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{\fdbmajor\f31501\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fhimajor\f31502\fbidi \froman\fcharset0\fprq2{\*\panose 00000000000000000000}Cambria;}
{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\flominor\f31504\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
{\fdbminor\f31505\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fhiminor\f31506\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri{\*\falt Calibri};}
{\fbiminor\f31507\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f460\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\f461\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\f463\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\f464\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\f465\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\f466\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\f467\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\f468\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\f470\fbidi \fswiss\fcharset238\fprq2 Arial CE;}{\f471\fbidi \fswiss\fcharset204\fprq2 Arial Cyr;}
{\f473\fbidi \fswiss\fcharset161\fprq2 Arial Greek;}{\f474\fbidi \fswiss\fcharset162\fprq2 Arial Tur;}{\f475\fbidi \fswiss\fcharset177\fprq2 Arial (Hebrew);}{\f476\fbidi \fswiss\fcharset178\fprq2 Arial (Arabic);}
{\f477\fbidi \fswiss\fcharset186\fprq2 Arial Baltic;}{\f478\fbidi \fswiss\fcharset163\fprq2 Arial (Vietnamese);}{\f480\fbidi \fmodern\fcharset238\fprq1 Courier New CE;}{\f481\fbidi \fmodern\fcharset204\fprq1 Courier New Cyr;}
{\f483\fbidi \fmodern\fcharset161\fprq1 Courier New Greek;}{\f484\fbidi \fmodern\fcharset162\fprq1 Courier New Tur;}{\f485\fbidi \fmodern\fcharset177\fprq1 Courier New (Hebrew);}{\f486\fbidi \fmodern\fcharset178\fprq1 Courier New (Arabic);}
{\f487\fbidi \fmodern\fcharset186\fprq1 Courier New Baltic;}{\f488\fbidi \fmodern\fcharset163\fprq1 Courier New (Vietnamese);}{\f800\fbidi \froman\fcharset238\fprq2 Cambria Math CE;}{\f801\fbidi \froman\fcharset204\fprq2 Cambria Math Cyr;}
{\f803\fbidi \froman\fcharset161\fprq2 Cambria Math Greek;}{\f804\fbidi \froman\fcharset162\fprq2 Cambria Math Tur;}{\f807\fbidi \froman\fcharset186\fprq2 Cambria Math Baltic;}{\f808\fbidi \froman\fcharset163\fprq2 Cambria Math (Vietnamese);}
{\f830\fbidi \fswiss\fcharset238\fprq2 Calibri CE{\*\falt Calibri};}{\f831\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr{\*\falt Calibri};}{\f833\fbidi \fswiss\fcharset161\fprq2 Calibri Greek{\*\falt Calibri};}
{\f834\fbidi \fswiss\fcharset162\fprq2 Calibri Tur{\*\falt Calibri};}{\f835\fbidi \fswiss\fcharset177\fprq2 Calibri (Hebrew){\*\falt Calibri};}{\f836\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic){\*\falt Calibri};}
{\f837\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic{\*\falt Calibri};}{\f838\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese){\*\falt Calibri};}{\f900\fbidi \fswiss\fcharset238\fprq2 Tahoma CE;}{\f901\fbidi \fswiss\fcharset204\fprq2 Tahoma Cyr;}
{\f903\fbidi \fswiss\fcharset161\fprq2 Tahoma Greek;}{\f904\fbidi \fswiss\fcharset162\fprq2 Tahoma Tur;}{\f905\fbidi \fswiss\fcharset177\fprq2 Tahoma (Hebrew);}{\f906\fbidi \fswiss\fcharset178\fprq2 Tahoma (Arabic);}
{\f907\fbidi \fswiss\fcharset186\fprq2 Tahoma Baltic;}{\f908\fbidi \fswiss\fcharset163\fprq2 Tahoma (Vietnamese);}{\f909\fbidi \fswiss\fcharset222\fprq2 Tahoma (Thai);}{\f910\fbidi \fmodern\fcharset238\fprq1 Consolas CE;}
{\f911\fbidi \fmodern\fcharset204\fprq1 Consolas Cyr;}{\f913\fbidi \fmodern\fcharset161\fprq1 Consolas Greek;}{\f914\fbidi \fmodern\fcharset162\fprq1 Consolas Tur;}{\f917\fbidi \fmodern\fcharset186\fprq1 Consolas Baltic;}
{\f918\fbidi \fmodern\fcharset163\fprq1 Consolas (Vietnamese);}{\flomajor\f31508\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flomajor\f31509\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\flomajor\f31511\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flomajor\f31512\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flomajor\f31513\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\flomajor\f31514\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flomajor\f31515\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flomajor\f31516\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fdbmajor\f31518\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbmajor\f31519\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbmajor\f31521\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
{\fdbmajor\f31522\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbmajor\f31523\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbmajor\f31524\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\fdbmajor\f31525\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbmajor\f31526\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhimajor\f31528\fbidi \froman\fcharset238\fprq2 Cambria CE;}
{\fhimajor\f31529\fbidi \froman\fcharset204\fprq2 Cambria Cyr;}{\fhimajor\f31531\fbidi \froman\fcharset161\fprq2 Cambria Greek;}{\fhimajor\f31532\fbidi \froman\fcharset162\fprq2 Cambria Tur;}
{\fhimajor\f31535\fbidi \froman\fcharset186\fprq2 Cambria Baltic;}{\fhimajor\f31536\fbidi \froman\fcharset163\fprq2 Cambria (Vietnamese);}{\fbimajor\f31538\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\fbimajor\f31539\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fbimajor\f31541\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fbimajor\f31542\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}
{\fbimajor\f31543\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbimajor\f31544\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbimajor\f31545\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}
{\fbimajor\f31546\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\flominor\f31548\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flominor\f31549\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\flominor\f31551\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flominor\f31552\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flominor\f31553\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\flominor\f31554\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flominor\f31555\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flominor\f31556\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fdbminor\f31558\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
{\fdbminor\f31562\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbminor\f31563\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbminor\f31564\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\fdbminor\f31565\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbminor\f31566\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhiminor\f31568\fbidi \fswiss\fcharset238\fprq2 Calibri CE{\*\falt Calibri};}
{\fhiminor\f31569\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr{\*\falt Calibri};}{\fhiminor\f31571\fbidi \fswiss\fcharset161\fprq2 Calibri Greek{\*\falt Calibri};}{\fhiminor\f31572\fbidi \fswiss\fcharset162\fprq2 Calibri Tur{\*\falt Calibri};}
{\fhiminor\f31573\fbidi \fswiss\fcharset177\fprq2 Calibri (Hebrew){\*\falt Calibri};}{\fhiminor\f31574\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic){\*\falt Calibri};}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic{\*\falt Calibri};}
{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese){\*\falt Calibri};}{\fbiminor\f31578\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fbiminor\f31579\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\fbiminor\f31581\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fbiminor\f31582\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fbiminor\f31583\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\fbiminor\f31584\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbiminor\f31585\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fbiminor\f31586\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}}
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\sbasedon0 \snext32 \slink33 \sunhideused \sqformat \spriority1 \styrsid11369884 Body Text;}{\*\cs33 \additive \rtlch\fcs1 \af37\afs18 \ltrch\fcs0 \i\f37\fs18\lang0\langfe2057\langnp0\langfenp2057
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: September 2020
\par Date }{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid10298215 Reviewed}{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid12780709 : }{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid10298215 September}{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid12780709 2021 }{
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\fs16\expnd0\expndtw-2\insrsid12780709 R}{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\expnd0\expndtw-1\insrsid12780709 evie}{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid12780709 w }{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\expnd0\expndtw-1\insrsid12780709 Du}{\rtlch\fcs1
\af1 \ltrch\fcs0 \fs16\expnd0\expndtw-2\insrsid12780709 e}{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid12780709 : September 202}{\rtlch\fcs1 \af1 \ltrch\fcs0 \fs16\insrsid10298215 2}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \fs16\insrsid12780709
\par }\pard\plain \ltrpar\s18\ql \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9900\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid149513 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f31506\fs16\insrsid8799724\charrsid16740793
\par }}{\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang {\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang {\pntxta )}}
{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl8
\pnlcltr\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang {\pntxtb (}{\pntxta )}}\ltrrow\trowd \irow0\irowband0\ltrrow\ts11\trrh244\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21
\trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tphmrg\tposy444\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10470\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3552\clcbpatraw22\clhidemark \cellx3547\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3557\clcbpatraw22\clhidemark \cellx7104\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3361\clcbpatraw22\clhidemark \cellx10465\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\pvpara\phmrg\posy444\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin107\pararsid4661896 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1
\ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 Referral Date:\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\pvpara\phmrg\posy444\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin108\pararsid4661896 {\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896
Priority:\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\pvpara\phmrg\posy444\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin107\pararsid4661896 {\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 NHS Number:\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896 \trowd \irow0\irowband0\ltrrow\ts11\trrh244\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb
\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tphmrg\tposy444\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10470\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3552\clcbpatraw22\clhidemark \cellx3547\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3557\clcbpatraw22\clhidemark \cellx7104\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3361\clcbpatraw22\clhidemark \cellx10465\row \ltrrow}\trowd \irow1\irowband1\lastrow \ltrrow\ts11\trrh244\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tphmrg\tposy444\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10470\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3552\clshdrawnil \cellx3547\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil \cellx7104\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3361\clshdrawnil \cellx10465\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\pvpara\phmrg\posy444\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin107\pararsid4661896 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057
{\*\bkmkstart dhzJoSXI2hA6vc2ue9Gm}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 00020000140000001464687a4a6f53584932684136766332756539476d00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname dhzJoSXI2hA6vc2ue9Gm}}}}
}{\fldrslt {\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Short date letter merged}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj
{\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend dhzJoSXI2hA6vc2ue9Gm} }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 \cell
}\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\pvpara\phmrg\posy444\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin108\pararsid621391 {\*\bkmkstart R9RKraM8zcVVYcuVLpto}{\field\fldedit{\*\fldinst {\rtlch\fcs1
\ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield
0002000014000000145239524b72614d387a635656596375564c70746f00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname R9RKraM8zcVVYcuVLpto}}}}}{\fldrslt {\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 Suspected Cancer Ref}{\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 erral }}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend R9RKraM8zcVVYcuVLpto}
{\*\bkmkstart Text28}}{\field{\*\fldinst {\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid931845 FORMTEXT }{\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid931845
{\*\datafield 00000000140000000654657874323800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text28}}}}}{\fldrslt {\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid931845
