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{\*\docvar {Tb1li86jaGWpovP5xmSa}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Moderate learning disability..." TableTitle="Single Code Entry" NoDataText="No events found." GUID="d4e0b7df-f394-4a22-b763-ec2a6daffff6" DisplayTitle="false" Displ
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&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1129781000000117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bSevere learning disability&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1
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{\*\docvar {Tb1ykt2aUPTJLbivHpc1}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Body weight" TableTitle="Single Code Entry" NoDataText="No events found." GUID="bbd522ba-0c91-4bb5-9852-8837e99707c0" DisplayTitle="false" DisplayHeaderRow="false" 
DisplayBorder="false" NoDataAction="1" TableType="11" LastBut="1"><IncludedColumns>Date</IncludedColumns><IncludedColumns>Value</IncludedColumns><IncludedColumns>Units</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-
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{\*\docvar {TBUDshNTlevdE2nlTstC}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Child removed from protection register" TableTitle="Single Code Entry" NoDataText="No events found." GUID="3d569e28-6acd-4862-a708-ab51915023cd" DisplayTitle="false
" DisplayHeaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="false"><SpecificNumber Value="1"><WithinTimeSpan Value="3" DurationType="2" /></SpecificNumber></Criteria><IncludedColumns>Date</IncludedColumns><Inclu
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{\*\docvar {TBVlkTjM64ObWfgVZo4o}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Smoking Status" TableTitle="Single Code Entry" NoDataText="No events found." GUID="3f454c37-f5ae-400e-987f-107ed160b747" DisplayTitle="false" DisplayHeaderRow="fals
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{\*\docvar {TcdhyltnqLVofAsv71Qn}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: History relating to military service" TableTitle="Single Code Entry" NoDataText="No events found." GUID="8c368d5a-466e-4fbf-8229-06b1d2f9b449" DisplayTitle="false" 
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{\*\docvar {TcFuO63DM8VMwr2Rrhae}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: No longer a vulnerable adult..." TableTitle="Single Code Entry" NoDataText="No events found." GUID="376f738e-05a7-4689-bac8-2fec12b8171a" DisplayTitle="false" Displ
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mns>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1909431000006111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bNo longer a vulnerable adult&lt\'3b/q1:term
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{\*\docvar {TcjAJg8b9lLREAtg4cK7}{T<ClinicalContentTableType IncludeMostRecentOnly="true" UIDisplayName="Information format: Requires information verbally..." TableTitle="Information format" NoDataText="No events recorded." GUID="003ebc14-c10f-4486-8b4b-399af5dbd63c" DisplayTitle="true" D
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ildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1779801000000113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in Easyread&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeCh
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ren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2398721000000110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in electronic audio format&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/
q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2398761000000119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in Moon alphabet&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue
&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2398801000000112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in Makaton&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&
lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2398841000000110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in contracted (Grade 2) Braille&lt\'3b/q1:term&gt\'3b&lt\'3bq1:incl
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ast 20 point sans serif font&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1947181000006116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequ
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/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires written information in at least 28 point sans serif font&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3b
q1:codeId&gt\'3b1947281000006112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information on USB (universal serial bus) mass storage device&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1
:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2418681000000113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in electronic downloadable format&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&
lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1967171000006114&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires healthcare information recording on personal audio recording device&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:inc
ludeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2504911000000111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires third party to read out written information&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildre
n&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b8458671000006119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information in aphasia-accessible format&lt\'3b/q1:term&gt\'3b&lt\'3b
q1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1779041000000118&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires information on audio cassette tape&lt\'3b/q1:t
erm&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>
}}
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dColumns>Units</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b253677014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bBody weight&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildre
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{\*\docvar {TDGEfYoJMjgFC3neScKZ}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Consultations" TableTitle="Consultations" NoDataText="No consultation was selected for this referral" GUID="3284257b-db11-44af-ab15-00426eb03071" DisplayTitle="true" DisplayHeaderRow=
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{\*\docvar {TEIQJCrsA5MUBixqxcEl}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: O/E - blood pressure reading" TableTitle="Single Code Entry" NoDataText="No BP result recorded" GUID="7c810191-3a87-4494-9fc1-8e3f658134c1" DisplayTitle="false" Dis
playHeaderRow="false" DisplayBorder="false" NoDataAction="2" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Value</IncludedColumns><IncludedColumns>Units</Included
Columns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b254063019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bO/E - blood pressure reading&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3bfa
lse&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TFctq7CPOJvdJW8TfRLs}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Is no longer a carer" TableTitle="Single Code Entry" NoDataText="No events found." GUID="9197ab47-91a9-4b94-a1ab-754b57470d0e" DisplayTitle="false" DisplayHeaderRow
="false" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:cod
es xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b301361000000110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bIs no longer a carer&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClini
calCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TfISZhPDjg62FLToc3CL}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Allergies" TableTitle="Allergies" NoDataText="No allergies recorded." GUID="c43546dd-4518-48c6-8868-5aa12a19a805" DisplayTitle="true" DisplayHeaderRow="true" DisplayBorder="false" NoD
ataAction="0" TableType="0" PromptWhenMerging="false"><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><IncludedColumns>Associated Text</IncludedColumns></ClinicalContentTableType>}}
{\*\docvar {TFpEDQxwQhM7YKqM5WWX}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Consultations" TableTitle="Consultations" NoDataText="No consultation was selected for this referral" GUID="a668b55a-e247-499d-a816-fac9a6761492" DisplayTitle="true" DisplayHeaderRow=
"true" DisplayBorder="false" NoDataAction="2" TableType="3" PromptWhenMerging="true"><Criteria IsSelectAll="false"><SpecificNumber Value="0" /></Criteria></ClinicalContentTableType>}}
{\*\docvar {TfxxIyTy3tEB9rvfXpNN}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Body weight" TableTitle="Single Code Entry" NoDataText="No events found." GUID="92c82f98-6259-4b2d-98ba-bd70e408d80c" DisplayTitle="false" DisplayHeaderRow="false" 
DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><IncludedColumns>Value</IncludedColumns><Include
dColumns>Units</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b253677014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bBody weight&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildre
n&gt\'3bfalse&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TGekr5w54qcytyn5drim}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Current Smoker NOS..." TableTitle="Single Code Entry" NoDataText="No events found." GUID="ce2bbc18-3c10-4256-a5d1-68d34ea9756f" DisplayTitle="false" DisplayHeaderRo
w="false" DisplayBorder="false" NoDataAction="2" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><IncludedColumns>Value</IncludedColumn
s><IncludedColumns>Units</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b604961000006114&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bCurrent Smoker NOS&lt\'3b/q1:term&g
t\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b397732011&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bNever smoked tobacco&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChi
ldren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b649841000006110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bEx-smoker&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:inc
ludeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2265711000000117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bElectronic cigarette user&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChi
ldren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2336091000000117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bEx user of electronic cigarette&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChil
dren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TgLLhGWHMgTfAsyN6Uag}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Body weight" TableTitle="Single Code Entry" NoDataText="No events found." GUID="6d7b956e-f18d-4418-87fa-5df262afd52d" DisplayTitle="false" DisplayHeaderRow="false" 
DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Value</IncludedColumns><IncludedColumns>Units</IncludedColumns><CodeDetails C
odesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b253677014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bBody weight&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3bfalse&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:ty
pe&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TH7gTqL38ZNGUV4fWZKf}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Has a carer" TableTitle="Single Code Entry" NoDataText="No events found." GUID="e6fc0b24-240e-431a-9347-0eab292c2e8e" DisplayTitle="false" DisplayHeaderRow="false" 
DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:
q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b284460017&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bHas a carer&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&
lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TigAF7VARRSrv6NfWypl}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Problems" TableTitle="Problems" NoDataText="No problems recorded." GUID="82618b14-6460-4f14-be2f-2e211e80fbd0" DisplayTitle="true" DisplayHeaderRow="true" DisplayBorder="false" NoData
Action="0" TableType="9" PromptWhenMerging="false"><Criteria IsSelectAll="true" /><IncludedColumns>Date</IncludedColumns><IncludedColumns>Problem</IncludedColumns><IncludedColumns>Associated Text</IncludedColumns><ProblemDetails IncludeSignificantPast="tr
ue" IncludeMinorPast="false" IncludeHealthAdmin="false" IncludeActive="true" /></ClinicalContentTableType>}}
{\*\docvar {TiQSkbAFu1T8hBijPtGP}{T<ClinicalContentTableType IncludeMostRecentOnly="true" UIDisplayName="Communication support: Uses a legal advocate..." TableTitle="Communication support" NoDataText="No events recorded." GUID="6eb4bdfd-3424-41fa-b6f8-7c387a86cb7b" DisplayTitle="true" Dis
playHeaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="2" PromptWhenMerging="false"><Criteria IsSelectAll="true" /><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:co
des xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b339334017&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses a legal advocate&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalC
ode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b339335016&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses a citizen advocate&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&
gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b423945013&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bDoes use hearing aid&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValu
e&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2532745018&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses sign language&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValu
e&gt\'3b&lt\'3bq1:codeId&gt\'3b7245641000006113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bDoes lip read&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&
gt\'3b216092019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUsing lip-reading&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162591000000110&lt
\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses manual note taker&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162501000000115&lt\'3b/q1:codeI
d&gt\'3b&lt\'3bq1:term&gt\'3bUses electronic note taker&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162631000000110&lt\'3b/q1:codeId&gt\'3b&
lt\'3bq1:term&gt\'3bUses speech to text reporter&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162691000000111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq
1:term&gt\'3bUses cued speech transliterator&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162461000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1
:term&gt\'3bUses lipspeaker&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162771000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses tex
tphone&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1162221000000110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bPreferred method of commun
ication: written&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1687181000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses alternative
 communication skill&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2173841000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses Persona
l Communication Passport&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2435361000000112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses com
munication device&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2440051000000118&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses deafblind 
intervener&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2496941000000110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses Deafblind Manual 
Alphabet&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2505171000000119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses personal audio reco
rding device to record information&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b8458861000006110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&g
t\'3bRequires aphasia-friendly communication&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b8458881000006117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1
:term&gt\'3bRequires support for expressive communication needs&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b8458871000006115&lt\'3b/
q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires support for receptive communication needs&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b845
8651000006112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses gestures for communication&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b8458
661000006114&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bUses objects for communication&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:
codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TKyApI4R7yA1IEhn4cgA}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Body mass index" TableTitle="Single Code Entry" NoDataText="No events found." GUID="cd3d3d38-625c-4a39-bf5f-98e572468826" DisplayTitle="false" DisplayHeaderRow="fal
se" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><IncludedColumns>Value</IncludedColumns><Inc
ludedColumns>Units</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b100716012&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bBody mass index&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includ
eChildren&gt\'3bfalse&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>
}}
{\*\docvar {TLueDOTpAiJZlwbislxZ}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Serum CRP (C reactive protein) level" TableTitle="Single Code Entry" NoDataText="No events found." GUID="db49f544-cd88-4994-96a1-bf0bd280d2aa" DisplayTitle="false" 
DisplayHeaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Value</IncludedColumns><IncludedColumns>Units</IncludedColumns><CodeDetails CodesDetailXml=
"&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b216602012&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bSerum CRP (C reactive protein) level&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3bfalse&lt\'3b/q1:includeChildren&g
t\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TMcefO1lEN78kPmtene8}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Child on protection register" TableTitle="Single Code Entry" NoDataText="No events found." GUID="d744f16b-07d8-41e1-9290-64cfd0e36fa6" DisplayTitle="false" DisplayH
eaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="false"><SpecificNumber Value="1"><WithinTimeSpan Value="3" DurationType="2" /></SpecificNumber></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns
>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b250836014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bChild on protection register&lt\'3b/q1:term&gt\'3b&lt\'3bq1
:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>
}}
{\*\docvar {TMnkIaA2RwiLYPel3kBG}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Main spoken language English..." TableTitle="Single Code Entry" NoDataText="No events found." GUID="68c4069c-7c27-41e0-b07b-becc9e0b3de4" DisplayTitle="false" Displ
ayHeaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www
.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460087014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language English&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt
\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460104018&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Sylheti&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeVa
lue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460097017&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Polish&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq
1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159257014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Turkish&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValu
e&gt\'3b&lt\'3bq1:codeId&gt\'3b460084019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Bengali&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1
:codeId&gt\'3b460106016&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Urdu&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460
101014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Somali&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460088016&lt\'3b/q
1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language French&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460099019&lt\'3b/q1:codeId&gt\'3b
&lt\'3bq1:term&gt\'3bMain spoken language Punjabi&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460083013&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term
&gt\'3bMain spoken language Arabic&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460098010&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spo
ken language Portuguese&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460102019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken lang
uage Spanish&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460085018&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Canton
ese&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460086017&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Czech&lt\'3b/q1:te
rm&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159256017&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Lithuanian&lt\'3b/q1:term&gt\'3b&
lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460100010&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Russian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:inclu
deChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460093018&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Hindi&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt
\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460089012&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Gujerati&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/
q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159261015&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Vietnamese&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:incl
udeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159242019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Italian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildre
n&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1488808019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Kurdish&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq
1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1488807012&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Farsi&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bCl
inicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159248015&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Albanian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCod
e&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159243012&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language German&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:ty
pe&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b460096014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Mandarin&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b
/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2159252015&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Greek&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValu
e&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670041000000119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Afar&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt
\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2160075010&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Akan&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue
&gt\'3b&lt\'3bq1:codeId&gt\'3b1166921000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Bamun&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&l
t\'3bq1:codeId&gt\'3b2160063017&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Brawa&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&
gt\'3b7511041000006119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Abkhaz&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b17
06011000006112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Avaric&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b6703110
00000117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Aymara&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1725911000006
111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Bamoun&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670521000000119&lt
\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Basque&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670661000000114&lt\'3b/q1:c
odeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Bihari&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670781000000113&lt\'3b/q1:codeId&
gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Breton&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2160057014&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:t
erm&gt\'3bMain spoken language Amharic&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706021000006116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&
gt\'3bMain spoken language Avestan&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706031000006118&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bM
ain spoken language Bambara&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670461000000111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain s
poken language Bashkir&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670721000000112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken
 language Bislama&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706041000006111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken lan
guage Bosnian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670851000000110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language
 Burmese&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b671031000000118&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Cata
lan&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706061000006110&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chechen&
lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706071000006115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chinese&lt\'3b/
q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706091000006119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chuvash&lt\'3b/q1:t
erm&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670171000000112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Armenian&lt\'3b/q1:term&
gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670241000000111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Assamese&lt\'3b/q1:term&gt\'3b&
lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706051000006113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chamorro&lt\'3b/q1:term&gt\'3b&lt\'3b
q1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706401000006119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chichewa&lt\'3b/q1:term&gt\'3b&lt\'3bq1:
includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670101000000116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Afrikaans&lt\'3b/q1:term&gt\'3b&lt\'3bq1:inc
ludeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2112371000000116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Aragonese&lt\'3b/q1:term&gt\'3b&lt\'3bq1:inclu
deChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706001000006114&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Aragonese&lt\'3b/q1:term&gt\'3b&lt\'3bq1:include
Children&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1656481000006113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Bulgarian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeCh
ildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b642141000000118&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Bulgarian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChild
ren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670911000000116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Belarusian&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildre
n&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670401000000112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Azerbaijani&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren
&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b670971000000114&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Central Khmer&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildre
n&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1706081000006117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Church Slavic&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChild
ren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1599291000000112&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chewa&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt
\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b7514931000006114&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bMain spoken language Chuang&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue
&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
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{\*\docvar {TPooqGwzjSpS7BMdOutf}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Partial deafness..." TableTitle="Single Code Entry" NoDataText="No recording of deafness" GUID="8531b49c-ff31-46de-8962-d6b0c6444e5e" DisplayTitle="false" DisplayHe
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{\*\docvar {TqX5bXM2TU3ngRqcbthV}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Military veteran" TableTitle="Single Code Entry" NoDataText="No events found." GUID="dcaff515-fcfa-4ea4-94c9-4e58c6a1f35d" DisplayTitle="false" DisplayHeaderRow="fa
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{\*\docvar {TRh6CmWnCjjvtUpXc61x}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Difficult intubation" TableTitle="Single Code Entry" NoDataText="No events found." GUID="296c97c8-5ccc-45db-aaf9-2c6ebf97da33" DisplayTitle="false" DisplayHeaderRow
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es xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b325195012&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bDifficult intubation&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCod
e&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TsiNvwI3yuO2u1IAwRYf}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Carer" TableTitle="Single Code Entry" NoDataText="No events found." GUID="23872db1-6d4e-4ddc-b010-f3709482f68b" DisplayTitle="false" DisplayHeaderRow="false" Displa
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{\*\docvar {TUGtuXZ2zYsZngYIuK1z}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Medication" TableTitle="Medication" NoDataText="No medication issued." GUID="3604a7d1-8916-4332-9239-e3f31aa7dbad" DisplayTitle="true" DisplayHeaderRow="true" DisplayBorder="false" No
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{\*\docvar {TvRNUoYRATYE11c8HwkV}{T<ClinicalContentTableType IncludeMostRecentOnly="true" UIDisplayName="Professional required: Interpreter needed - British Sign Language..." TableTitle="Professional required" NoDataText="No events recorded." GUID="e26219f2-fa1a-45af-8903-f573cb980358" Di
splayTitle="true" DisplayHeaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="2" PromptWhenMerging="false"><Criteria IsSelectAll="true" /><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><CodeDetails Code
sDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b312701000000119&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bInterpreter needed - British Sign Language&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt
\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b312731000000113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bInterpreter needed - Makaton Sign Language&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&g
t\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b339336015&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bNeeds an advocate&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeC
hildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1779881000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires deafblind communicator guide&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:inc
ludeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2399091000000116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bSign Supported English interpreter needed&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&l
t\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2440101000000118&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires deafblind manual alphabet interpreter&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChil
dren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2440141000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires deafblind block alphabet interpreter&lt\'3b/q1:term&gt\'3b&lt\'3bq
1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2440231000000116&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires deafblind haptic communication interpreter&l
t\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2419031000000111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires manual note taker&lt\'3b/q1:
term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2419071000000113&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires lipspeaker&lt\'3b/q1:term&gt\'3b&lt\'3bq
1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2418601000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bVisual frame sign language interpreter needed&lt\'3b/q1:
term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2418641000000117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bHands-on signing interpreter needed&lt\'3b/
q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2461161000000117&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires speech to text reporter&lt\'3b/
q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2504171000000115&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires sighted guide&lt\'3b/q1:term&gt
