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span><o:p>=
</o:p></b></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><v:shape id=3D"_x0000_s1045" type=3D"#_x0000_t202" style=3D'posi=
tion:absolute;
  margin-left:32.55pt;margin-top:0;width:528.85pt;height:114.2pt;z-index:7'>
  <v:textbox style=3D'mso-next-textbox:#_x0000_s1045'>
   <![if !mso]>
   <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
    <tr>
     <td><![endif]>
     <div>
     <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=
=3D0
      width=3D690 style=3D'width:517.4pt;margin-left:-1.7pt;border-collapse=
:collapse;
      mso-yfti-tbllook:1184;mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
      <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'font-size:18.0pt;font-family:"Ca=
libri","sans-serif"'>Discharge
       Summary<o:p></o:p></span></p>
       </td>
       <td width=3D126 valign=3Dtop style=3D'width:94.7pt;padding:0cm 5.4pt=
 0cm 5.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D291 colspan=3D2 valign=3Dtop style=3D'width:218.0pt;padd=
ing:0cm 5.4pt 0cm 5.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:10.0pt;font-family:"Calibri","sans-serif";mso-far=
east-font-family:
       Calibri;mso-bidi-font-family:"Times New Roman";mso-fareast-language:
       EN-GB;mso-no-proof:yes'><v:shape id=3D"Picture_x0020_12" o:spid=3D"_=
x0000_i1025"
        type=3D"#_x0000_t75" alt=3D"nhs_logo_transparent.png" style=3D'widt=
h:70.5pt;
        height:27.75pt;visibility:visible;mso-wrap-style:square'>
        <v:imagedata src=3D"v0-4-1Mockup3_files/image001.png" o:title=3D"nh=
s_logo_transparent"/>
       </v:shape></span><span style=3D'mso-bidi-font-size:16.0pt;font-famil=
y:
       "Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:1;height:15.4pt'>
       <td width=3D273 colspan=3D2 valign=3Dtop style=3D'width:204.7pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D126 valign=3Dtop style=3D'width:94.7pt;border:none;borde=
r-bottom:
       solid windowtext 1.0pt;mso-border-bottom-alt:solid windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal><span style=3D'mso-bidi-font-size:16.0pt;font-f=
amily:
       "Calibri","sans-serif"'><o:p>&nbsp;</o:p></span></p>
       </td>
       <td width=3D291 colspan=3D2 valign=3Dtop style=3D'width:218.0pt;bord=
er:none;
       border-bottom:solid windowtext 1.0pt;mso-border-bottom-alt:solid win=
dowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:15.4pt'>
       <p class=3DMsoNormal align=3Dright style=3D'text-align:right'><span
       style=3D'font-size:8.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'>Another
       Hospital, The Royal Another NHS Foundation Trust<o:p></o:p></span></=
p>
       </td>
      </tr>
      <tr style=3D'mso-yfti-irow:2;mso-yfti-lastrow:yes;height:44.25pt'>
       <td width=3D208 valign=3Dtop style=3D'width:155.95pt;border-top:none;
       border-left:solid windowtext 1.0pt;border-bottom:solid windowtext 1.=
0pt;
       border-right:none;mso-border-top-alt:solid windowtext .5pt;mso-borde=
r-top-alt:
       solid windowtext .5pt;mso-border-left-alt:solid windowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;padding:0cm 5.4pt 0cm 5.=
4pt;
       height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>PATIENT</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>SMITH,
       William<span style=3D'mso-spacerun:yes'>&nbsp; </span>(Mr)</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D191 colspan=3D2 valign=3Dtop style=3D'width:143.45pt;bor=
der:none;
       border-bottom:solid windowtext 1.0pt;mso-border-top-alt:solid window=
text .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>BORN</span></b><b style=3D'mso-bidi-font-weight:norma=
l'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>01-Jan-1946
       (63yr)</span><span style=3D'font-size:9.0pt;mso-bidi-font-size:10.0p=
t;
       font-family:"Calibri","sans-serif"'><o:p></o:p></span></p>
       </td>
       <td width=3D121 valign=3Dtop style=3D'width:90.45pt;border:none;bord=
er-bottom:
       solid windowtext 1.0pt;mso-border-top-alt:solid windowtext .5pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-bottom-alt:solid=
 windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>GENDER</span></b><b style=3D'mso-bidi-font-weight:nor=
mal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp;&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>Male</span><b
       style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:9.0pt;
       mso-bidi-font-size:10.0pt;font-family:"Calibri","sans-serif"'><o:p><=
/o:p></span></b></p>
       </td>
       <td width=3D170 valign=3Dtop style=3D'width:127.55pt;border-top:none;
       border-left:none;border-bottom:solid windowtext 1.0pt;border-right:s=
olid windowtext 1.0pt;
       mso-border-top-alt:solid windowtext .5pt;mso-border-top-alt:solid wi=
ndowtext .5pt;
       mso-border-bottom-alt:solid windowtext .5pt;mso-border-right-alt:sol=
id windowtext .5pt;
       padding:0cm 5.4pt 0cm 5.4pt;height:44.25pt'>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:8.0pt;font-family:"Calib=
ri","sans-serif";
       color:#1F497D'>NHS No.</span></b><b style=3D'mso-bidi-font-weight:no=
rmal'><span
       style=3D'font-size:9.0pt;mso-bidi-font-size:10.0pt;font-family:"Cali=
bri","sans-serif"'><span
       style=3D'mso-spacerun:yes'>&nbsp; </span></span></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>123
       728 7652</span><span style=3D'font-size:14.0pt;font-family:"Calibri"=
,"sans-serif"'><o:p></o:p></span></p>
       <p class=3DMsoNormal style=3D'margin-top:3.0pt;margin-right:0cm;marg=
in-bottom:
       3.0pt;margin-left:0cm'><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif";color:#1=
7365D'>HOSPITAL
       No.</span></b><b style=3D'mso-bidi-font-weight:normal'><span
       style=3D'font-size:9.0pt;font-family:"Calibri","sans-serif"'> </span=
></b><span
       style=3D'mso-bidi-font-size:12.0pt;font-family:"Calibri","sans-serif=
"'>ABC12345</span><span
       style=3D'font-size:14.0pt;mso-bidi-font-size:9.0pt;font-family:"Cali=
bri","sans-serif"'>
       </span><b style=3D'mso-bidi-font-weight:normal'><span style=3D'font-=
size:
       9.0pt;font-family:"Calibri","sans-serif"'><o:p></o:p></span></b></p>
       </td>
      </tr>
      <![if !supportMisalignedColumns]>
      <tr height=3D0>
       <td width=3D208 style=3D'border:none'></td>
       <td width=3D65 style=3D'border:none'></td>
       <td width=3D126 style=3D'border:none'></td>
       <td width=3D121 style=3D'border:none'></td>
       <td width=3D170 style=3D'border:none'></td>
      </tr>
      <![endif]>
     </table>
     <p class=3DMsoNormal><span style=3D'font-size:11.0pt;mso-bidi-font-siz=
e:10.0pt'><o:p>&nbsp;</o:p></span></p>
     </div>
     <![if !mso]></td>
    </tr>
   </table>
   <![endif]></v:textbox>
 </v:shape><![endif]--><![if !vml]><span style=3D'mso-ignore:vglayout;posit=
ion:
 relative;z-index:4'><span style=3D'position:absolute;left:42px;top:-1px;
 width:712px;height:978px'><img width=3D712 height=3D978
 src=3D"v0-4-1Mockup3_files/image007.gif" v:shapes=3D"_x0000_s1033 _x0000_s=
1045"></span></span><![endif]><!--[if gte vml 1]></o:wrapblock><![endif]-->=
<o:p>&nbsp;</o:p></p>