\u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 {\*\bkmkend Text28}\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\pvpara\phmrg\posy444\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin107\pararsid4661896 {\*\bkmkstart PbtLJ78TvJ7VLKTiCSZe}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield
0002000014000000145062744c4a373854764a37564c4b546943535a6500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PbtLJ78TvJ7VLKTiCSZe}}}}}{\fldrslt {\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 NHS Number}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \ab\af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 {\*\bkmkend PbtLJ78TvJ7VLKTiCSZe}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1
\af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896 \trowd \irow1\irowband1\lastrow \ltrrow\ts11\trrh244\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21
\trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tphmrg\tposy444\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10470\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3552\clshdrawnil \cellx3547\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3557\clshdrawnil \cellx7104\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3361\clshdrawnil \cellx10465\row }\pard\plain \ltrpar\s1\qj \li0\ri0\sb44\nowidctlpar\wrapdefault\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid4661896 \rtlch\fcs1 \ab\af37\afs28\alang1025
\ltrch\fcs0 \b\f37\fs28\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \insrsid4661896 Priority
\par }{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \fs16\insrsid4661896
\par }\pard\plain \ltrpar\qj \li0\ri0\sa52\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4661896 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af37
\ltrch\fcs0 \b\f31506\fs28\insrsid4661896\charrsid4661896 Patient Details / Contact Information
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkstart _Hlk22818910}Title:\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Forename:\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Surname:\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow0\irowband0\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\*\bkmkstart P5qbwsfZG5gefRUOTVUQ}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37
\ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 000200001400000014503571627773665a473567656652554f5456555100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P5qbwsfZG5gefRUOTVUQ
}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Title}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37
\ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend P5qbwsfZG5gefRUOTVUQ} \cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108
{\*\bkmkstart P4OrcWvPXZwnAXCYibwK}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 00020000140000001450344f7263577650585a776e415843596962774b00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P4OrcWvPXZwnAXCYibwK}}}}
}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Given Name}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37
\ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend P4OrcWvPXZwnAXCYibwK} \cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107
{\*\bkmkstart POWaapVejBp9xYEkoMNV}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 000200001400000014504f5761617056656a4270397859456b6f4d4e5600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname POWaapVejBp9xYEkoMNV}}}}
}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Surname}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37
\ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend POWaapVejBp9xYEkoMNV} \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1
\af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896 \trowd \irow1\irowband1\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485
\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Date of Birth:\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid10298215 Gender:}{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\highlight7\langnp1033\langfenp1033\insrsid4661896\charrsid11546285 \cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Ethnicity:\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896 \trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb
\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\*\bkmkstart PyOo9FRP7YtlnqvjuRJj}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37
\ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 00020000140000001450794f6f394652503759746c6e71766a75524a6a00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PyOo9FRP7YtlnqvjuRJj
}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Date of Birth}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend PyOo9FRP7YtlnqvjuRJj} \cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108
{\*\bkmkstart P9jobc8UXbsdbpWlF5iI}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid9241826 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid9241826 {\*\datafield 00020000140000001450396a6f62633855586273646270576c4635694900000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname
P9jobc8UXbsdbpWlF5iI}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid9241826 Gender(full)}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid9241826 {\*\bkmkend P9jobc8UXbsdbpWlF5iI} }{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\highlight7\langnp1033\langfenp1033\insrsid4661896\charrsid11546285 \cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107
{\*\bkmkstart PhAfZNw4N2HnNfbtmdAi}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 000200001400000014506841665a4e77344e32486e4e6662746d64416900000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PhAfZNw4N2HnNfbtmdAi}}}}
}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Ethnic Origin}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1
\af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend PhAfZNw4N2HnNfbtmdAi} {\*\bkmkstart Text26}}{\field{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982
FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 {\*\datafield 00000000140000000654657874323600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text26}}}}}{\fldrslt {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid5189982 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend Text26}\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow3\irowband3\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485
\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-243\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Address:
\par }\pard \ltrpar\s31\ql \li220\ri0\sb10\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin220 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 \cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Home Telephone Number:\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Email:\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow4\irowband4\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts11\trrh75\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3
\clvmgf\clvertalc\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard \ltrpar\ql \li142\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin142\pararsid4661896
{\*\bkmkstart P2KtTXie65HvK8SlbF3X}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896
{\*\datafield 00020000140000001450324b7454586965363548764b38536c6246335800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P2KtTXie65HvK8SlbF3X}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896 Home Full Address (stacked)}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896 {\*\bkmkend P2KtTXie65HvK8SlbF3X} }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896\charrsid4661896 \cell }\pard\plain \ltrpar
\s31\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkstart PeGvSNLc3YiJRFIbj8TD}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1
\af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 00020000140000001450654776534e4c633359694a524649626a38544400000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname
PeGvSNLc3YiJRFIbj8TD}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Patient Home Telephone}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend PeGvSNLc3YiJRFIbj8TD} {\*\bkmkstart Text23}}
{\field{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 {\*\datafield
00000000140000000654657874323300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text23}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid5189982 \u8194\'20\u8194\'20
\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896
{\*\bkmkend Text23}\cell }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkstart P2fDBKEg1IScm9hp7n5z}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield
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\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Patient E-mail Address}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend P2fDBKEg1IScm9hp7n5z} {\*\bkmkstart Text25}}{\field{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 FORMTEXT }{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 {\*\datafield 00000000140000000654657874323500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text25}}}}}{\fldrslt {\rtlch\fcs1
\af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid5189982 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend Text25}\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow5\irowband5\ltrrow\ts11\trrh75\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af37
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896 \cell }\pard\plain \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 OR Mobile Telephone Number:\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Text Message Consent:\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow6\irowband6\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow7\irowband7\ltrrow\ts11\trrh249\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3
\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid4661896 \cell }\pard\plain \ltrpar\s31\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkstart PlVWxuOF1HFCQO2Aya5m}}{\field\fldedit{\*\fldinst {\rtlch\fcs1
\af37\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896
{\*\datafield 000200001400000014506c565778754f4631484643514f32417961356d00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PlVWxuOF1HFCQO2Aya5m}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 Patient Mobile Telephone}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1
\af37\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 {\*\bkmkend PlVWxuOF1HFCQO2Aya5m} {\*\bkmkstart Text24}}{\field{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 {\*\datafield
00000000140000000654657874323400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text24}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f31506\fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid5189982 \u8194
\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896\charrsid4661896 {\*\bkmkend Text24}\cell }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Yes {\*\bkmkstart Check19}}
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896
{\*\datafield 650000001400000007436865636b313900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check19}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend Check19} No
{\*\bkmkstart Check20}}{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 650000001400000007436865636b323000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check20}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs18\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend Check20}\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow7\irowband7\ltrrow\ts11\trrh249\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\row \ltrrow}\trowd \irow8\irowband8\ltrrow\ts11\trrh239\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11629128\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22 \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22 \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-219\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 \rtlch\fcs1
\af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 Preferred Contact Time:\cell }\pard \ltrpar
\s31\ql \li108\ri0\sl-219\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 Interpreter Required }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 \cell }\pard \ltrpar\s31\ql \li107\ri0\sl-219\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 Preferred Language }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4661896 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow8\irowband8\ltrrow\ts11\trrh239\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11629128\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22 \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22 \cellx10485\row \ltrrow}\trowd \irow9\irowband9\lastrow \ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard\plain \ltrpar\s31\ql \li142\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin142\pararsid4661896 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\*\bkmkstart Text8}{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896 \hich\af37\dbch\af0\loch\f0 FORMTEXT }{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896 {\*\datafield 000000001400000005546578743800000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text8}}}}}{\fldrslt {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1024\langfe1024\loch\af0\noproof\langnp1033\langfenp1033\insrsid4661896 \loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37