\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b8458841000006111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRequires speech and language therapist support 
to communicate&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType
>}}
{\*\docvar {TxZgguwON4zFxQQlNVEn}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Vulnerable adult" TableTitle="Single Code Entry" NoDataText="No events found." GUID="f0d5c2e2-6000-4054-a554-0b5fca29c247" DisplayTitle="false" DisplayHeaderRow="fa
lse" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="false"><SpecificNumber Value="1"><WithinTimeSpan Value="3" DurationType="2" /></SpecificNumber></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description
</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b2548392010&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bVulnerable adult&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3bfal
se&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TynzOksoDLpcEVnEBBBa}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Erythrocyte sedimentation rate" TableTitle="Single Code Entry" NoDataText="No events found." GUID="9a07f46f-fde2-4627-b4a8-416e80630ce4" DisplayTitle="false" Displa
yHeaderRow="false" DisplayBorder="false" NoDataAction="1" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Value</IncludedColumns><IncludedColumns>Units</IncludedColumns><CodeDetails CodesDetailXml="&lt\'3bq
1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b648521000006111&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bErythrocyte sedimentation rate&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq
1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {TyU7V4SjtedsfXVgnNK5}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Alcohol consumption" TableTitle="Single Code Entry" NoDataText="No events found." GUID="7587cfae-4e2c-4410-ae71-c7f28ce74cb4" DisplayTitle="false" DisplayHeaderRow=
"false" DisplayBorder="false" NoDataAction="2" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Value</IncludedColumns><IncludedColumns>Units</IncludedColumns><CodeD
etails CodesDetailXml="&lt\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b1221271018&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bAlcohol consumption&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3bfalse&lt\'3b/q1:includeChil
dren&gt\'3b&lt\'3bq1:type&gt\'3bClinicalCode&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}
{\*\docvar {Tz4P3231oyKPNV1MiqQN}{T<ClinicalContentTableType IncludeMostRecentOnly="false" UIDisplayName="Single Code Entry: Registered blind" TableTitle="Single Code Entry" NoDataText="no recording of being blind" GUID="d3903e47-cd99-43e1-939e-edcd30297eca" DisplayTitle="false" DisplayHe
aderRow="false" DisplayBorder="false" NoDataAction="2" TableType="11"><Criteria IsSelectAll="true"><SpecificNumber Value="1" /></Criteria><IncludedColumns>Date</IncludedColumns><IncludedColumns>Description</IncludedColumns><CodeDetails CodesDetailXml="&lt
\'3bq1:codes xmlns:q1=&quot\'3bhttp://www.e-mis.com/emisopen&quot\'3b&gt\'3b&lt\'3bq1:codeValue&gt\'3b&lt\'3bq1:codeId&gt\'3b264661019&lt\'3b/q1:codeId&gt\'3b&lt\'3bq1:term&gt\'3bRegistered blind&lt\'3b/q1:term&gt\'3b&lt\'3bq1:includeChildren&gt\'3btrue&lt\'3b/q1:includeChildren&gt\'3b&lt\'3bq1:type&gt\'3bClinical
Code&lt\'3b/q1:type&gt\'3b&lt\'3b/q1:codeValue&gt\'3b&lt\'3bq1:codeSystem&gt\'3bSNOMED_CONCEPT&lt\'3b/q1:codeSystem&gt\'3b&lt\'3b/q1:codes&gt\'3b" /></ClinicalContentTableType>}}{\*\ftnsep \ltrpar \pard\plain \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10769627 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid4011428 \chftnsep 
\par }}{\*\ftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10769627 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4011428 \chftnsepc 
\par }}{\*\aftnsep \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10769627 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4011428 \chftnsep 
\par }}{\*\aftnsepc \ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10769627 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4011428 \chftnsepc 
\par }}\ltrpar \sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid16676364\sftnbj {\headerr \ltrpar \pard\plain \ltrpar\s15\qc \li0\ri0\widctlpar
\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9637406 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\fs24\insrsid16676364\charrsid9637406 
\par }}{\footerr \ltrpar \pard\plain \ltrpar\s17\qr \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 Page }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid16676364  PAGE }}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\lang1024\langfe1024\noproof\insrsid16676364 2}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364  of }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid16676364  NUMPAGES  }}{\fldrslt {
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\lang1024\langfe1024\noproof\insrsid16676364 2}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 
\par }\pard \ltrpar\s17\ql \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 
\par }}{\headerf \ltrpar \pard\plain \ltrpar\s15\qc \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 
\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7689382 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs32 \ltrch\fcs0 
\b\fs32\insrsid16676364\charrsid7279995 The ÃÛÌÒAPP
\par }{\rtlch\fcs1 \ab\af0\afs40 \ltrch\fcs0 \b\fs40\insrsid16676364 Suspected Early Inflammatory Arthritis
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid16676364 (Referral form - Emis web)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 
\par }}{\footerf \ltrpar \pard\plain \ltrpar\s17\qr \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 Page }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid16676364  PAGE }}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\lang1024\langfe1024\noproof\insrsid2634592 1}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364  of }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid16676364  NUMPAGES  }}{\fldrslt {
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\lang1024\langfe1024\noproof\insrsid2634592 1}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 
\par }\pard \ltrpar\s17\ql \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 
\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 )}}\pard\plain \ltrpar\qc \li0\ri0\sl259\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 
\fs16\cf2\insrsid1789418\charrsid7689382 {\*\bkmkstart _Hlk40945557}
\par }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf2\insrsid9637406\charrsid7689382 This form is partially unlocked (indicated by the}{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\insrsid9637406  }{\rtlch\fcs1 \ab\af41 \ltrch\fcs0 
\b\f41\cf17\lang2057\langfe2057\langfenp2057\insrsid9637406\charrsid2179459 {\upr{\*\bkmkstart ????????????}{\*\ud\uc0{\*\bkmkstart {\uc1\u-4001 ?\u-4024 ?\u-3988 ?\u-3989 ?\u-4044 ?\u-4048 ?\u-4039 ?\u-4044 ?\u-4043 ?\u-4043 ?\u-4043 ?\u-4041 ?}}}}
{\upr{\*\bkmkend ????????????}{\*\ud\uc0{\*\bkmkend {\uc1\u-4001 ?\u-4024 ?\u-3988 ?\u-3989 ?\u-4044 ?\u-4048 ?\u-4039 ?\u-4044 ?\u-4043 ?\u-4043 ?\u-4043 ?\u-4041 ?}}}}\'d0}{\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \fs24\insrsid9637406\charrsid1789418 
{\*\bkmkend _Hlk40945557} }{\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf2\insrsid9637406\charrsid7689382 symbol) to allow referrer to delete sensitive/extraneous data)
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts19\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5969826\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2235\clshdrawnil\clhidemark \cellx2127\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2693\clshdrawnil\clhidemark \cellx4820
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3544\clshdrawnil\clhidemark \cellx8364\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1984\clshdrawnil\clhidemark \cellx10348\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5969826\charrsid1789418 Date of referral letter}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\cf2\insrsid5969826\charrsid1789418 \cell 
}\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 {\*\bkmkstart djMhn3wtmHtWrSIFPsZi}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826\charrsid5969826 
 FORMTEXT }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826\charrsid5969826 {\*\datafield 000200001400000014646a4d686e3377746d4874577253494650735a6900000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname 
djMhn3wtmHtWrSIFPsZi}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\insrsid5969826\charrsid5969826 Short date letter merged}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid16676364\sftnbj {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826\charrsid5969826 {\*\bkmkend djMhn3wtmHtWrSIFPsZi} }{\rtlch\fcs1 
\ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\cf2\insrsid5969826\charrsid5969826 \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid5969826\charrsid1789418 Date of referral if different to stated:  }{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f31506\fs22\cf2\insrsid5969826\charrsid1789418 \cell }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid5969826\charrsid5969826  FORMTEXT }{\rtlch\fcs1 \ab\af39\afs24 
\ltrch\fcs0 \b\fs24\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid5969826\charrsid5969826 {\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 
\ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\lang1024\langfe1024\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid5969826\charrsid5969826 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid16676364\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \f31506\cf2\insrsid5969826\charrsid5969826 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39\afs20 \ltrch\fcs0 
\fs20\lang2057\langfe2057\langfenp2057\insrsid5969826\charrsid5969826 \trowd \irow0\irowband0\lastrow \ltrrow\ts19\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5969826\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2235\clshdrawnil\clhidemark \cellx2127\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2693\clshdrawnil\clhidemark \cellx4820\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3544\clshdrawnil\clhidemark \cellx8364\clvertalt
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1984\clshdrawnil\clhidemark \cellx10348\row }\pard \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \af0\afs16 \ltrch\fcs0 \fs16\insrsid5969826\charrsid1789418 
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts19\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5969826\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth877\clshdrawnil\clhidemark \cellx769\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4329\clshdrawnil\clhidemark \cellx5098
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth718\clshdrawnil\clhidemark \cellx5816\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1558\clshdrawnil\clhidemark \cellx7374\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth992\clshdrawnil\clhidemark 
\cellx8366\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1946\clshdrawnil\clhidemark \cellx10312\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\f31506\fs24\insrsid5969826\charrsid5969826 Name:\cell {\*\bkmkstart PjpyUuNBTA6na63b2QPv}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 \b\fs28\insrsid5969826  FORMTEXT }{\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 
\b\fs28\insrsid5969826 {\*\datafield 000200001400000014506a707955754e425441366e613633623251507600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PjpyUuNBTA6na63b2QPv}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs28 
\ltrch\fcs0 \b\f31506\fs28\insrsid5969826 Full Name}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid16676364\sftnbj {\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 \b\fs28\insrsid5969826 
{\*\bkmkend PjpyUuNBTA6na63b2QPv} }{\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 \b\f31506\fs28\insrsid5969826\charrsid5969826 \cell }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \f31506\fs24\insrsid5969826\charrsid5969826 DOB:}{\rtlch\fcs1 \ab\af39\afs24 
\ltrch\fcs0 \b\f31506\fs24\insrsid5969826\charrsid5969826 \cell {\*\bkmkstart PUZYJaJtBpT54NUIpkGE}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826  FORMTEXT }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\fs24\insrsid5969826 {\*\datafield 00020000140000001450555a594a614a7442705435344e5549706b474500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PUZYJaJtBpT54NUIpkGE}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs24 
\ltrch\fcs0 \b\f31506\fs24\insrsid5969826 Date of Birth}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid16676364\sftnbj {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826 
{\*\bkmkend PUZYJaJtBpT54NUIpkGE} }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\insrsid5969826\charrsid5969826 \cell }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \f31506\fs24\insrsid5969826\charrsid5969826 NHS No\cell 
{\*\bkmkstart PmMWvEngFxrlypMbbPgx}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826\charrsid5969826  FORMTEXT }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid5969826\charrsid5969826 {\*\datafield 
000200001400000014506d4d5776456e674678726c79704d626250677800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PmMWvEngFxrlypMbbPgx}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\f31506\fs24\insrsid5969826\charrsid5969826 NHS Number}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid16676364\sftnbj {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\fs24\insrsid5969826\charrsid5969826 {\*\bkmkend PmMWvEngFxrlypMbbPgx} }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\insrsid5969826\charrsid5969826 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39\afs20 \ltrch\fcs0 
\fs20\lang2057\langfe2057\langfenp2057\insrsid5969826\charrsid5969826 \trowd \irow0\irowband0\lastrow \ltrrow\ts19\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5969826\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth877\clshdrawnil\clhidemark \cellx769\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4329\clshdrawnil\clhidemark \cellx5098\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth718\clshdrawnil\clhidemark \cellx5816\clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1558\clshdrawnil\clhidemark \cellx7374\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth992\clshdrawnil\clhidemark \cellx8366\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1946\clshdrawnil\clhidemark \cellx10312\row 
}\pard \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \ab\af1\afs10 \ltrch\fcs0 \b\fs10\insrsid5969826 
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts19\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5969826\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420\clshdrawnil\clhidemark \cellx10312\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13057600\yts19 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid13057600 {\*\bkmkstart PzrsY3rXy9XcXEaoWqTj}{\*\bkmkend PzrsY3rXy9XcXEaoWqTj}Attach this form to the e-referral }{\rtlch\fcs1 
\ab\af1\afs28 \ltrch\fcs0 \b\f39\fs28\insrsid15957328 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid15957328\charrsid15957328 (see \lquote suspected Inflammatory Arthritis \endash  URGENT}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid414994 \rquote }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f39\fs24\insrsid15957328\charrsid15957328 )}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid13057600\charrsid15957328 
\par }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\cf2\insrsid13057600 If e-RS not available, then send this }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\ul\cf2\insrsid13057600 \lquote service form\rquote }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 
\b\f39\fs24\cf2\insrsid13057600  }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\cf6\insrsid13057600 AND }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\ul\cf2\insrsid13057600 \lquote Referral Header Sheet\rquote }{\rtlch\fcs1 \ab\af1\afs24 
\ltrch\fcs0 \b\f39\fs24\cf2\insrsid13057600  by secure email }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\cf2\insrsid15957328 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid15957328\yts19 {\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \f39\fs24\cf18\insrsid15957328 
NB: Emailed referrals must be sent from a secure email address e.g. nhs.net
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid13057600\yts19 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f39\cf2\insrsid15957328\charrsid14767358 
\par }\pard \ltrpar\qj \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid15957328\yts19 {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid15957328\charrsid15957328 This form will serve as the referral letter. }{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827 T}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid15957328\charrsid15957328 hank you for carefully considering the need to refer to this service, intended for people with }{\rtlch\fcs1 
\ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid15957328\charrsid15957328 new onset inflammatory arthritis}{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid15957328 .