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:p></i></p>

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:p></i></p>

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:p></i></p>

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:p></i></p>

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:p></i></p>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</o=
:p></i></p>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</o=
:p></i></p>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</o=
:p></i></p>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</o=
:p></i></p>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</o=
:p></i></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</=
o:p></i></p>

<i style=3D'mso-bidi-font-style:normal'><span style=3D'font-size:12.0pt;mso=
-bidi-font-size:
10.0pt;font-family:"Arial","sans-serif";mso-fareast-font-family:"Times New =
Roman";
mso-ansi-language:EN-GB;mso-fareast-language:EN-US;mso-bidi-language:AR-SA'=
><br
clear=3Dall style=3D'mso-special-character:line-break;page-break-before:alw=
ays'>
</span></i>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</=
o:p></i></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</=
o:p></i></p>

<p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;tab-s=
tops:
36.0pt right 729.0pt'><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</=
o:p></i></p>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'><o:p>&nbsp;</o=
:p></i></p>

<br style=3D'mso-ignore:vglayout' clear=3DALL>

<p class=3DMsoNormal><i style=3D'mso-bidi-font-style:normal'>Other data ass=
ociated
with the Discharge Summary record &#8211; stored in the originating informa=
tion
system only:<o:p></o:p></i></p>

<p class=3DMsoNormal><!--[if gte vml 1]><v:shape id=3D"_x0000_s1034" type=
=3D"#_x0000_t202"
 style=3D'position:absolute;margin-left:21pt;margin-top:10pt;width:539.1pt;
 height:149.25pt;z-index:5'>
 <v:textbox style=3D'mso-next-textbox:#_x0000_s1034'/>
</v:shape><![endif]--><![if !vml]><span style=3D'mso-ignore:vglayout'>