\u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896 {\*\bkmkend Text8}\cell }\pard \ltrpar\s31\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 Yes }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 {\*\datafield 650000001400000007436865636b313900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check19}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 No }{\field\flddirty\fldpriv{\*\fldinst {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 {\*\datafield
650000001400000007436865636b323000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check20}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid4661896 \cell \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid4661896
\trowd \irow9\irowband9\lastrow \ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4661896\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485
\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid4661896 {\*\bkmkend _Hlk22818910}
\par }\pard \ltrpar\ql \li0\ri0\sa52\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11369884 {\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f31506\fs28\insrsid11369884\charrsid11369884 Referrer / Practice Details}{\rtlch\fcs1 \af37
\ltrch\fcs0 \f31506\insrsid4661896\charrsid11369884
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15613395\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 \rtlch\fcs1 \af37\afs22\alang1025
\ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 Referring Name:\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid15613395 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 Referrer Code:\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 Practice Code:\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid11369884
\trowd \irow0\irowband0\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15613395\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15613395\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\*\bkmkstart uBbN2WiNxAlIc2oLpH1Y}{\*\bkmkstart Text22}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid6245884 FORMTEXT }{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid6245884 {\*\datafield 0002000014000000147542624e3257694e78416c4963326f4c7048315900000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname
uBbN2WiNxAlIc2oLpH1Y}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid6245884 Current User}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid6245884 {\*\bkmkend uBbN2WiNxAlIc2oLpH1Y} }{\field{\*\fldinst {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4875762 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4875762 {\*\datafield
00000000140000000654657874323200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text22}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid4875762 \u8194\'20\u8194\'20
\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884
{\*\bkmkend Text22}\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid15613395 {\*\bkmkstart Text10}{\field{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 {\*\datafield 00000000140000000654657874313000000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text10}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid11369884 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 {\*\bkmkend Text10}\cell }\pard \ltrpar
\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 {\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid2698271\charrsid9202405 FORMTEXT }{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid2698271\charrsid9202405 {\*\datafield 0002000014000000144f5a506d6b34686a6a7159316c4856476b43685300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20
{\*\ffname OZPmk4hjjqY1lHVGkChS}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid2698271\charrsid9202405 Registered GP Organisation National Practice Code}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid11369884
\trowd \irow1\irowband1\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15613395\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15613395\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 Registered GP:\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid15613395 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 Surgery Name:\cell }\pard \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid11369884 Surgery Address:\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid11369884 \trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb
\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15613395\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15358128\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvmgf\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\*\bkmkstart PSUt1PyYBa9NUWldG7Tc}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 FORMTEXT }{\rtlch\fcs1 \af37
\ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\datafield 00020000140000001450535574315079594261394e55576c644737546300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname
PSUt1PyYBa9NUWldG7Tc}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 Registered GP Full Name}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\bkmkend PSUt1PyYBa9NUWldG7Tc} {\*\bkmkstart Text27}}
{\field{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5189982 {\*\datafield
00000000140000000654657874323700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text27}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid5189982 \u8194\'20\u8194\'20
\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748
{\*\bkmkend Text27}\cell }\pard \ltrpar\s31\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid15613395 {\*\bkmkstart OkEFKmJX9eDYEGZTgeih}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\datafield
0002000014000000144f6b45464b6d4a583965445945475a546765696800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OkEFKmJX9eDYEGZTgeih}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid621391 Registered GP O}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 rganisation Name}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\bkmkend OkEFKmJX9eDYEGZTgeih} \cell }\pard \ltrpar
\s31\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid15613395 {\*\bkmkstart OZwcsJBW9MAf4ljpcRUK}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\datafield
0002000014000000144f5a7763734a4257394d4166346c6a706352554b00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OZwcsJBW9MAf4ljpcRUK}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 Organisation Full Address (single line)}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\bkmkend OZwcsJBW9MAf4ljpcRUK}
\par }\pard \ltrpar\s31\ql \li0\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11369884 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748
\par }\pard \ltrpar\s31\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15613395 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid12990748
\trowd \irow3\irowband3\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15358128\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvmgf\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15358128\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\pard\plain \ltrpar\s31\ql \li107\ri0\sl-243\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid4863494 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 Surgery Telephone Number:\cell }\pard \ltrpar\s31\ql \li0\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid11369884 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 Generic Surgery Email Address:\cell }\pard \ltrpar\s31\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15613395 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\insrsid12990748 \trowd \irow4\irowband4\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb
\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid15358128\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3560\clcbpatraw22\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3607\clcbpatraw22\clhidemark \cellx7167\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth3318\clcbpatraw22\clhidemark \cellx10485\row \ltrrow}\trowd \irow5\irowband5\lastrow \ltrrow\ts11\trrh236\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb
\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11369884\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\pard \ltrpar\ql \li142\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin142\pararsid15613395 {\*\bkmkstart O2flXjo9LjzcYwAwoyv6}{\field\fldedit{\*\fldinst {\rtlch\fcs1
\af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid12990748 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid12990748 {\*\datafield
0002000014000000144f32666c586a6f394c6a7a63597741776f79763600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname O2flXjo9LjzcYwAwoyv6}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid12990748 Organisation Telephone Number}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid12990748 {\*\bkmkend O2flXjo9LjzcYwAwoyv6}
\par }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid4863494\charrsid4661896 \cell }\pard\plain \ltrpar\s31\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid15613395 \rtlch\fcs1
\af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\bkmkstart OgtnVAzgPgKsJ1FnZaDF}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\datafield
0002000014000000144f67746e56417a6750674b734a31466e5a61444600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OgtnVAzgPgKsJ1FnZaDF}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 Organisation E-mail Address}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\bkmkend OgtnVAzgPgKsJ1FnZaDF} {\*\bkmkstart Text20}}{\field{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 FORMTEXT }{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12990748 {\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1
\af37 \ltrch\fcs0 \fs20\lang1024\langfe1024\noproof\langnp1033\langfenp1033\insrsid12990748 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid12990748 {\*\bkmkend Text20}\cell \cell
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\insrsid12990748 \trowd \irow5\irowband5\lastrow \ltrrow\ts11\trrh236\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21
\trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10485\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11369884\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw20\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3560\clshdrawnil\clhidemark \cellx3560\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3607\clshdrawnil \cellx7167\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth3318\clshdrawnil \cellx10485\row }\pard \ltrpar\qj \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\b\f37\fs28\insrsid2824433
\par }{\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f37\fs28\insrsid621391\charrsid621391 Mandatory Information \endash }{\rtlch\fcs1 \af37 \ltrch\fcs0 \b\i\f37\fs28\insrsid621391\charrsid621391 will be returned if not complete
\par }\pard\plain \ltrpar\s32\qj \li0\ri368\sb51\sl276\slmult1\nowidctlpar\wrapdefault\faauto\adjustright\rin368\lin0\itap0\pararsid2824433 \rtlch\fcs1 \af37\afs18\alang1025 \ltrch\fcs0 \i\f37\fs18\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\rtlch\fcs1 \af37 \ltrch\fcs0 \b\fs20\cf6\insrsid2824433\charrsid9241826
Most patients will have investigations prior to having an appointment or during their first hospital visit. It is therefore important that patients are prepared for this and aware of the reason for t
heir referral. Please ensure the mandatory information below is provided and all relevant investigations are completed and attached.}{\rtlch\fcs1 \af37 \ltrch\fcs0 \b\fs20\cf6\insrsid2824433
\par }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid621391 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \f37\insrsid621391\charrsid621391 \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid621391\charrsid621391 Yes No}{\rtlch\fcs1 \af0
\ltrch\fcs0 \f37\insrsid621391\charrsid2824433
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trrh248\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8264\clcbpatraw22\clhidemark \cellx8782\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\pard \ltrpar\ql \li107\ri0\sl-235\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkstart _Hlk22821069}1.\cell }\pard \ltrpar\ql \li108\ri0\sl-235\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Has the patient been informed they are on a suspected cancer pathway, given appropriate support and advised they need to be }{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid12082971 available }{\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid12082971 a}{\rtlch\fcs1 \af37 \ltrch\fcs0
\b\f37\fs20\lang1033\langfe1033\langnp1033\insrsid12082971\charrsid12082971 t a}{\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid12082971 ny time}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 within the next two weeks?\cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1
\af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
650000001400000007436865636b323200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check22}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell {\*\bkmkstart Check22}}
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b323200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check22}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Check22}\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow0\irowband0\ltrrow\ts11\trrh248\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8264\clcbpatraw22\clhidemark \cellx8782\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trrh243\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2597\clcbpatraw22\clhidemark \cellx3116\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5542\clcbpatraw8 \cellx8657\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth125\clcbpatraw22
\cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 If no, please explain why:\cell }\pard \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 {\*\bkmkstart Text13}}
{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
{\*\datafield 00000000140000000654657874313300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text13}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1024\langfe1024\noproof\langnp1033\insrsid621391\charrsid621391 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {
\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Text13}\cell }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell
}\pard \ltrpar\qc \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391
\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow1\irowband1\ltrrow\ts11\trrh243\trleft0\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2597\clcbpatraw22\clhidemark \cellx3116\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5542\clcbpatraw8 \cellx8657\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth125\clcbpatraw22
\cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft0\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil
\cellx10477\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0
}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 2.\cell }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391
\hich\af37\dbch\af0\loch\f0 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 Have you ensured that the telephone contact details are correct?}{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\*\bkmkstart Check29}{\field\flddirty\fldpriv{\*\fldinst {
\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
650000001400000007436865636b323900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check29}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Check29}\cell {\*\bkmkstart Check30}}
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
{\*\datafield 650000001400000007436865636b333000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check30}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Check30}\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil
\cellx10477\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrnone
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvmgf\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw20\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2597\clcbpatraw22\clhidemark \cellx3116\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw20\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5542\clcbpatraw8 \cellx8657\clvmgf\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth125\clcbpatraw22
\cellx8782\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmrg\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-230\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Landline Number:
\par }\pard \ltrpar\ql \li108\ri0\sb29\sl-243\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 OR Mobile Number:\cell
}\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0
{\*\bkmkstart Text14}}{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 00000000140000000654657874313400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text14}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1024\langfe1024\noproof\langnp1033\insrsid621391\charrsid621391 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {
\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Text14}\cell }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell
\cell \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow3\irowband3\ltrrow\ts11\trrh244\trleft0\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrnone \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvmgf\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw20\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2597\clcbpatraw22\clhidemark \cellx3116\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw20\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5542\clcbpatraw8 \cellx8657\clvmgf\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth125\clcbpatraw22
\cellx8782\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmrg\clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trrh248\trleft0\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvmrg\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw20\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2597\clshdrawnil\clhidemark \cellx3116\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw20\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5542\clcbpatraw8 \cellx8657\clvmrg\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth125\clshdrawnil\clhidemark
\cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell \cell }\pard \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs18\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 {\*\bkmkstart Text15}}
{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
{\*\datafield 00000000140000000654657874313500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text15}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1024\langfe1024\noproof\langnp1033\insrsid621391\charrsid621391 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {
\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Text15}\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow4\irowband4\ltrrow\ts11\trrh248\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvmrg\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw20\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth2597\clshdrawnil\clhidemark \cellx3116\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf21 \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw20\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5542\clcbpatraw8 \cellx8657\clvmrg\clvertalc\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw20\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth125\clshdrawnil\clhidemark
\cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts11\trrh484\trleft0\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22 \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8264\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\pard \ltrpar\ql \li107\ri0\sl-235\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 3.}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-235\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid9241826 Have you told your patient they may have appointments and tests arranged }
{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid1651566\charrsid9241826 at any hospital }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid9241826 across Greater Manchester?}{
\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 \cell }\pard \ltrpar\ql \li107\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 {\*\datafield 650000001400000007436865636b323900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check29}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 \cell }{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 {\*\datafield 650000001400000007436865636b323900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check29}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid11031216\charrsid621391 \trowd \irow5\irowband5\ltrrow\ts11\trrh484\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22 \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8264\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth840\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts11\trrh484\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8264\clcbpatraw22\clhidemark \cellx8782\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\pard \ltrpar\ql \li107\ri0\sl-235\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 4.}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-235\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
Accurate functional status is needed to assess the most appropriate investigation and treatment.
\par }\pard \ltrpar\ql \li108\ri0\sl-229\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
Please select a score from one of the following and enter in the score field:\cell }\pard \ltrpar\ql \li107\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
\par
\par
\par }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Score: {\*\bkmkstart Text12}}
{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
00000000140000000654657874313200000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text12}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1024\langfe1024\noproof\langnp1033\insrsid621391\charrsid621391 \u8194\'20\u8194
\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
{\*\bkmkend Text12}\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow6\irowband6\ltrrow\ts11\trrh484\trleft0
\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth520\clcbpatraw22\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8264\clcbpatraw22\clhidemark \cellx8782\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow7\irowband7\ltrrow\ts11\trrh242\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21
\trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-222\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Rockwood Score 1-3\cell }\pard \ltrpar\ql \li107\ri0\sl-222\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Managing Well. Not limited by any comorbidities\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow7\irowband7\ltrrow\ts11\trrh242\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow8\irowband8\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Rockwood Score 4\cell }\pard \ltrpar\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Vulnerable, not dependent, symptoms limit activities\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow8\irowband8\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Rockwood Score 5\cell }\pard \ltrpar\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Mildly frail, evident slowing, need help with daily activities\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow9\irowband9\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-225\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Rockwood Score 6\cell }\pard \ltrpar\ql \li107\ri0\sl-225\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Moderately frail, need help with all outside activities and bathing\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow10\irowband10\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Rockwood Score 7-8\cell }\pard \ltrpar\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Severely frail, completely dependent for personal care\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow11\irowband11\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow12\irowband12\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Rockwood Score 9\cell }\pard \ltrpar\ql \li107\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Terminally ill, life expectancy of <6 months\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391
{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f37\fs20\insrsid621391\charrsid621391 \trowd \irow12\irowband12\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21
\trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trwWidthA11\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth520\clshdrawnil\clhidemark \cellx519\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2075\clcbpatraw22\clhidemark \cellx2594\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth6189\clcbpatraw22\clhidemark \cellx8782\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1695\clshdrawnil \cellx10477\row \ltrrow}\trowd \irow13\irowband13\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil \cellx10490\pard \ltrpar
\ql \li107\ri0\sl-233\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 {\*\bkmkend _Hlk22821069}5}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 Are there any concerns about this patient\rquote s capacity to consent to investigation/treatment? }{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\*\bkmkstart Check31}{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1
\af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Check31}\cell }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow13\irowband13\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil \cellx10490\row \ltrrow
}\trowd \irow14\irowband14\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil \cellx10490\pard \ltrpar
\ql \li107\ri0\sl-233\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391
If yes, has the next of kin/advocate been asked to attend?\cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 65000000140000000000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow14\irowband14\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil \cellx10490\row \ltrrow
}\trowd \irow15\irowband15\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil
\cellx10490\pard \ltrpar\ql \li107\ri0\sl-233\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 {\*\bkmkstart _Hlk22826201}6}{
\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Is the patient taking anti-coagulants?\cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow15\irowband15\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil
\cellx10490\row \ltrrow}\trowd \irow16\irowband16\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2639\clcbpatraw22\clhidemark \cellx3168\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5566\clcbpatraw8 \cellx8733\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth49\clcbpatraw22
\cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 If Yes please give details:\cell }\pard \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 {\*\bkmkstart Text21}}
{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 {\*\datafield 00000000140000000654657874323100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text21}}}}}{\fldrslt {\rtlch\fcs1 \af37