\par }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f39\insrsid15957328\charrsid414994 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827 Please note that due to pressures on appointments in this service, referrals will be triaged by a Consultant Rheumatologist. 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f39\insrsid414994\charrsid414994 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid15957328 This is a RAPID ACCESS CLINIC, and we will aim to see patients within 15 days or referral. }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid414994 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827 Patients will have }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid414994\charrsid414994 TWO}{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid2632827\charrsid414994  }{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827 appointments at the Freeman hospital}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid414994 ,}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827  one week apart. 
\par {\listtext\pard\plain\ltrpar \s21 \intbl\rtlch\fcs1 \af1 \ltrch\fcs0 \f3\lang2057\langfe2057\langfenp2057\insrsid2632827\charrsid3629007 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s21\qj \fi-360\li720\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls1\adjustright\rin0\lin720\pararsid3629007\yts19\contextualspace \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827\charrsid3629007 At the first of these, they will undergo musculoskeletal ultrasound and blood tests and X rays as appropriate; they may also be offered the opportunity to participate in research}
{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid14837666 .}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827\charrsid3629007 
\par {\listtext\pard\plain\ltrpar \s21 \intbl\rtlch\fcs1 \af1 \ltrch\fcs0 \f3\lang2057\langfe2057\langfenp2057\insrsid2632827\charrsid3629007 \loch\af3\dbch\af0\hich\f3 \'b7\tab}At the second, th
ey will be reviewed by their Consultant Rheumatologist to discuss their results and }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid414994 A }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827\charrsid3629007 detailed management plan.

\par }\pard\plain \ltrpar\qj \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid15957328\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f39\fs24\insrsid2632827 
\par }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid2632827\charrsid3629007 Please complete all fields of the referral.  
\par }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid2632827\charrsid10491404 Please include requested blood tests results}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827  }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 
\b\f39\fs24\cf6\insrsid2632827\charrsid10491404 where they are available.}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827   
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid2632827\charrsid3629007 However, because blood tests will normally be undertaken as part of the assessment in secondary care, }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 
\b\f39\fs24\insrsid2632827\charrsid3629007 please do not delay referrals by requesting investigations if an inflammatory arthritis is suspected }{\rtlch\fcs1 \ab\ai\af1\afs24 \ltrch\fcs0 \b\i\f39\fs24\insrsid2632827\charrsid3629007 clinically. }{
\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid2632827\charrsid3629007 
\par }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid2632827 
\par X rays do not need to be performed.  
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid3629007 
\par Please do not prescribe corticosteroid.  }{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 \f39\fs24\insrsid3629007 If you feel this is necessary, please contact the on-call registrar for urgent review.}{\rtlch\fcs1 \ab\af1\afs24 \ltrch\fcs0 
\f39\fs24\insrsid3629007\charrsid3629007 
\par }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \f39\cf19\insrsid5969826\charrsid14767358 
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f39\fs24\cf6\insrsid397355\charrsid414994 If you have concerns about SEPTIC ARTHRITIS or a patient with LARGE JOINT inflammatory arthritis, please contact the team direc
tly by asking to speak to the on-call rheumatology registrar or consultant.   0191 2336161}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\f39\fs22\insrsid14767358\charrsid3629007 
\par }{\rtlch\fcs1 \ab\af1\afs22 \ltrch\fcs0 \b\f39\fs22\cf2\insrsid10893694\charrsid397355 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39\afs20 \ltrch\fcs0 \fs20\lang2057\langfe2057\langfenp2057\insrsid5969826 \trowd \irow0\irowband0\lastrow \ltrrow\ts19\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5969826\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10420\clshdrawnil\clhidemark \cellx10312\row }\pard \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16676364 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid13057600  }{\rtlch\fcs1 \ab\af41 \ltrch\fcs0 \b\f41\cf17\lang2057\langfe2057\langfenp2057\insrsid16676364 
\par }\pard \ltrpar\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16676364 {\rtlch\fcs1 \ab\af41 \ltrch\fcs0 \b\f41\cf17\lang2057\langfe2057\langfenp2057\insrsid16676364 \'d0}{\rtlch\fcs1 
\ab\af39\afs28 \ltrch\fcs0 \b\fs28\lang2057\langfe2057\langfenp2057\insrsid16676364  Reason for Referral}{\rtlch\fcs1 \ab\af41\afs28 \ltrch\fcs0 \b\fs28\lang2057\langfe2057\langfenp2057\insrsid16676364  \sect }\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectunlocked1\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj \pard\plain \ltrpar\ql \fi284\li-426\ri-286\sl259\slmult1
\widctlpar\wrapdefault\faauto\rin-286\lin-426\itap0\pararsid16676364 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af41 \ltrch\fcs0 
\cf2\lang2057\langfe2057\langfenp2057\insrsid16676364 Note to referrer:  Extraneous/sensitive information }{\rtlch\fcs1 \ab\af41 \ltrch\fcs0 \cf18\lang2057\langfe2057\langfenp2057\insrsid16676364 MUST BE DELETED}{\rtlch\fcs1 \ab\af41 \ltrch\fcs0 
\cf2\lang2057\langfe2057\langfenp2057\insrsid16676364  from the consultation below}{\rtlch\fcs1 \af0\afs10 \ltrch\fcs0 \fs10\insrsid16676364 
\par }\pard \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16676364 {\*\bkmkstart TFpEDQxwQhM7YKqM5WWX}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364  FORMTEXT }{
\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 {\*\datafield 000200001400000014544670454451787751684d37594b714d3557575800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TFpEDQxwQhM7YKqM5WWX}}}}}{\fldrslt {\rtlch\fcs1 
\af0 \ltrch\fcs0 \insrsid16676364 Consultations}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectunlocked1\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16676364 
{\*\bkmkend TFpEDQxwQhM7YKqM5WWX} \sect }\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\headerr \ltrpar \pard\plain \ltrpar\s15\qc \li0\ri0\widctlpar
\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9637406 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\fs24\insrsid9637406\charrsid9637406 
\par }}{\footerr \ltrpar \pard\plain \ltrpar\s17\qr \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050 Page }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid12455050  PAGE }}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\lang1024\langfe1024\noproof\insrsid2634592 2}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050  of }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid12455050  NUMPAGES  }}{\fldrslt {
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\lang1024\langfe1024\noproof\insrsid2634592 2}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050 
\par }\pard \ltrpar\s17\ql \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050 
\par }}{\headerf \ltrpar \pard\plain \ltrpar\s15\qc \li0\ri0\widctlpar\brdrt\brdrs\brdrw10\brsp20 \brdrl\brdrs\brdrw10\brsp80 \brdrb\brdrs\brdrw10\brsp20 \brdrr\brdrs\brdrw10\brsp80 
\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7689382 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs32 \ltrch\fcs0 
\b\fs32\insrsid7279995\charrsid7279995 The ÃÛÌÒAPP
\par }{\rtlch\fcs1 \ab\af0\afs40 \ltrch\fcs0 \b\fs40\insrsid7279995 Suspected Early Inflammatory Arthritis}{\rtlch\fcs1 \ab\af0\afs40 \ltrch\fcs0 \b\fs40\insrsid3213325 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid3213325 (Referral form - Emis web)}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid3213325 
\par }}{\footerf \ltrpar \pard\plain \ltrpar\s17\qr \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050 Page }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid12455050  PAGE }}{\fldrslt {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 
\b\lang1024\langfe1024\noproof\insrsid12455050 2}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050  of }{\field{\*\fldinst {\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\insrsid12455050  NUMPAGES  }}{\fldrslt {
\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\lang1024\langfe1024\noproof\insrsid12455050 2}}}\sectd \ltrsect\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050 
\par }\pard \ltrpar\s17\ql \li0\ri0\widctlpar\tqc\tx4513\tqr\tx9026\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid12455050 
\par }}\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16676364 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {
\rtlch\fcs1 \af0\afs10 \ltrch\fcs0 \fs10\insrsid16676364 
\par }\pard \ltrpar\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16676364 {\rtlch\fcs1 \af0\afs24 \ltrch\fcs0 \b\fs24\ul\insrsid16676364 Any Other information not included in \lquote 
reason for referral\rquote  above
\par {\*\bkmkstart Text21}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f39\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid16676364\charrsid10491404  FORMTEXT }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f39\chbrdr
\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid16676364\charrsid10491404 {\*\datafield 00000000140000000654657874323100000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text21}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 
\b\f39\lang1024\langfe1024\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid16676364\charrsid10491404 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f39\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid16676364 {\*\bkmkend Text21}
\par 
\par 
\par 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \b\insrsid16676364\charrsid10491404 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3870995\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6062\clshdrawnil \cellx5954\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2236\clshdrawnil \cellx8190\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2236\clshdrawnil \cellx10426\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid3870995\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\f31506\fs24\insrsid16676364\charrsid414994 Has the patient been reviewed by rheumatology before?\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid16676364\charrsid10491404  FORMCHECKBOX }{
\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid16676364\charrsid10491404 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid16676364\charrsid10491404  Yes}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid16676364\charrsid10491404 \cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid16676364\charrsid10491404  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 
\b\cf6\insrsid16676364\charrsid10491404 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid16676364\charrsid10491404  No\cell }\pard\plain \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\fs24\insrsid16676364 \trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3870995\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6062\clshdrawnil \cellx5954\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2236\clshdrawnil \cellx8190\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2236\clshdrawnil \cellx10426\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10534\clshdrawnil \cellx10426\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f39\fs22\cf2\insrsid10491404\charrsid10491404 If yes, and not at Freeman Hospital, please include details below and/or attach relevant correspondence\cell 
}\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 
\ltrch\fcs0 \b\fs24\insrsid10491404 \trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10534\clshdrawnil \cellx10426\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11280604\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5267\clshdrawnil \cellx5159\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth5267\clshdrawnil \cellx10426\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid16676364 Details }{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f39\fs24\insrsid10491404\charrsid10491404 \cell }{\rtlch\fcs1 \ab\af39\afs24 
\ltrch\fcs0 \b\f31506\fs24\insrsid10491404\charrsid414994 Further information attached?}{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\cf2\insrsid10491404\charrsid414994     }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs24 
\ltrch\fcs0 \b\f31506\fs24\cf6\insrsid10491404\charrsid414994  FORMCHECKBOX }{\rtlch\fcs1 \af39\afs24 \ltrch\fcs0 \b\fs24\cf6\insrsid10491404\charrsid414994 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs24 
\ltrch\fcs0 \b\f31506\fs24\insrsid10491404\charrsid414994  Yes}{\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\f31506\fs24\cf2\insrsid10491404\charrsid414994 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid10491404 
\trowd \irow2\irowband2\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid11280604\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5267\clshdrawnil \cellx5159\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5267\clshdrawnil \cellx10426\row \ltrrow
}\trowd \irow3\irowband3\lastrow \ltrrow\ts19\trgaph108\trrh630\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16676364\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10534\clshdrawnil \cellx10426\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs12 \ltrch\fcs0 \b\f39\fs12\insrsid10491404 