<table cellpadding=3D0 cellspacing=3D0 align=3Dleft>
 <tr>
  <td width=3D27 height=3D12></td>
 </tr>
 <tr>
  <td></td>
  <td width=3D725 height=3D205 bgcolor=3Dwhite style=3D'border:.75pt solid =
black;
  vertical-align:top;background:white'><![endif]><![if !mso]><span
  style=3D'position:absolute;mso-ignore:vglayout;z-index:5'>
  <table cellpadding=3D0 cellspacing=3D0 width=3D"100%">
   <tr>
    <td><![endif]>
    <div v:shape=3D"_x0000_s1034" style=3D'padding:4.35pt 7.95pt 4.35pt 7.9=
5pt'
    class=3Dshape>
    <table class=3DMsoNormalTable border=3D0 cellspacing=3D0 cellpadding=3D=
0 width=3D697
     style=3D'width:522.8pt;border-collapse:collapse;mso-yfti-tbllook:1184;
     mso-padding-alt:0cm 5.4pt 0cm 5.4pt'>
     <tr style=3D'mso-yfti-irow:0;mso-yfti-firstrow:yes'>
      <td width=3D225 colspan=3D2 valign=3Dtop style=3D'width:168.45pt;back=
ground:black;
      padding:0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt;backgro=
und:
      black'><span style=3D'mso-bidi-font-size:14.0pt;color:white'>Distribu=
tion
      Record<o:p></o:p></span></p>
      </td>
      <td width=3D123 valign=3Dtop style=3D'width:92.1pt;background:black;p=
adding:
      0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt;backgro=
und:
      black'><span style=3D'mso-bidi-font-size:14.0pt;color:white'><o:p>&nb=
sp;</o:p></span></p>
      </td>
      <td width=3D170 colspan=3D2 valign=3Dtop style=3D'width:127.6pt;backg=
round:black;
      padding:0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal style=3D'tab-stops:71.35pt right 729.0pt;backgro=
und:
      black'><span style=3D'mso-bidi-font-size:14.0pt;color:white'><o:p>&nb=
sp;</o:p></span></p>
      </td>
      <td width=3D180 colspan=3D2 valign=3Dtop style=3D'width:134.65pt;back=
ground:black;
      padding:0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal align=3Dright style=3D'text-align:right;tab-stop=
s:71.35pt right 729.0pt;
      background:black'><span style=3D'mso-bidi-font-size:14.0pt;color:whit=
e'>(3
      recorded)<o:p></o:p></span></p>
      </td>
     </tr>
     <tr style=3D'mso-yfti-irow:1;height:20.55pt'>
      <td width=3D130 style=3D'width:97.55pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
      height:20.55pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1F=
497D;
      text-transform:uppercase'>RECIPIENT<span style=3D'mso-spacerun:yes'>&=
nbsp;
      </span>Name<o:p></o:p></span></b></p>
      </td>
      <td width=3D95 style=3D'width:70.9pt;border:none;border-bottom:solid =
#D9D9D9 1.0pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
      height:20.55pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1F=
497D;
      text-transform:uppercase'>RECIPIENT Organisation<span style=3D'mso-bi=
di-font-weight:
      bold'><o:p></o:p></span></span></b></p>
      </td>
      <td width=3D123 style=3D'width:92.1pt;border:none;border-bottom:solid=
 #D9D9D9 1.0pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
      height:20.55pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi-=
font-family:
      Calibri;color:#1F497D;text-transform:uppercase'>Description of Content
      (Version Reference)</span></b><b style=3D'mso-bidi-font-weight:normal=
'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";color:#1F=
497D;
      text-transform:uppercase'><o:p></o:p></span></b></p>
      </td>
      <td width=3D123 style=3D'width:92.15pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
      height:20.55pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi-=
font-family:
      Calibri;color:#1F497D;text-transform:uppercase'>Person Distributing</=
span></b><b
      style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
      font-family:"Calibri","sans-serif";color:#1F497D;text-transform:upper=
case'>
      Name</span></b><b style=3D'mso-bidi-font-weight:normal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi-=
font-family:
      Calibri;color:#1F497D;text-transform:uppercase'><o:p></o:p></span></b=
></p>
      </td>
      <td width=3D132 colspan=3D2 style=3D'width:99.25pt;border:none;border=
-bottom:
      solid #D9D9D9 1.0pt;mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:
      0cm 5.4pt 0cm 5.4pt;height:20.55pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi-=
font-family:
      Calibri;color:#1F497D;text-transform:uppercase'>Person Distributing</=
span></b><b
      style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
      font-family:"Calibri","sans-serif";color:#1F497D;text-transform:upper=
case'>
      Role</span></b><b style=3D'mso-bidi-font-weight:normal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi-=
font-family:
      Calibri;color:#1F497D;text-transform:uppercase'><o:p></o:p></span></b=
></p>
      </td>
      <td width=3D94 style=3D'width:70.85pt;border:none;border-bottom:solid=
 #D9D9D9 1.0pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt;
      height:20.55pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><b style=3D'mso-bidi-font-weight:nor=
mal'><span
      style=3D'font-size:8.0pt;font-family:"Calibri","sans-serif";mso-bidi-=
font-family:
      Calibri;color:#1F497D;text-transform:uppercase'>Date of Distribution<=
/span></b><b
      style=3D'mso-bidi-font-weight:normal'><span style=3D'font-size:8.0pt;
      font-family:"Calibri","sans-serif";color:#1F497D;text-transform:upper=
case'><o:p></o:p></span></b></p>
      </td>
     </tr>
     <tr style=3D'mso-yfti-irow:2'>
      <td width=3D130 style=3D'width:97.55pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
      mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9D=
9 .5pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
      font-family:"Calibri","sans-serif"'>Mr. William Smith<b style=3D'mso-=
bidi-font-weight:
      normal'><o:p></o:p></b></span></p>
      </td>
      <td width=3D95 style=3D'width:70.9pt;border:none;border-bottom:solid =
#D9D9D9 1.0pt;
      mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9D=
9 .5pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
      font-family:"Calibri","sans-serif"'>Patient<o:p></o:p></span></p>
      </td>
      <td width=3D123 style=3D'width:92.1pt;border:none;border-bottom:solid=
 #D9D9D9 1.0pt;
      mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9D=
9 .5pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
      <p class=3DMsoNormal style=3D'margin-bottom:0cm;margin-bottom:.0001pt;
      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
      font-family:"Calibri","sans-serif"'>Full Discharge Summary (V1.0)<o:p=
></o:p></span></p>
      </td>
      <td width=3D123 style=3D'width:92.15pt;border:none;border-bottom:soli=
d #D9D9D9 1.0pt;
      mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9D=
9 .5pt;
      mso-border-bottom-alt:solid #D9D9D9 .5pt;padding:0cm 5.4pt 0cm 5.4pt'>
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</p>
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bidi-font-weight:
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      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
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d #D9D9D9 1.0pt;
      mso-border-top-alt:solid #D9D9D9 .5pt;mso-border-top-alt:solid #D9D9D=
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      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
      font-family:"Calibri","sans-serif"'>Jonathan Thomas<o:p></o:p></span>=
</p>
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      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
      font-family:"Calibri","sans-serif"'>FY1 Orthopaedics<o:p></o:p></span=
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      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
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      font-family:"Calibri","sans-serif"'>Mr. Peter Owen<b style=3D'mso-bid=
i-font-weight:
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an></p>
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      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
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</p>
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 #D9D9D9 1.0pt;
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      tab-stops:71.35pt right 729.0pt'><span style=3D'font-size:11.0pt;
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<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