\ltrch\fcs0 \fs16\lang1024\langfe1024\loch\af0\hich\af37\noproof\langnp1033\insrsid621391\charrsid621391 \loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194
\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Text21}\cell \cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f37\fs20\insrsid621391\charrsid621391 \trowd \irow16\irowband16\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21
\trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2639\clcbpatraw22\clhidemark \cellx3168\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat8\cltxlrtb\clftsWidth3\clwWidth5566\clcbpatraw8 \cellx8733\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth49\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil
\cellx10490\row \ltrrow}\trowd \irow17\irowband17\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil
\cellx10490\pard \ltrpar\ql \li107\ri0\sl-233\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 7}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-243\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Is the patient diabetic and taking Metformin?\cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \trowd \irow17\irowband17\ltrrow\ts11\trrh244\trleft0
\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth902\clshdrawnil \cellx9684\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth804\clshdrawnil
\cellx10490\row \ltrrow}\trowd \irow18\irowband18\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2639\clcbpatraw22\clhidemark \cellx3168\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5566\clcbpatraw8 \cellx8733\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth49\clcbpatraw22
\cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 If Yes please give details:\cell }\pard \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 }
{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 {\*\datafield 00000000140000000654657874323100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text21}}}}}{\fldrslt {\rtlch\fcs1 \af37
\ltrch\fcs0 \fs16\lang1024\langfe1024\loch\af0\hich\af37\noproof\langnp1033\insrsid621391\charrsid621391 \loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20\loch\af0\dbch\af0\hich\f37 \u8194
\'20\loch\af0\dbch\af0\hich\f37 \u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell \cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \trowd \irow18\irowband18\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2639\clcbpatraw22\clhidemark \cellx3168\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5566\clcbpatraw8 \cellx8733\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth49\clcbpatraw22
\cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow19\irowband19\ltrrow
\ts11\trrh239\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil\clhidemark \cellx10490\pard \ltrpar\ql \li107\ri0\sl-238\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 8}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-238\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid3360776 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3360776\charrsid3360776 Current eGFR of patient:
\par
\par }\pard \ltrpar\ql \li108\ri0\sl-238\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid5667682 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid5667682\charrsid5667682
Recent changes to guidance mean eGFR is no longer required in all patients for CT, however }{\rtlch\fcs1 \ab\af37 \ltrch\fcs0 \b\f37\fs20\ul\lang1033\langfe1033\langnp1033\insrsid5667682\charrsid11745127 it is still needed prior to colonoscopy
\par }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid5667682\charrsid5667682
\par
\par If the value is not appearing this has not been recorded in the last 3 months, has the eGFR been requested today}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3360776\charrsid3360776
\par }\pard \ltrpar\ql \li108\ri157\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin157\lin108\pararsid3360776 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li107\ri0\sl-219\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Value:\cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow19\irowband19\ltrrow\ts11\trrh239\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil\clhidemark \cellx10490\row \ltrrow}\trowd \irow20\irowband20\ltrrow\ts11\trrh778\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8254\clshdrawnil\clhidemark \cellx8782\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell \cell }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37\afs16 \ltrch\fcs0
\f37\fs16\cf1\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \f37\fs16\cf1\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 {\*\datafield
000200001400000014546a677167694741414c4b51744c4e4468614e5300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TjgqgiGAALKQtLNDhaNS}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs16 \ltrch\fcs0
\f37\fs16\cf1\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 Single Code Entry: Glomerular filtration rate...}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {
\rtlch\fcs1 \af37 \ltrch\fcs0 \lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f37\fs20\insrsid621391\charrsid621391 \trowd \irow20\irowband20\ltrrow\ts11\trrh778\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21
\trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8254\clshdrawnil\clhidemark \cellx8782\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow21\irowband21\ltrrow\ts11\trrh500\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21
\trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8254\clshdrawnil\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell \cell }\pard \ltrpar\qc \li255\ri249\sb1\sl-223\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin249\lin255\pararsid621391 {\rtlch\fcs1 \ab\af37\afs18 \ltrch\fcs0
\b\f37\fs18\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 YES
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }{\rtlch\fcs1 \ab\af37\afs18 \ltrch\fcs0
\b\f37\fs18\lang2057\langfe2057\langfenp2057\insrsid621391\charrsid621391 NO
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow21\irowband21\ltrrow\ts11\trrh500\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth8254\clshdrawnil\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow22\irowband22\ltrrow\ts11\trrh243\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21
\trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt
\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil
\cellx10490\pard \ltrpar\ql \li107\ri0\sl-233\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 9}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348 .}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0
\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \b\f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid1641092 Full Blood Count Requested (FBC)\cell }\pard \ltrpar
\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391 FORMCHECKBOX }{
\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}
\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391
\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid8984348\charrsid621391 \trowd \irow22\irowband22\ltrrow\ts11\trrh243\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22 \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil
\cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow23\irowband23\ltrrow
\ts11\trrh243\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil
\cellx10490\pard \ltrpar\ql \li107\ri0\sl-233\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 10}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-224\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Does the patient require Translation or Interpretation Services?\cell }\pard \ltrpar\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow23\irowband23\ltrrow\ts11\trrh243\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw22\clhidemark \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf1 \clbrdrr
\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil
\cellx10490\row \ltrrow}\trowd \irow24\irowband24\ltrrow\ts11\trrh249\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv
\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21
\clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21
\clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2639\clcbpatraw22\clhidemark \cellx3168\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5566\clcbpatraw8 \cellx8733\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth49\clcbpatraw22
\cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrnone
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391
{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li108\ri0\sl-229\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 If Yes, which language:\cell }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs18\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 {\*\bkmkstart Text16}}{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
00000000140000000654657874313600000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text16}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1024\langfe1024\noproof\langnp1033\insrsid621391\charrsid621391 \u8194\'20
\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Text16}\cell }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs18\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar
\qc \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs18\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \cell \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391 \trowd \irow24\irowband24\ltrrow\ts11\trrh249\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2639\clcbpatraw22\clhidemark \cellx3168\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw20\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat8\cltxlrtb\clftsWidth3\clwWidth5566\clcbpatraw8 \cellx8733\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth49\clcbpatraw22
\cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf1 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth855\clshdrawnil \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrnone
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow25\irowband25\ltrrow\ts11\trrh239\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21
\trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth9960\clcbpatraw22\clhidemark \cellx10490\pard \ltrpar\ql \li107\ri0\sl-238\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin107\pararsid621391
{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid8984348 1}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid11031216 1}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 .\cell }\pard \ltrpar\ql \li108\ri0\sl-219\slmult0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin108\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 Please list any other impairments requiring }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid12082971 specialist help}{\rtlch\fcs1 \af37
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid12082971\charrsid12082971 for example deaf or blind}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid12082971 :}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f37\fs20\insrsid621391\charrsid621391
\trowd \irow25\irowband25\ltrrow\ts11\trrh239\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmgf\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw22\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth9960\clcbpatraw22\clhidemark \cellx10490\row \ltrrow}\trowd \irow26\irowband26\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth9960\clshdrawnil \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {
\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend _Hlk22826201}\cell }\pard \ltrpar\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37
\ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid621391\charrsid621391 \hich\af37\dbch\af0\loch\f0 {\*\bkmkstart Text17}}{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 FORMTEXT }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\datafield
00000000140000000654657874313700000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text17}}}}}{\fldrslt {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1024\langfe1024\noproof\langnp1033\insrsid621391\charrsid621391 \u8194\'20
\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid621391\charrsid621391 {\*\bkmkend Text17}\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f37\fs20\insrsid621391\charrsid621391 \trowd \irow26\irowband26\ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21
\trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvmrg\clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth530\clshdrawnil\clhidemark \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth9960\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow27\irowband27\lastrow \ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21
\trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21
\clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw24 \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw24 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat25\cltxlrtb\clftsWidth3\clwWidth853\clcbpatraw25 \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat25\cltxlrtb\clftsWidth3\clwWidth853\clcbpatraw25 \cellx10490\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263 12.}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid621391 \cell }\pard \ltrpar