\par }\pard \ltrpar\ql \fi-142\li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10491404\yts19 {\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af1\afs22 \ltrch\fcs0 \b\f39\fs22\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\insrsid10491404\charrsid10491404  FORMTEXT }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f39\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid10491404\charrsid10491404 {\*\datafield 00000000140000000654657874323100000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text21}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs22 \ltrch\fcs0 \b\f39\fs22\lang1024\langfe1024\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid10491404\charrsid10491404 \u8194\'20\u8194\'20
\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid10491404\charrsid10491404 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \ab\af39\afs12 \ltrch\fcs0 \b\f39\fs12\insrsid10491404\charrsid10491404 \cell }\pard\plain \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\fs24\insrsid10491404 \trowd \irow3\irowband3\lastrow \ltrrow\ts19\trgaph108\trrh630\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid16676364\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10534\clshdrawnil \cellx10426\row }\pard \ltrpar\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\fs24\insrsid2632827 
\par }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid10491404 Blood }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid414994 test }{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid10491404 results}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 
\b\fs24\insrsid414994 , if known  (there were a lot more bloods mentioned in current form?}{\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid10491404 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2106\clshdrawnil \cellx1998\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6366\clshdrawnil \cellx8364\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2062\clshdrawnil \cellx10426\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\f31506\fs24\insrsid10491404\charrsid10491404 Blood test\cell Latest Result \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10491404\yts19 {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 
\b\f31506\fs24\insrsid10491404\charrsid10491404 Requested\cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af39\afs24 \ltrch\fcs0 \b\fs24\insrsid10491404\charrsid10491404 \trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2106\clshdrawnil \cellx1998\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6366\clshdrawnil \cellx8364\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2062\clshdrawnil \cellx10426\row \ltrrow
}\trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2106\clshdrawnil \cellx1998\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3105\clshdrawnil \cellx5103\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3261\clshdrawnil \cellx8364\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth2062\clshdrawnil \cellx10426\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid10491404\charrsid10491404 CRP\cell {\*\bkmkstart TLueDOTpAiJZlwbislxZ}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid10491404\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536 {\*\datafield 000200001400000014544c7565444f547041694a5a6c776269736c785a00000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TLueDOTpAiJZlwbislxZ}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 Single Code Entry: Serum CRP (C reactive protein) level}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536 {\*\bkmkend TLueDOTpAiJZlwbislxZ}  }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 \cell {\*\bkmkstart T5hhqr5gqKVYPlZhT4P4}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid10491404\charrsid8011536 {\*\datafield 0002000014000000145435686871723567714b5659506c5a685434503400000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T5hhqr5gqKVYPlZhT4P4}}}}}{\fldrslt {\rtlch\fcs1 
\ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 Single Code Entry: Serum CRP (C reactive protein) level}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536 {\*\bkmkend T5hhqr5gqKVYPlZhT4P4}  }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10491404\yts19 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\cf6\insrsid10491404\charrsid10491404  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid10491404\charrsid10491404 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid10491404\charrsid10491404 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \f39\insrsid10491404\charrsid10491404 \trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2106\clshdrawnil \cellx1998\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3105\clshdrawnil \cellx5103\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3261\clshdrawnil \cellx8364\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2062\clshdrawnil \cellx10426\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid10491404\charrsid10491404 ESR\cell {\*\bkmkstart TynzOksoDLpcEVnEBBBa}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid10491404\charrsid8011536 {\*\datafield 00020000140000001454796e7a4f6b736f444c706345566e454242426100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TynzOksoDLpcEVnEBBBa}}}}}{\fldrslt {\rtlch\fcs1 
\ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 Single Code Entry: Erythrocyte sedimentation rate}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536 {\*\bkmkend TynzOksoDLpcEVnEBBBa}  }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 \cell {\*\bkmkstart T1yET5NF3zbssjLXUimk}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid10491404\charrsid8011536 {\*\datafield 0002000014000000145431794554354e46337a6273736a4c5855696d6b00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T1yET5NF3zbssjLXUimk}}}}}{\fldrslt {\rtlch\fcs1 
\ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 Single Code Entry: Erythrocyte sedimentation rate}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid10491404\charrsid8011536 {\*\bkmkend T1yET5NF3zbssjLXUimk}  }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid10491404\charrsid8011536 \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid10491404\yts19 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\cf6\insrsid414994\charrsid10491404  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid414994\charrsid10491404 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\cf6\insrsid10491404\charrsid10491404 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \f39\insrsid10491404\charrsid10491404 \trowd \irow2\irowband2\lastrow \ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 
\trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid10491404\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2106\clshdrawnil \cellx1998\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3105\clshdrawnil \cellx5103\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3261\clshdrawnil \cellx8364\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2062\clshdrawnil \cellx10426\row }\pard \ltrpar\ql \fi-142\li0\ri0\sl259\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid10491404 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3629007\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2093\clshdrawnil \cellx1985\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8441\clshdrawnil \cellx10426\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3629007\charrsid8011536 Weight\cell {\*\bkmkstart TfxxIyTy3tEB9rvfXpNN}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid11886594\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid11886594\charrsid8011536 {\*\datafield 0002000014000000145466787849795479337445423972766658704e4e00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TfxxIyTy3tEB9rvfXpNN}}}}}{\fldrslt {\rtlch\fcs1 
\ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid11886594\charrsid8011536 Single Code Entry: Body weight}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 
\ab\af39 \ltrch\fcs0 \b\insrsid11886594\charrsid8011536 {\*\bkmkend TfxxIyTy3tEB9rvfXpNN}  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3629007\charrsid8011536   \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid3629007 
\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3629007\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2093\clshdrawnil \cellx1985\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8441\clshdrawnil \cellx10426\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid3629007\charrsid8011536 Height\cell {\*\bkmkstart T14rcxlErFfB9wJfQNqd}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid3629007\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid3629007\charrsid8011536 {\*\datafield 0002000014000000145431347263786c457246664239774a66514e716400000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T14rcxlErFfB9wJfQNqd}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3629007\charrsid8011536 Single Code Entry: Standing height}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid3629007\charrsid8011536 {\*\bkmkend T14rcxlErFfB9wJfQNqd}  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3629007\charrsid8011536 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid3629007 
\trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3629007\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2093\clshdrawnil \cellx1985\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8441\clshdrawnil \cellx10426\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid3629007\charrsid8011536 BMI\cell {\*\bkmkstart TKyApI4R7yA1IEhn4cgA}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid3629007\charrsid8011536  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid3629007\charrsid8011536 {\*\datafield 000200001400000014544b794170493452377941314945686e3463674100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TKyApI4R7yA1IEhn4cgA}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3629007\charrsid8011536 Single Code Entry: Body mass index}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid3629007\charrsid8011536 {\*\bkmkend TKyApI4R7yA1IEhn4cgA}  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3629007\charrsid8011536 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid3629007 
\trowd \irow2\irowband2\lastrow \ltrrow\ts19\trgaph108\trrh284\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3629007\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2093\clshdrawnil \cellx1985\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8441\clshdrawnil \cellx10426\row }\pard \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4750499 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid9901334 
\par }\pard \ltrpar\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \ab\af0\afs24 \ltrch\fcs0 \b\fs24\insrsid397355\charrsid397355 
Clinical features suggestive of early inflammatory arthritis in this patient include:}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf2\insrsid397355\charrsid397355  Please \lquote x\rquote  all that apply}{\rtlch\fcs1 \af0\afs8 \ltrch\fcs0 
\fs8\cf18\insrsid397355\charrsid397355 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf18\insrsid397355\charrsid397355 1 and 2 }{\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\cf18\insrsid397355\charrsid397355 must}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf18\insrsid397355\charrsid397355  be present, }{\rtlch\fcs1 \af0 
\ltrch\fcs0 \cf2\insrsid397355\charrsid397355 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw30\brdrcf18 \trbrdrl\brdrs\brdrw30\brdrcf18 \trbrdrb\brdrs\brdrw30\brdrcf18 \trbrdrr\brdrs\brdrw30\brdrcf18 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw30\brdrcf18 \clbrdrl\brdrs\brdrw30\brdrcf18 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw30\brdrcf18 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil 
\cellx1560\clvertalc\clbrdrt\brdrs\brdrw30\brdrcf18 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw30\brdrcf18 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid397355\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid397355 1}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid397355\charrsid3213325  FORMCHECKBOX }{
\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid397355\charrsid3213325 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid397355 Persistent symptoms < 12 months}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid397355\charrsid397355 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 \trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw30\brdrcf18 \trbrdrl\brdrs\brdrw30\brdrcf18 
\trbrdrb\brdrs\brdrw30\brdrcf18 \trbrdrr\brdrs\brdrw30\brdrcf18 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw30\brdrcf18 \clbrdrl\brdrs\brdrw30\brdrcf18 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw30\brdrcf18 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil 
\cellx1560\clvertalc\clbrdrt\brdrs\brdrw30\brdrcf18 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw30\brdrcf18 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\row \ltrrow}\trowd \irow1\irowband1\lastrow \ltrrow
\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw30\brdrcf18 \trbrdrl\brdrs\brdrw30\brdrcf18 \trbrdrb\brdrs\brdrw30\brdrcf18 \trbrdrr\brdrs\brdrw30\brdrcf18 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw30\brdrcf18 \clbrdrb
\brdrs\brdrw30\brdrcf18 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw30\brdrcf18 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw30\brdrcf18 \clbrdrr\brdrs\brdrw30\brdrcf18 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid397355\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid397355 2}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid397355\charrsid3213325  FORMCHECKBOX }{
\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid397355\charrsid3213325 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid397355\charrsid397355 
Involvement of the small joints (hands, wrists, ankle and/or feet)\cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 \trowd \irow1\irowband1\lastrow \ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw30\brdrcf18 \trbrdrl