<p class=3DMsoNormal><o:p>&nbsp;</o:p></p>

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<div style=3D'mso-element:footnote-list'><![if !supportFootnotes]><br clear=
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<hr align=3Dleft size=3D1 width=3D"33%">

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<div style=3D'mso-element:footnote' id=3Dftn1>

<p class=3DMsoFootnoteText><a style=3D'mso-footnote-id:ftn1' href=3D"#_ftnr=
ef1"
name=3D"_ftn1" title=3D""><span class=3DMsoFootnoteReference><span style=3D=
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style=3D'font-size:10.0pt;font-family:"Arial","sans-serif";mso-fareast-font=
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"Times New Roman";mso-ansi-language:EN-GB;mso-fareast-language:EN-US;
mso-bidi-language:AR-SA'>[1]</span></span><![endif]></span></span></a> <i
style=3D'mso-bidi-font-style:normal'>Display of Clinical Statements: Design
Consultation Document, Version 1.0.0.0 Baseline</i>, Microsoft Corporation =
and
Crown Copyright 2009.</p>

</div>

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Content-Type: text/xml; charset="utf-8"

<xml xmlns:o=3D"urn:schemas-microsoft-com:office:office">
 <o:MainFile HRef=3D"../v0-4-1Mockup3.htm"/>
 <o:File HRef=3D"item0014.xml"/>
 <o:File HRef=3D"props0015.xml"/>
 <o:File HRef=3D"themedata.thmx"/>
 <o:File HRef=3D"colorschememapping.xml"/>
 <o:File HRef=3D"image001.png"/>
 <o:File HRef=3D"image002.gif"/>
 <o:File HRef=3D"image003.gif"/>
 <o:File HRef=3D"image004.gif"/>
 <o:File HRef=3D"image005.gif"/>
 <o:File HRef=3D"image006.gif"/>
 <o:File HRef=3D"image007.gif"/>
 <o:File HRef=3D"header.htm"/>
 <o:File HRef=3D"filelist.xml"/>
</xml>
------=_NextPart_01CCD03F.45E58AD0--