\ql \li0\ri0\nowidctlpar\intbl\wrapdefault\faauto\adjustright\rin0\lin0\pararsid621391 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid3497263 \hich\af37\dbch\af0\loch\f0 }{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid9241826 Previous colonoscopy (please attach}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid274545\charrsid9241826 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid9241826 report)}{\rtlch\fcs1 \af37 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid3497263\charrsid621391 \cell }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263 }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid3497263\charrsid621391 \cell }{\rtlch\fcs1
\af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263 }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid621391 FORMCHECKBOX }{
\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid3497263\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}
\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs16\lang1033\langfe1033\loch\af0\hich\af37\langnp1033\insrsid3497263\charrsid621391 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f37\fs20\insrsid3497263\charrsid621391 \trowd \irow27\irowband27\lastrow \ltrrow\ts11\trrh244\trleft0\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh
\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21 \trftsWidth3\trwWidth10490\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3497263\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind5\tblindtype3 \clvertalc\clbrdrt
\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth530\clcbpatraw24 \cellx529\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl
\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth8254\clcbpatraw24 \cellx8782\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat25\cltxlrtb\clftsWidth3\clwWidth853\clcbpatraw25 \cellx9637\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr
\brdrs\brdrw10\brdrcf21 \clcbpat25\cltxlrtb\clftsWidth3\clwWidth853\clcbpatraw25 \cellx10490\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid11369884
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid5404681
\par }{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \b\f31506\fs28\insrsid2824433\charrsid9241826 Referral Reason}{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \b\f31506\fs28\insrsid11546285\charrsid9241826 }{\rtlch\fcs1 \ai\af37\afs24 \ltrch\fcs0
\b\i\fs24\insrsid11546285\charrsid9241826 {\*\bkmkstart _Hlk89773838}(include relevant family history and previous history of cancer)}{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid2824433 {\*\bkmkend _Hlk89773838}
\par
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts20\trgaph108\trleft0\trbrdrt\brdrs\brdrw60\brdrcf26 \trbrdrl\brdrs\brdrw60\brdrcf26 \trbrdrb\brdrs\brdrw60\brdrcf26 \trbrdrr\brdrs\brdrw60\brdrcf26 \trbrdrh\brdrs\brdrw60\brdrcf26 \trbrdrv
\brdrs\brdrw60\brdrcf26 \trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13980947\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind108\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw60\brdrcf26 \clbrdrl
\brdrs\brdrw60\brdrcf26 \clbrdrb\brdrs\brdrw60\brdrcf26 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10513\clshdrawnil \cellx10513\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2698271 {
\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \b\f31506\fs28\insrsid2698271 \line }{\rtlch\fcs1 \ab\ai\af1\afs24 \ltrch\fcs0 \fs24\insrsid2698271
\par }\pard \ltrpar\ql \li79\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin79\pararsid2698271 {\rtlch\fcs1 \ab\ai\af1\afs24 \ltrch\fcs0 \fs24\insrsid2698271
\par }{\rtlch\fcs1 \ab\ai\af1\afs24 \ltrch\fcs0 \fs24\insrsid2824433
\par
\par
\par
\par
\par }{\rtlch\fcs1 \ab\ai\af1\afs24 \ltrch\fcs0 \fs24\insrsid5320298
\par
\par }{\rtlch\fcs1 \ab\ai\af1\afs24 \ltrch\fcs0 \fs24\insrsid2824433
\par }\pard \ltrpar\ql \li0\ri0\sb2\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2824433 {\rtlch\fcs1 \af37 \ltrch\fcs0 \b\i\f31506\fs28\cf6\insrsid12015126\charrsid9269164
\par }\pard \ltrpar\ql \li79\ri0\sb2\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin79\pararsid2698271 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid9269164 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid9269164 \trowd \irow0\irowband0\lastrow \ltrrow\ts20\trgaph108\trleft0\trbrdrt\brdrs\brdrw60\brdrcf26 \trbrdrl
\brdrs\brdrw60\brdrcf26 \trbrdrb\brdrs\brdrw60\brdrcf26 \trbrdrr\brdrs\brdrw60\brdrcf26 \trbrdrh\brdrs\brdrw60\brdrcf26 \trbrdrv\brdrs\brdrw60\brdrcf26
\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid13980947\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind108\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw60\brdrcf26 \clbrdrl\brdrs\brdrw60\brdrcf26
\clbrdrb\brdrs\brdrw60\brdrcf26 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10513\clshdrawnil \cellx10513\row }\pard \ltrpar\ql \li0\ri0\sb44\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9269164 {\rtlch\fcs1
\af37\afs16 \ltrch\fcs0 \b\f31506\fs16\insrsid541840
\par }\pard \ltrpar\ql \li0\ri0\sb44\widctlpar\tx8900\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3569052 {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f31506\fs24\cf6\insrsid3569052\charrsid9241826
Please complete a FIT test for ALL colorectal referrals. You}{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f31506\fs24\insrsid3569052\charrsid9241826 }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f31506\fs24\cf6\insrsid3569052\charrsid9241826
DO NOT need to wait for}{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f31506\fs24\insrsid3569052\charrsid9241826 }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f31506\fs24\cf6\insrsid3569052\charrsid9241826 the result before making your referral.}{\rtlch\fcs1
\af37\afs20 \ltrch\fcs0 \b\f31506\fs24\cf6\insrsid3569052\charrsid5320298 }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \b\f31506\fs24\cf6\insrsid5320298\charrsid5320298
\par }{\rtlch\fcs1 \af37\afs18 \ltrch\fcs0 \b\f31506\cf6\insrsid5320298
\par
\par
\par
\par }{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\cf6\insrsid13980947\charrsid3569052 \tab }{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\insrsid6162518 }{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\insrsid5320298
\par }{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0
\b\f31506\fs20\insrsid13980947 Y}{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\insrsid5320298 ES}{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\insrsid13980947 N}{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\insrsid5320298 O}
{\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs20\insrsid16082416\charrsid16082416
\par }\pard \ltrpar\ql \li0\ri0\sb44\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9269164 {\rtlch\fcs1 \af37\afs16 \ltrch\fcs0 \b\f31506\fs16\insrsid541840
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trrh248\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil
\cellx9639\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard\plain \ltrpar\s31\qc \li0\ri0\sl-229\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 1\cell }\pard \ltrpar\s31\ql \li112\ri0\sl-229\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin112\absnoovrlp1\pararsid5320298 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
Aged 40 and over with:}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5320298
\par \cell {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-229\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
unexplained weight loss and abdominal}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\expnd0\expndtw-1\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 pain
\par }\pard \ltrpar\s31\qj \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid13980947 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 \cell }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid6761083 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0
\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}
}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow0\irowband0\ltrrow\ts11\trrh248\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil
\cellx9639\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts11\trrh380\trleft-5\trkeep\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil
\cellx9639\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard\plain \ltrpar\s31\qc \li0\ri0\sl-224\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 2\cell }\pard \ltrpar\s31\ql \li112\ri0\sl-224\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin112\absnoovrlp1\pararsid11035447 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
Aged 50 and over with:
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1
\ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid13980947 \cell {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}
}\pard\plain \ltrpar\s31\qj \fi-360\li820\ri0\sl-224\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025
\ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 unexplained rectal}{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\expnd0\expndtw-1\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 bleeding\cell }\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid6761083 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1
\af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield
650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 65000000140000000000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow1\irowband1\ltrrow\ts11\trrh380\trleft-5\trkeep\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil
\cellx9639\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow2\irowband2\ltrrow
\ts11\trrh244\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639\clvertalt
\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard\plain \ltrpar\s31\qc \li0\ri0\sl-225\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 3\cell }\pard \ltrpar\s31\ql \li112\ri0\sl-225\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin112\absnoovrlp1\pararsid11035447 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
Aged 60 and over with:\cell {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-225\slmult0
\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
iron deficiency anaemia and / or\cell }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid6761083 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0
\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}
}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow2\irowband2\ltrrow\ts11\trrh244\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639\clvertalt
\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow3\irowband3\ltrrow\ts11\trrh235\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth675\clshdrawnil\clhidemark \cellx670\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10
\clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639\clvertalt
\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490{\listtext\pard\plain\ltrpar \s21 \intbl\rtlch\fcs1 \af0\afs22 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \hich\af37\dbch\af0\loch\f37 1.\tab}\pard\plain \ltrpar
\s21\qc \fi-360\li720\ri0\widctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls26\adjustright\rin0\lin720\absnoovrlp1\pararsid6447352\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0
\f31506\fs22\lang4105\langfe1033\cgrid\langnp4105\langfenp1033 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \cell }\pard\plain \ltrpar
\s31\ql \li0\ri0\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid11035447 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs16\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid13980947 \cell {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0
\f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-215\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid7367024 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 changes in their bowel}
{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\expnd0\expndtw-2\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 habit }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid7367024 (please indicate if the patient has diarrhoea or constipation)}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 \cell
}\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid6761083 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield
650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{
\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}
}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow3\irowband3\ltrrow\ts11\trrh235\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth675\clshdrawnil\clhidemark \cellx670\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10
\clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639\clvertalt
\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts11\trrh238\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639
\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard\plain \ltrpar\s31\qc \li0\ri0\sl-218\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 4\cell }\pard \ltrpar\s31\ql \li112\ri0\sl-218\slmult0
\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin112\absnoovrlp1\pararsid11035447 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 At any age:
\cell {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-218\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 rectal mass
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-218\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid13980947 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 abdominal}{
\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\expnd0\expndtw-3\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 mass
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}unexplained anal mass or ulceration}{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid13980947 \cell }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 \rtlch\fcs1 \af1\afs22\alang1025
\ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0