\brdrs\brdrw30\brdrcf18 \trbrdrb\brdrs\brdrw30\brdrcf18 \trbrdrr\brdrs\brdrw30\brdrcf18 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw30\brdrcf18 \clbrdrb
\brdrs\brdrw30\brdrcf18 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw30\brdrcf18 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw30\brdrcf18 \clbrdrr\brdrs\brdrw30\brdrcf18 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\row }\pard \ltrpar
\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \af0\afs8 \ltrch\fcs0 \fs8\cf18\insrsid7616298\charrsid7616298 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf18\insrsid7616298 P}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf18\insrsid397355\charrsid397355 lus one of 3 \endash  6.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid397355 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid397355\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f39\fs22\insrsid397355\charrsid397355 3\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid397355\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid397355\charrsid3213325 
{\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355 Tenderness }{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid15941951 and/}
{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355 or swelling of }{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\ul\insrsid397355\charrsid397355 >}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355  2 joints}{
\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355  (not including DIP, 1}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\super\insrsid397355\charrsid397355 st}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355  CMC or 1}{
\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\super\insrsid397355\charrsid397355 st}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355  MTP Joints)}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 
\ltrch\fcs0 \insrsid397355\charrsid397355 \trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\row \ltrrow}\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid397355\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f39\fs22\insrsid397355\charrsid397355 4\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid397355\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid397355\charrsid3213325 
{\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 Early morning stiffness > 30 minutes\cell }\pard\plain \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\insrsid397355\charrsid397355 \trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\row \ltrrow}\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid397355\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f39\fs22\insrsid397355\charrsid397355 5\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid397355\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid397355\charrsid3213325 
{\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355 Systemic symptoms and/or history of inflammatory bowel disease uveitis or }{
\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid15941951 psoriasis}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355\charrsid397355 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 
\trowd \irow2\irowband2\ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\row \ltrrow}\pard\plain \ltrpar
\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid397355\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f39\fs22\insrsid397355\charrsid397355 6\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid397355\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid397355\charrsid3213325 
{\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid1789418\yts19 {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid397355 Positive MCP/MTP squeeze test}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid397355\charrsid397355 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid397355\charrsid397355 \trowd \irow3\irowband3\lastrow \ltrrow\ts19\trgaph108\trrh340\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb
\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid397355\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth959\clshdrawnil \cellx851\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth709\clshdrawnil \cellx1560\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8866\clshdrawnil \cellx10426\row }\pard \ltrpar
\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1789418 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid397355 
\par }\pard \ltrpar\qc \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16676364 {\rtlch\fcs1 \af0\afs28 \ltrch\fcs0 \b\fs28\cf19\insrsid7616298\charrsid7616298 PLEASE COMPLETE THE REST OF THIS FORM

\par }\pard \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 \b\fs28\insrsid12594863 \page 
\par }\pard \ltrpar\ql \fi-142\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3213325 {\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 \b\fs28\insrsid3213325\charrsid6230221 Referrer details
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1844\clshdrawnil\clhidemark \cellx1560\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3874\clshdrawnil\clhidemark \cellx5434
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\clhidemark \cellx7371\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2552\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Name of referrer:\cell {\*\bkmkstart RQ49AyXNz9MrhYnKcU6f}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid2847763\charrsid2847763  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 000200001400000014525134394179584e7a394d7268596e4b6355366600000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname RQ49AyXNz9MrhYnKcU6f}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Referring User}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend RQ49AyXNz9MrhYnKcU6f} }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325 {\*\datafield 
00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325 \cell   }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Date of referral:}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325 
\cell {\*\bkmkstart dAHQ3VwzFVf7efriZsRH}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid14056113  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid14056113 {\*\datafield 
000200001400000014644148513356777a46566637656672695a73524800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname dAHQ3VwzFVf7efriZsRH}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid14056113 
Short date letter merged}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid14056113 {\*\bkmkend dAHQ3VwzFVf7efriZsRH} }{
\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid14056113 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1844\clshdrawnil\clhidemark \cellx1560\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3874\clshdrawnil\clhidemark \cellx5434
\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1937\clshdrawnil\clhidemark \cellx7371\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2552\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr
\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5718\clshdrawnil\clhidemark \cellx5434\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4489\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\ul\insrsid3213325\charrsid7171227 {\*\bkmkstart P2vWB2ix1uEkGZrtU7Qk}Referring Organisation}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\ul\insrsid3213325\charrsid7171227 {\*\bkmkend P2vWB2ix1uEkGZrtU7Qk}
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 {\*\bkmkstart O2CQgMlTrIBRcSh7bio3}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  FORMTEXT }{
\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 0002000014000000144f324351674d6c54724942526353683762696f3300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname O2CQgMlTrIBRcSh7bio3}}}}
}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Organisation Name}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {
\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\bkmkend O2CQgMlTrIBRcSh7bio3} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid2847763 ,}{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid3213325\charrsid2847763 {\*\bkmkstart OSLq8qn6UD5FoOFqWWe6} {\*\bkmkstart OP95TWFhxMXAb4HPrY3N}{\*\bkmkend OSLq8qn6UD5FoOFqWWe6}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  FORMTEXT }{
\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 0002000014000000144f50393554574668784d5841623448507259334e00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OP95TWFhxMXAb4HPrY3N}}}}
}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Organisation Full Address (single line)}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\bkmkend OP95TWFhxMXAb4HPrY3N} }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid2847763   
\par }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Tel:}{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid3213325\charrsid3213325 {\*\bkmkstart OloeRYoIhN2TuAVqzJwm}  {\*\bkmkstart OJF4UBsNFqjxQEUgFhJu}
{\*\bkmkend OloeRYoIhN2TuAVqzJwm}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 
0002000014000000144f4a46345542734e46716a785145556746684a7500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OJF4UBsNFqjxQEUgFhJu}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid2847763\charrsid2847763 Organisation Telephone Number}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 
\insrsid2847763 {\*\bkmkend OJF4UBsNFqjxQEUgFhJu} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 
\par Email}{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \insrsid3213325\charrsid3213325 {\*\bkmkstart O9xYqPUhJcjVCtbOHCRU}: {\*\bkmkstart OJKeavJucZko8aJBH8MK}{\*\bkmkend O9xYqPUhJcjVCtbOHCRU}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid2847763  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 0002000014000000144f4a4b6561764a75635a6b6f38614a4248384d4b00000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OJKeavJucZko8aJBH8MK}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Organisation E-mail Address}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend OJKeavJucZko8aJBH8MK} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 
\par Fax:}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325   {\*\bkmkstart OKIafNKI4vkaFMa1dZdM}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 0002000014000000144f4b4961664e4b4934766b61464d6131645a644d00000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OKIafNKI4vkaFMa1dZdM}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Organisation Fax Number}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend OKIafNKI4vkaFMa1dZdM} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid3213325\charrsid3213325  \cell }\pard \ltrpar\qc \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\ul\insrsid3213325\charrsid3213325 
GP details
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 {\*\bkmkstart Pe3gTAP3GVF1wVziFemn}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763  FORMTEXT }{\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid2847763 {\*\datafield 00020000140000001450653367544150334756463177567a6946656d6e00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pe3gTAP3GVF1wVziFemn}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid2847763 Usual GP Full Name}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763 
{\*\bkmkend Pe3gTAP3GVF1wVziFemn}     }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325         
\par {\*\bkmkstart PJoeiFcmXTDKOZ2R6Eqh}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 
000200001400000014504a6f656946636d5854444b4f5a32523645716800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PJoeiFcmXTDKOZ2R6Eqh}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid2847763\charrsid2847763 Usual GP Organisation Name}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 
{\*\bkmkend PJoeiFcmXTDKOZ2R6Eqh} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325   {\*\bkmkstart P82EcOMPUDYtF36Ag93k}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 
 FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 00020000140000001450383245634f4d5055445974463336416739336b00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname 
P82EcOMPUDYtF36Ag93k}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Usual GP Full Address (single line)}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend P82EcOMPUDYtF36Ag93k} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid3213325\charrsid3213325  
\par }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Tel:  {\*\bkmkstart Pd3v1EEq1nPePZm7YehD}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  FORMTEXT}{\rtlch\fcs1 
\ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763  }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 0002000014000000145064337631454571316e5065505a6d375965684400000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pd3v1EEq1nPePZm7YehD}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Usual GP Phone Number}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend Pd3v1EEq1nPePZm7YehD} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325  
\par Fax:}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325   {\*\bkmkstart PMssqWl2yF8XOJvtaRpo}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763  }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid2847763 {\*\datafield 000200001400000014504d737371576c32794638584f4a76746152706f00000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PMssqWl2yF8XOJvtaRpo}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid2847763 Usual GP Fax Number}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend PMssqWl2yF8XOJvtaRpo} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid3213325\charrsid3213325       \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth5718\clshdrawnil\clhidemark \cellx5434\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4489\clshdrawnil\clhidemark \cellx9923