\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield
65000000140000000000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1
\ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1 \ltrch\fcs0
\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0
\lang1033\langfe1033\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 \lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow4\irowband4\ltrrow\ts11\trrh238\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw22\clhidemark \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrnone \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22\clhidemark \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639
\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf21 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrnone \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts11\trrh248\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth675\clshdrawnil\clhidemark \cellx670\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10
\clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490{\listtext\pard\plain\ltrpar \s21 \intbl\rtlch\fcs1 \af0\afs22
\ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \hich\af37\dbch\af0\loch\f37 1.\tab}\pard\plain \ltrpar
\s21\qc \fi-360\li720\ri0\widctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls26\adjustright\rin0\lin720\absnoovrlp1\pararsid6447352\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0
\f31506\fs22\lang4105\langfe1033\cgrid\langnp4105\langfenp1033 {\rtlch\fcs1 \af37 \ltrch\fcs0 \f37\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \cell }\pard\plain \ltrpar
\s31\ql \li0\ri0\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid11035447 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs18\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid13980947 \cell }\pard \ltrpar\s31\qj \li0\ri0\sl-229\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid13980947 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 \cell }\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13980947 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0
\lang1033\langfe1033\langnp1033\insrsid13980947 \cell }\pard\plain \ltrpar\s31\qj \li720\ri0\sl-229\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin720\absnoovrlp1\pararsid13980947 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0 \f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1
\af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0
\f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow5\irowband5\ltrrow\ts11\trrh248\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvmrg\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth675\clshdrawnil\clhidemark \cellx670\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10
\clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22\clhidemark \cellx8789\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts11\trrh248\trleft-5\trbrdrt
\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw24 \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22 \cellx8789
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard\plain \ltrpar
\s31\qc \li0\ri0\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947 5}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid6447352 \cell
}\pard \ltrpar\s31\ql \li0\ri0\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid11035447 {\rtlch\fcs1 \af37 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid16408408 Those under 50 years with rectal bleeding AND}{\rtlch\fcs1 \af37 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 :}{\rtlch\fcs1
\af37 \ltrch\fcs0 \f31506\fs18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid16408408 \cell }\pard \ltrpar\s31\qj \li0\ri0\sl-229\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-229\slmult0
\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid6447352 abdominal pain
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-229\slmult0
\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid7367024 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid6447352 change in bowel habit}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 }{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid7367024 (please indicate if the patient has diarrhoea or constipation)}{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid6447352
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\qj \fi-360\li820\ri0\sl-229\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\ls25\adjustright\rin0\lin820\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 weight loss
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\langnp1033\insrsid13980947\charrsid6447352 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}{\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid6447352 iron deficiency anaemia}{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par }\pard \ltrpar\s31\qj \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par \cell }\pard \ltrpar\s31\qc \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid13980947 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }\pard \ltrpar\s31\qc \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6162518 {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid6162518
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid6162518
\par }\pard \ltrpar\s31\qc \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid13980947 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20
\ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield
650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid13980947 \cell }{\rtlch\fcs1 \af37\afs20
\ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid6162518
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow6\irowband6\ltrrow\ts11\trrh248\trleft-5\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh
\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw24 \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22 \cellx8789
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row \ltrrow}\trowd \irow7\irowband7\lastrow \ltrrow\ts11\trrh173\trleft-5\trkeep\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl
\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw24 \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22 \cellx8789\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\pard\plain \ltrpar
\s31\qc \li0\ri0\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6447352 \rtlch\fcs1 \af37\afs22\alang1025 \ltrch\fcs0
\f37\fs22\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid76580 6\cell }\pard \ltrpar
\s31\ql \li0\ri0\nowidctlpar\intbl\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid5598535 {\rtlch\fcs1 \af37 \ltrch\fcs0
\b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid9241826 Consider FIT testing if available:}{\rtlch\fcs1 \af37 \ltrch\fcs0 \b\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid76580
\par }{\rtlch\fcs1 \af37 \ltrch\fcs0 \i\fs18\lang1033\langfe1033\loch\af0\langnp1033\langfenp1033\insrsid13980947\charrsid76580 \cell }\pard \ltrpar\s31\ql \li0\ri0\sl-229\slmult0\nowidctlpar\intbl
\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid11035447 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\charscalex99\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}}\pard \ltrpar\s31\ql \fi-360\li828\ri0\sl-234\slmult0
\nowidctlpar\intbl\tx829\wrapdefault\faauto\ls19\adjustright\rin0\lin828\pararsid3676564 {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 aged 50 and over with unexplained abdominal pain or}{\rtlch\fcs1
\af37 \ltrch\fcs0 \fs20\expnd-2\expndtw-12\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 weight loss
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\charscalex99\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}aged 60 and over with anaemia even in the absence of iron deficiency
\par {\listtext\pard\plain\ltrpar \s31 \intbl\rtlch\fcs1 \af37\afs22 \ltrch\fcs0 \f10\fs20\lang1033\langfe1033\charscalex99\langnp1033\insrsid13980947 \loch\af10\dbch\af0\hich\f10 \'a7\tab}
aged 60 or less with a change in bowel habit or iron deficiency anaemia }{\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947\charrsid3676564
\par }\pard \ltrpar\s31\ql \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid11035447 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par
\par
\par
\par \cell }\pard \ltrpar\s31\qc \li0\ri0\sl-229\slmult0\nowidctlpar\intbl\tx829\pvpara\posx4\posy0\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid6162518 {\rtlch\fcs1 \af37 \ltrch\fcs0
\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid13980947 \cell }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947
\par
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 FORMCHECKBOX }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid621391 {\*\datafield 650000001400000007436865636b333100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check31}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \fs20\lang1033\langfe2057\langnp1033\insrsid13980947\charrsid13980947 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af1\afs22\alang1025 \ltrch\fcs0 \f1\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\lang2057\langfe2057\langfenp2057\insrsid13980947 \trowd \irow7\irowband7\lastrow \ltrrow\ts11\trrh173\trleft-5\trkeep\trbrdrt\brdrs\brdrw10\brdrcf21 \trbrdrl\brdrs\brdrw10\brdrcf21 \trbrdrb\brdrs\brdrw10\brdrcf21 \trbrdrr
\brdrs\brdrw10\brdrcf21 \trbrdrh\brdrs\brdrw10\brdrcf21 \trbrdrv\brdrs\brdrw10\brdrcf21
\tpvpara\tposx4\tposy0\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth10495\trftsWidthB3\trftsWidthA3\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid13980947\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \clcbpat24\cltxlrtb\clftsWidth3\clwWidth675\clcbpatraw24 \cellx670\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \clcbpat22\cltxlrtb\clftsWidth3\clwWidth2272\clcbpatraw22 \cellx2942\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21
\clcbpat22\cltxlrtb\clftsWidth3\clwWidth5847\clcbpatraw22 \cellx8789\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth850\clshdrawnil \cellx9639
\clvertalt\clbrdrt\brdrnone \clbrdrl\brdrs\brdrw10\brdrcf21 \clbrdrb\brdrs\brdrw10\brdrcf21 \clbrdrr\brdrs\brdrw10\brdrcf21 \cltxlrtb\clftsWidth3\clwWidth851\clshdrawnil \cellx10490\row }\pard \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \lbr3\insrsid11035447 \line }{\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid11035447\charrsid3676564 {\*\bkmkstart TQZdhaI3F71EXXvkI2ar}
\par }{\rtlch\fcs1 \af37\afs24 \ltrch\fcs0 \b\f31506\fs24\insrsid534425\charrsid534425 Consultations
\par {\*\bkmkstart TdiRQ7M74g4OGL4Ko1dc}{\*\bkmkend TQZdhaI3F71EXXvkI2ar}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af37 \ltrch\fcs0 \f31506\insrsid10040250\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af37 \ltrch\fcs0 \f31506\insrsid10040250\charrsid534425
{\*\datafield 0002000014000000145464695251374d373467344f474c344b6f31646300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TdiRQ7M74g4OGL4Ko1dc}}}}}{\fldrslt {\rtlch\fcs1 \af37 \ltrch\fcs0
\f31506\insrsid10040250\charrsid534425 Consultations}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af37 \ltrch\fcs0 \f31506\insrsid534425\charrsid534425
{\*\bkmkend TdiRQ7M74g4OGL4Ko1dc}
\par }{\rtlch\fcs1 \af37\afs24 \ltrch\fcs0 \f31506\fs24\insrsid534425
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11035447 {\rtlch\fcs1 \af37\afs24 \ltrch\fcs0 \f31506\fs24\insrsid931845\charrsid11035447
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts20\trgaph108\trleft-108\trbrdrt\brdrs\brdrw30\brdrcf26 \trbrdrl\brdrs\brdrw30\brdrcf26 \trbrdrb\brdrs\brdrw30\brdrcf26 \trbrdrr\brdrs\brdrw30\brdrcf26 \trbrdrh\brdrs\brdrw30\brdrcf26 \trbrdrv
\brdrs\brdrw5\brdrcf26 \trftsWidth3\trwWidth10456\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10040250\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone
\clbrdrl\brdrnone \clbrdrb\brdrs\brdrw30\brdrcf26 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth10456\clshdrawnil \cellx10348\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid534425 {\rtlch\fcs1 \ab\af37\afs28 \ltrch\fcs0
\b\f37\fs28\cf1\insrsid534425\charrsid534425 Pathology }{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \f37\fs28\cf1\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Sodium: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum sodium
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Potassium:\tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum potassium
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Total Chol: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum total cholesterol level
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 LDL Chol: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum LDL cholesterol level
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 HDL Chol: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum HDL cholesterol level
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 WCC: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Total white cell count
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Platelet Count: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Platelet count
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 MCV: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Mean corpuscular volume (MCV)
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Urea}{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 : \tab Single Code Entry: Serum urea level
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Creatinine: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum creatinine
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 eGFR: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Glomerular filtration rate...