\row \ltrrow}\trowd \irow2\irowband2\lastrow \ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7171227\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6663\clshdrawnil\clhidemark \cellx6379\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3544\clshdrawnil\clhidemark \cellx9923
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\f31506\insrsid3213325\charrsid7171227 Name of GP to address correspondence to, if different to accountable GP\cell {\*\bkmkstart _Hlk522003714}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\chbrdr
\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325 {\*\datafield 
00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325 {\*\bkmkend _Hlk522003714}\cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow2\irowband2\lastrow \ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid7171227\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6663\clshdrawnil\clhidemark \cellx6379\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3544\clshdrawnil\clhidemark \cellx9923
\row }\pard \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3213325 {\rtlch\fcs1 \ab\af39\afs16 \ltrch\fcs0 \caps\fs16\insrsid3213325\charrsid7171227 
\par }\pard \ltrpar\ql \fi-284\li0\ri0\sl259\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3213325 {\rtlch\fcs1 \ab\af39\afs28 \ltrch\fcs0 \b\fs28\insrsid3213325\charrsid6230221 Patient details}{\rtlch\fcs1 
\ab\af39\afs28 \ltrch\fcs0 \b\caps\fs28\insrsid3213325\charrsid6230221 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3517\clshdrawnil\clhidemark \cellx4651
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1019\clshdrawnil\clhidemark \cellx5670\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4253\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Name:\cell {\*\bkmkstart PaWxTfozLfBQp9nWjAYE}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 0002000014000000145061577854666f7a4c66425170396e576a41594500000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PaWxTfozLfBQp9nWjAYE}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Full Name}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\bkmkend PaWxTfozLfBQp9nWjAYE} }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325 Address:\cell {\*\bkmkstart Pyi7svSeZzy3oKK6EzCp}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 00020000140000001450796937737653655a7a79336f4b4b36457a437000000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pyi7svSeZzy3oKK6EzCp}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 ÃÛÌÒAPP Full Address (stacked)}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\bkmkend Pyi7svSeZzy3oKK6EzCp} }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow0\irowband0\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3517\clshdrawnil\clhidemark \cellx4651
\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1019\clshdrawnil\clhidemark \cellx5670\clvmgf\clvertalt\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4253\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 
\trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt
\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth3517\clshdrawnil\clhidemark \cellx4651\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx5670\clvmrg\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 Gender:\cell {\*\bkmkstart PrPnHXarAZLJXHzprduu}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\datafield 0002000014000000145072506e48586172415a4c4a58487a707264757500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PrPnHXarAZLJXHzprduu}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Gender(full)}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\bkmkend PrPnHXarAZLJXHzprduu} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\langfenp1033\insrsid3213325\charrsid3213325 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow1\irowband1\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3517\clshdrawnil\clhidemark \cellx4651
\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx5670\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 DOB & Age:\cell {\*\bkmkstart PjrneXnrxsSoC63QQYI6}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid9596709\charrsid9596709  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid9596709\charrsid9596709 {\*\datafield 000200001400000014506a726e65586e727873536f433633515159493600000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PjrneXnrxsSoC63QQYI6}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid9596709\charrsid9596709 Date of Birth}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid9596709 {\*\bkmkend PjrneXnrxsSoC63QQYI6} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 Age}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325 : {\*\bkmkstart PbE6VyBQ1dnU9IdhpeNQ}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 000200001400000014506245365679425131646e553949646870654e5100000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PbE6VyBQ1dnU9IdhpeNQ}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Age}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \insrsid2847763 {\*\bkmkend PbE6VyBQ1dnU9IdhpeNQ} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid3213325\charrsid3213325  \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang2057\langfe1033\langfenp1033\insrsid3213325\charrsid3213325 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow2\irowband2\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth3517\clshdrawnil\clhidemark \cellx4651\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx5670\clvmrg\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 NHS number:\cell {\*\bkmkstart P6GRn4EtrtlJFgAK91oa}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\datafield 000200001400000014503647526e34457472746c4a4667414b39316f6100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P6GRn4EtrtlJFgAK91oa}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 NHS Number}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\bkmkend P6GRn4EtrtlJFgAK91oa} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\lang2057\langfe1033\langfenp1033\insrsid3213325\charrsid3213325 \cell \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 
\ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow3\irowband3\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt
\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3517\clshdrawnil\clhidemark \cellx4651
\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx5670\clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow4\irowband4\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1412\clshdrawnil\clhidemark \cellx2546\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2702\clshdrawnil\clhidemark \cellx5248\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1164\clshdrawnil\clhidemark \cellx6412\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3511\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Patient Contacts:\cell ÃÛÌÒAPP: \cell {\*\bkmkstart Pff6gKM3eFtnc16ebWqb}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 
\ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 00020000140000001450666636674b4d336546746e633136656257716200000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pff6gKM3eFtnc16ebWqb}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Patient ÃÛÌÒAPP Telephone}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\bkmkend Pff6gKM3eFtnc16ebWqb} }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Mobile:\cell {\*\bkmkstart PyygZbBRJmTQPjoVNTle}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 000200001400000014507979675a6242524a6d5451506a6f564e546c6500000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PyygZbBRJmTQPjoVNTle}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Patient Mobile Telephone}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\bkmkend PyygZbBRJmTQPjoVNTle} }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow4\irowband4\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvmgf\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 
\clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1412\clshdrawnil\clhidemark 
\cellx2546\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2702\clshdrawnil\clhidemark \cellx5248\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1164\clshdrawnil\clhidemark \cellx6412\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth3511\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth1412\clshdrawnil\clhidemark \cellx2546\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2702\clshdrawnil\clhidemark \cellx5248\clvertalc
\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1164\clshdrawnil\clhidemark \cellx6412\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth3511\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\langfenp1033\insrsid3213325\charrsid3213325 \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 Work: \cell {\*\bkmkstart PWNoFLMihnhBxZMwdkgn}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\datafield 00020000140000001450574e6f464c4d69686e6842785a4d77646b676e00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PWNoFLMihnhBxZMwdkgn}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Patient Work Telephone}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\bkmkend PWNoFLMihnhBxZMwdkgn} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Email: 
\cell {\*\bkmkstart PMTXc7hi7kaSPnGvbb7C}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 
000200001400000014504d545863376869376b6153506e47766262374300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PMTXc7hi7kaSPnGvbb7C}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid2847763\charrsid7171227 Patient E-mail Address}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227 {\*\bkmkend PMTXc7hi7kaSPnGvbb7C} }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow5\irowband5\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1412\clshdrawnil\clhidemark 
\cellx2546\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth2702\clshdrawnil\clhidemark \cellx5248\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1164\clshdrawnil\clhidemark \cellx6412\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth3511\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\langfenp1033\insrsid3213325\charrsid3213325 \cell }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid3213325\charrsid3213325 Carer/Advocate:  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 The patient has confirmed the following person should be included in correspondence \endash  Name: }
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\insrsid3213325\charrsid3213325 {\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024
\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325     Contact Details:  }{\field\fldedit{\*\fldinst {
\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325 
{\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024\chbrdr
\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325  \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow6\irowband6\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvmrg\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth1\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark 
\cellx9923\row \ltrrow}\trowd \irow7\irowband7\ltrrow\ts19\trgaph108\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4394\clshdrawnil\clhidemark \cellx5528
\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4395\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 Contact Consent:}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325 \cell {\*\bkmkstart _Hlk59010405}}{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 
\insrsid3213325\charrsid3213325 {\*\bkmkend _Hlk59010405}  Can l}{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 eave message on answer machine 
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 
650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325   Can contact by text    
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 
650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325   Can contact by Email\cell }{\rtlch\fcs1 \af39\afs22 
\ltrch\fcs0 \f31506\fs22\cf20\insrsid3213325\charrsid3213325 NB:  Not all services use Texts or Emails as a method of communication.}{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf20\insrsid3213325\charrsid3213325 \cell }\pard\plain \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow7\irowband7\ltrrow\ts19\trgaph108\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth4394\clshdrawnil\clhidemark \cellx5528\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth4395\clshdrawnil\clhidemark \cellx9923\row \ltrrow
}\trowd \irow8\irowband8\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 Ethnicity: }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325 \cell {\*\bkmkstart PNINQLACvIs2B9mrdlcl}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\b\insrsid2847763\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\datafield 000200001400000014504e494e514c41437649733242396d72646c636c00000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PNINQLACvIs2B9mrdlcl}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid2847763\charrsid7171227 Ethnic Origin}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\insrsid2847763\charrsid7171227 {\*\bkmkend PNINQLACvIs2B9mrdlcl} }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid7171227  \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow8\irowband8\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl
\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923
\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Interpreter: }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid15613164\yts19 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{
\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325   Yes         }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Language:}{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \insrsid15613164 {\*\bkmkstart THf4CauVfMh4iNj2Wlhm} {\*\bkmkstart TMnkIaA2RwiLYPel3kBG}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39 \ltrch\fcs0 
\b\insrsid14641770\charrsid15613164  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid14641770\charrsid15613164 {\*\datafield 000200001400000014544d6e6b496141325277694c5950656c336b424700000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TMnkIaA2RwiLYPel3kBG}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid14641770\charrsid15613164 Single Code Entry: Main spoken language English...}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \insrsid14641770 {\*\bkmkend TMnkIaA2RwiLYPel3kBG}  {\*\bkmkend THf4CauVfMh4iNj2Wlhm}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\insrsid3213325\charrsid3213325 {\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024
\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid3213325   \cell }\pard\plain \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow9\irowband9\ltrrow\ts19\trgaph108\trrh340\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow10\irowband10\ltrrow\ts19\trgaph108\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 
\trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Accessibility Needs:\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325  Wheelchair access         
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 
650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325  Deaf  {\*\bkmkstart TPooqGwzjSpS7BMdOutf}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f39\fs22\insrsid9840050\charrsid2442292  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\f39\insrsid9840050\charrsid2442292 {\*\datafield 
00020000140000001454506f6f7147777a6a53705337424d644f75746600000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TPooqGwzjSpS7BMdOutf}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f39\fs22\insrsid2442292\charrsid2442292 Single Code Entry: Partial deafness...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\insrsid9840050 {\*\bkmkend TPooqGwzjSpS7BMdOutf}  }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \cf19\insrsid3213325\charrsid1720070   }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\cf19\insrsid3213325\charrsid9840050       }{\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \f31506\fs22\cf19\insrsid3213325\charrsid1720070 
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 
650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325  Registered Blind {\*\bkmkstart Tz4P3231oyKPNV1MiqQN}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid1720070\charrsid8405707  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid1720070\charrsid8405707 {\*\datafield 
000200001400000014547a3450333233316f794b504e56314d6971514e00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Tz4P3231oyKPNV1MiqQN}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid1720070\charrsid8405707 Single Code Entry: Registered blind}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 
\insrsid1720070 {\*\bkmkend Tz4P3231oyKPNV1MiqQN}  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid1720070 
\par {\*\bkmkstart TuHkdSJHvbCUdrfly5ZJ}}{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 
{\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325   Learning Disability,}{\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \insrsid3213325\charrsid3213325 {\*\bkmkend TuHkdSJHvbCUdrfly5ZJ}  {\*\bkmkstart T69AcbnGH9gxjDdPUhoP}{\*\bkmkstart TicbneYebSzCtMf7lKGX}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid8405707  FORMTEXT }{
\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid8405707 {\*\datafield 0002000014000000145436394163626e47483967786a44645055686f5000000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T69AcbnGH9gxjDdPUhoP}}}}
}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid8405707\charrsid8405707 Single Code Entry: On learning disability register}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \insrsid8405707 {\*\bkmkend T69AcbnGH9gxjDdPUhoP}  {\*\bkmkstart Tb1li86jaGWpovP5xmSa}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid8405707  }{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid8405707\charrsid8405707 FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid8405707 
{\*\datafield 0002000014000000145462316c6938366a614757706f765035786d536100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Tb1li86jaGWpovP5xmSa}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid8405707\charrsid8405707 Single Code Entry: Moderate learning disability...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \insrsid8405707 {\*\bkmkend Tb1li86jaGWpovP5xmSa}  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid8405707 
\par {\*\bkmkend TicbneYebSzCtMf7lKGX}}{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 
650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325   Other disability needing consideration  }
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\insrsid3213325\charrsid3213325 {\*\datafield 00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024
\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 
650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325   Accompanied by Carer\cell }\pard\plain \ltrpar
\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 
\lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow10\irowband10\ltrrow\ts19\trgaph108\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv
\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb
\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923\row \ltrrow}\trowd \irow11\irowband11\ltrrow\ts19\trgaph108\trrh334\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh
\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 \trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 
\cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\fs20\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Risks:\cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\cf6\insrsid3213325\charrsid3213325  FORMCHECKBOX }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\cf6\insrsid3213325\charrsid3213325 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20
{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 
\f31506\fs22\insrsid3213325\charrsid3213325 Vulnerable Adult  (Details of any recording within last 3 yrs)  {\*\bkmkstart TxZgguwON4zFxQQlNVEn}{\*\bkmkstart TIlI936EU4IrI2ehMD5m}{\*\bkmkstart T1oYK3f7rDE3EJD8fnod}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 
\af39 \ltrch\fcs0 \b\insrsid8405707\charrsid15423223  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid15423223 {\*\datafield 00020000140000001454785a676775774f4e347a467851516c4e56456e00000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TxZgguwON4zFxQQlNVEn}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid8405707\charrsid15423223 Single Code Entry: Vulnerable adult}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \insrsid8405707 {\*\bkmkend TxZgguwON4zFxQQlNVEn}  {\*\bkmkstart TcFuO63DM8VMwr2Rrhae}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid8405707\charrsid15423223  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid15423223 {\*\datafield 
000200001400000014546346754f3633444d38564d777232527268616500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TcFuO63DM8VMwr2Rrhae}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid9596709\charrsid15423223 Single Code Entry: No longer a vulnerable adult...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39 
\ltrch\fcs0 \insrsid8405707 {\*\bkmkend TcFuO63DM8VMwr2Rrhae}  }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid8405707 
\par {\*\bkmkstart TRh6CmWnCjjvtUpXc61x}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid15423223  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \b\insrsid8405707\charrsid15423223 {\*\datafield 
00020000140000001454526836436d576e436a6a76745570586336317800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TRh6CmWnCjjvtUpXc61x}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\b\f31506\fs22\insrsid8405707\charrsid15423223 Single Code Entry: Difficult intubation}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 
\b\insrsid8405707\charrsid15423223 {\*\bkmkend TRh6CmWnCjjvtUpXc61x}  }{\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \b\f31506\fs22\insrsid3213325\charrsid15423223 {\*\bkmkend TIlI936EU4IrI2ehMD5m}{\*\bkmkend T1oYK3f7rDE3EJD8fnod}
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid8405707\yts19 {\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\cf21\insrsid3213325\charrsid3213325 {\*\bkmkstart THjzE42TEl5E3cX7xMIO} 
{\*\bkmkend THjzE42TEl5E3cX7xMIO}   }{\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 Other:    }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\chbrdr
\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325  FORMTEXT }{\rtlch\fcs1 \ab\af39 \ltrch\fcs0 \b\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 \insrsid3213325\charrsid3213325 {\*\datafield 
00000000140000000654657874323000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text20}}}}}{\fldrslt {\rtlch\fcs1 \ab\af39\afs22 \ltrch\fcs0 \b\f31506\fs22\lang1024\langfe1024\chbrdr\brdrdash\brdrw10\brdrcf18\brdrframe1 
\noproof\insrsid3213325\charrsid3213325 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs22 
\ltrch\fcs0 \f31506\fs22\insrsid3213325\charrsid3213325 \cell }\pard\plain \ltrpar\ql \li0\ri0\sl259\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 
\f31506\fs22\lang2057\langfe1033\cgrid\langnp2057\langfenp1033 {\rtlch\fcs1 \af39 \ltrch\fcs0 \lang2057\langfe2057\langfenp2057\insrsid3213325\charrsid3213325 \trowd \irow11\irowband11\ltrrow\ts19\trgaph108\trrh334\trleft-284\trbrdrt\brdrs\brdrw10 
\trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth1418\clshdrawnil\clhidemark \cellx1134\clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth8789\clshdrawnil\clhidemark \cellx9923
\row \ltrrow}\trowd \irow12\irowband12\lastrow \ltrrow\ts19\trgaph108\trrh334\trleft-284\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10 
\trftsWidth1\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3213325\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind-176\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10 \clbrdrl\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr
\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth10207\clshdrawnil\clhidemark \cellx9923\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts19 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
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\f39\fs22\insrsid13174827\charrsid7171227 Single Code Entry: Military veteran}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 
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\af39\afs22 \ltrch\fcs0 \f39\fs22\insrsid13174827\charrsid7171227 Single Code Entry: Left military service}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 
\af39 \ltrch\fcs0 \f39\insrsid13174827\charrsid7171227 {\*\bkmkend T35sjuPJNNKPtAAdH8zz}  {\*\bkmkstart TcdhyltnqLVofAsv71Qn}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f39\fs22\insrsid13174827\charrsid7171227  FORMTEXT }{
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}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f39\fs22\insrsid13174827\charrsid7171227 Single Code Entry: History relating to military service}}}\sectd \ltrsect
\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 \f39\insrsid13174827\charrsid7171227 {\*\bkmkend TcdhyltnqLVofAsv71Qn}  {\*\bkmkstart T3DmH13dT6oKNiKlS4CR}}
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\f39\fs22\insrsid13174827\charrsid7171227 Single Code Entry: History relating to Army service...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 
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{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f39\fs22\insrsid13174827\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \af39 \ltrch\fcs0 \f39\insrsid13174827\charrsid7171227 {\*\datafield 
00020000140000001454466374713743504f4a76644a57385466524c7300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TFctq7CPOJvdJW8TfRLs}}}}}{\fldrslt {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 
\f39\fs22\insrsid13174827\charrsid7171227 Single Code Entry: Is no longer a carer}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \af39 \ltrch\fcs0 
\f39\insrsid13174827\charrsid7171227 {\*\bkmkend TFctq7CPOJvdJW8TfRLs}  {\*\bkmkstart Tae4a6EochMjxo36PhzG}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af39\afs22 \ltrch\fcs0 \f39\fs22\insrsid13174827\charrsid7171227  FORMTEXT }{\rtlch\fcs1 \af39 
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Access}{\rtlch\fcs1 \ab\af39\afs20 \ltrch\fcs0 \b\fs20\ul\insrsid13853683\charrsid11759655 ible information
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Contact method: Requires contact by telephone...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs20 \ltrch\fcs0 \fs20\insrsid3807508 
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Information format: Requires information verbally...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs20 \ltrch\fcs0 \fs20\insrsid3807508 
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Professional required: Interpreter needed - British Sign Language...}}}\sectd \ltrsect\sbknone\linex0\headery510\footery454\colsx708\endnhere\titlepg\sectlinegrid360\sectdefaultcl\sectrsid803642\sftnbj {\rtlch\fcs1 \ab\af39\afs20 \ltrch\fcs0 
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\fs16\cf2\insrsid3213325\charrsid8010447  HYPERLINK "mailto:Ngccg.informatics@nhs.net?body=DO%20NOT%20USE%20THIS%20EMAIL%20TO%20REFER%20A%20PATIENT.%0D
%0A%0D%0AThis%20email%20is%20to%20inform%20the%20'Referral%20Form%20Group'%20of%20any%20suggested%20changes%20to%20a%20referral%20form.%0D%0A%0D%0APlease%20remember%20to%20state%20the%20name%20of%20the%20Referral%20Form.&subject=Query%20to%20referral%20fo
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If you have any problem with this form or suggested changes, please control & click here to open direct email.  (NB: NOT TO BE USED FOR REFERRING A PATIENT)}}}\sectd \ltrsect
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Suspected Early Inflammatory Arthritis }{\rtlch\fcs1 \af39\afs16 \ltrch\fcs0 \fs16\insrsid16585934 Referral Form }{\rtlch\fcs1 \af39\afs16 \ltrch\fcs0 \fs16\insrsid7880552 January 2021}{\rtlch\fcs1 \af39\afs16 \ltrch\fcs0 \fs16\insrsid16585934  V}{
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