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Bilirubin Level: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum bilirubin level
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Folate: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Blood folate
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 Ferritin: \tab }{\rtlch\fcs1 \af37\afs20
\ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 Single Code Entry: Serum ferritin
\par
\par }\pard \ltrpar\ql \li0\ri0\sb60\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f37\fs24\lang4105\langfe4105\langnp4105\langfenp4105\insrsid534425\charrsid534425
HAEMOTOLOGY}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 {\*\datafield
0002000014000000145437645231786f69554d636a62424f58365a517300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T7dR1xoiUMcjbBOX6ZQs}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f37\fs20\insrsid534425\charrsid534425 Haemoglobin}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 :}{
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 \tab \tab }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f37\fs20\insrsid534425\charrsid534425 {\*\datafield 0002000014000000145437645231786f69554d636a62424f58365a517300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T7dR1xoiUMcjbBOX6ZQs}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 Haemoglobin}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 {\*\datafield
00020000140000001454446b7447454c336b7469754e52736b3546524700000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TDktGEL3ktiuNRsk5FRG}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f37\fs20\insrsid534425\charrsid534425 ALT}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 : \tab \tab
\tab }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 ALT}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014543468577a54425072537963733563635a62455200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T4hWzTBPrSycs5ccZbER}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f37\fs20\insrsid534425\charrsid534425 Blood Glucose}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 :
\tab \tab }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 Blood Glucose}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 {\*\datafield
000200001400000014546767685046436e3137626637443964477a4d6b00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TgghPFCn17bf7D9dGzMk}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f37\fs20\cf1\insrsid534425\charrsid534425 Alkaline Phosphatase}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f37\fs20\cf1\insrsid534425\charrsid534425 :\tab }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Alkaline Phosphatase}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f37\fs24\cf1\insrsid534425\charrsid534425 RADIOLOGY\line }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\insrsid534425\charrsid534425 Radiology}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f37\fs24\cf1\insrsid534425\charrsid534425
\par }\pard \ltrpar\ql \li0\ri0\sb60\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f37\fs24\cf1\insrsid534425\charrsid534425
\par DIABETIC CONTROL
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20
\ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 {\*\datafield 000200001400000014546e4a5a4c5058735a344f4e77614a697249363600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TnJZLPXsZ4ONwaJirI66}}}}}{\fldrslt {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425 HbA1c: \tab \tab Single Code Entry: Haemoglobin A1c level \endash IFCC standardised }}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f37\fs20\insrsid534425\charrsid534425
\par
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f37\fs24\insrsid534425\charrsid534425 THYROID FUNCTION}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f37\fs16\insrsid534425\charrsid534425 T4: \tab \tab }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f37\fs20\cf1\insrsid534425\charrsid534425 {\*\datafield 000200001400000014547350376d31676b3859554657724b4c3254636500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TsP7m1gk8YUFWrKL2Tce}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum free T4 level}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20
\ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f37\fs16\insrsid534425\charrsid534425 TSH: \tab \tab }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f37\fs20\cf1\insrsid534425\charrsid534425 {\*\datafield 000200001400000014546338514e6a5451615753384135677076474b4c00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Tc8QNjTQaWS8A5gpvGKL}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Serum TSH level}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f37\fs20\cf1\insrsid534425\charrsid534425 }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }\pard \ltrpar\ql \li0\ri0\sb60\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f37\fs16\cf1\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f37\fs24\cf1\insrsid534425\charrsid534425 HEALTH PROFILE}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f37\fs16\cf1\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014547570456c563672495648645544446849346a4300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TupElV6rIVHdUDDhI4jC}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Problems}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
00020000140000001454334a6b454644585974704f6f53316c537a685000000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T3JkEFDXYtpOoS1lSzhP}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Medication}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
00020000140000001454426575784851665a57366f6a66616a50574e4400000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TBeuxHQfZW6ojfajPWND}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Allergies}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
00020000140000001454625034464e74416a63424c6872367a4564484800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TbP4FNtAjcBLhr6zEdHH}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Family History}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014546f35386b4f483964396b66537a39616234356600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname To58kOH9d9kfSz9ab45f}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Alcohol Consumption}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014547a47446a68794a5548796f4765713962586c3800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TzGDjhyJUHyoGeq9bXl8}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Smoking}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014547a5a743438534d714c6e54734e754c4e69426200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TzZt48SMqLnTsNuLNiBb}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Weight}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014546a3563316d7451756347653853343347746a7200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Tj5c1mtQucGe8S43Gtjr}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
Height}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425 {\*\datafield
000200001400000014544a3438633331694c314d6f59594d436a44466300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TJ48c31iL1MoYYMCjDFc}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
BMI}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\insrsid534425\charrsid534425
\par }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 {\*\datafield
0002000014000000145468546c7431534e61666a72646a33633177467300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname ThTlt1SNafjrdj3c1wFs}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f37\fs20\cf1\insrsid534425\charrsid534425 Blood Pressure}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectlinegrid360\sectdefaultcl\sectrsid4923093\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid534425 {\rtlch\fcs1 \ab\af37\afs28 \ltrch\fcs0 \b\f37\fs28\cf1\insrsid534425
\par }{\rtlch\fcs1 \ab\af37\afs28 \ltrch\fcs0 \b\f37\fs28\cf1\insrsid534425\charrsid534425 Long Term Conditions }{\rtlch\fcs1 \af37\afs28 \ltrch\fcs0 \b\f37\fs28\cf1\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 IHD: \tab \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Ischaemic heart disease
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Diabetes: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Diabetes mellitus...
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Hypertension: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Essential hypertension
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Epilepsy: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Epilepsy}{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\cf1\insrsid534425
\par }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Stroke/TIA: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0
\f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Cerebrovascular disease
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Parkinson\rquote s:\tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Parkinson's disease
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Dementia: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Senile dementia...
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 COPD: \tab \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Chronic obstructive pulmonary disease
\par }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 CKD: \tab \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Chronic kidney disease stage 1 with proteinuria...
\line }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0 \b\f37\fs20\cf1\insrsid534425\charrsid534425 Neoplasms: \tab }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Neoplasms
\par }\pard \ltrpar\ql \li0\ri0\sb60\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f37\fs16\cf1\insrsid534425\charrsid534425
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid534425 {\rtlch\fcs1 \ab\af37\afs28 \ltrch\fcs0 \b\f37\fs28\cf1\insrsid534425\charrsid534425 Contraception }{\rtlch\fcs1 \ab\af37\afs20 \ltrch\fcs0
\b\f37\fs20\cf1\lang4105\langfe4105\langnp4105\langfenp4105\insrsid534425\charrsid534425 (please check medication screen for items that may not have filtered through)}{\rtlch\fcs1 \ab\af37\afs28 \ltrch\fcs0 \b\f37\fs28\cf1\insrsid534425\charrsid534425
\par }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425 Single Code Entry: Prescribed post-coital OCP
\par }\pard \ltrpar\ql \li0\ri0\sb60\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid534425 {\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f37\fs16\cf1\insrsid534425\charrsid534425
\par
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\faauto\rin0\lin0\pararsid534425 {\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425
\par
\par
\par
\par
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\par }{\rtlch\fcs1 \af37\afs20 \ltrch\fcs0 \f37\fs20\cf1\insrsid534425\charrsid534425
\par }\pard \ltrpar\ql \li0\ri0\sb60\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11471815 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f31506\fs24\insrsid4015354\charrsid10040250 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid4015354\charrsid4015354 \trowd \irow0\irowband0\lastrow \ltrrow\ts20\trgaph108\trleft-108\trbrdrt\brdrs\brdrw30\brdrcf26 \trbrdrl
\brdrs\brdrw30\brdrcf26 \trbrdrb\brdrs\brdrw30\brdrcf26 \trbrdrr\brdrs\brdrw30\brdrcf26 \trbrdrh\brdrs\brdrw30\brdrcf26 \trbrdrv\brdrs\brdrw5\brdrcf26
\trftsWidth3\trwWidth10456\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10040250\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrnone \clbrdrl\brdrnone
\clbrdrb\brdrs\brdrw30\brdrcf26 \clbrdrr\brdrnone \cltxlrtb\clftsWidth3\clwWidth10456\clshdrawnil \cellx10348\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f31506\fs20\insrsid11543434 {\*\bkmkstart TnJZLPXsZ4ONwaJirI66}{\*\bkmkend TnJZLPXsZ4ONwaJirI66}
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