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<657863656C6C656E7420> Tj /F3 8.5 Tf 1 0 0 1 198.00 579.96 Tm <70726F66657373696F6E616C20> Tj /F3 9.5 Tf 1 0 0 1 249.12 579.60 Tm <636172652E20> Tj 1 0 0 1 273.60 579.60 Tm <496620> Tj /F3 8.5 Tf 1 0 0 1 282.24 579.96 Tm <796F7520> Tj 1 0 0 1 299.52 579.24 Tm <6861766520> Tj 1 0 0 1 320.76 579.96 Tm <7175657374696F6E7320> Tj 1 0 0 1 361.08 579.24 Tm <61626F757420> Tj 1 0 0 1 385.20 579.24 Tm <74686520> Tj 1 0 0 1 400.32 579.24 Tm <736572766963657320> Tj 1 0 0 1 434.52 579.60 Tm <796F7520> Tj 1 0 0 1 451.80 579.24 Tm <7265636569766520> Tj 1 0 0 1 483.48 579.24 Tm <6F7220> Tj 1 0 0 1 494.28 579.24 Tm <6861766520> Tj 1 0 0 1 515.88 579.24 Tm <616E7920> Tj 1 0 0 1 532.44 579.60 Tm <70726F626C656D73> Tj /F3 9.5 Tf 1 0 0 1 34.20 568.08 Tm <7769746820> Tj /F3 8.5 Tf 1 0 0 1 54.36 568.08 Tm <736572766963657320> Tj /F3 8.0 Tf 1 0 0 1 88.56 568.08 Tm <617420> Tj /F3 8.5 Tf 1 0 0 1 97.92 567.72 Tm <74686520> Tj /F3 9.0 Tf 1 0 0 1 112.68 568.08 Tm <4865616C746820> Tj /F3 8.5 Tf 1 0 0 1 141.84 567.72 Tm <616E6420> Tj 1 0 0 1 159.12 567.72 Tm <436F756E73656C696E6720> Tj 1 0 0 1 207.00 567.72 Tm <63656E7465722C20> Tj /F3 8.0 Tf 1 0 0 1 236.16 568.44 Tm <706C6561736520> Tj 1 0 0 1 263.88 567.72 Tm <6469736375737320> Tj 1 0 0 1 294.48 567.72 Tm <746865736520> Tj /F3 8.5 Tf 1 0 0 1 317.16 567.72 Tm <6D61747465727320> Tj /F3 9.0 Tf 1 0 0 1 349.20 567.72 Tm <7769746820> Tj 1 0 0 1 369.00 568.08 Tm <796F757220> Tj /F3 8.5 Tf 1 0 0 1 389.88 567.36 Tm <7365727669636520> Tj /F3 9.0 Tf 1 0 0 1 420.48 568.08 Tm <70726F766964657220> Tj /F3 8.5 Tf 1 0 0 1 457.20 567.36 Tm <6F7220> Tj 1 0 0 1 467.64 567.36 Tm <74686520> Tj /F3 9.0 Tf 1 0 0 1 482.76 567.36 Tm <4469726563746F7220> Tj /F3 9.5 Tf 1 0 0 1 518.40 567.36 Tm <6F6620> Tj /F3 8.5 Tf 1 0 0 1 529.56 567.36 Tm <53747564656E74> Tj 1 0 0 1 34.20 556.20 Tm <4865616C746820> Tj 1 0 0 1 63.00 556.20 Tm <616E6420> Tj 1 0 0 1 79.92 556.20 Tm <436F756E73656C696E672E> Tj 1 0 0 1 34.20 532.80 Tm <54686520> Tj /F3 9.5 Tf 1 0 0 1 52.20 532.44 Tm <55414620> Tj 1 0 0 1 74.88 532.44 Tm <4865616C746820> Tj 1 0 0 1 106.20 532.44 Tm <43656E74657220> Tj /F3 8.0 Tf 1 0 0 1 138.60 532.44 Tm <46656520> Tj /F3 9.5 Tf 1 0 0 1 155.88 532.80 Tm <796F7520> Tj 1 0 0 1 174.60 532.80 Tm <7061696420> Tj /F3 8.0 Tf 1 0 0 1 195.84 532.44 Tm <617320> Tj /F3 10.0 Tf 1 0 0 1 207.36 532.80 Tm <7061727420> Tj /F3 10.5 Tf 1 0 0 1 228.24 532.44 Tm <6F66796F757220> Tj 1 0 0 1 261.72 532.44 Tm <756E6976657273697B20> Tj /F3 8.0 Tf 1 0 0 1 306.72 532.08 Tm <6665657320> Tj /F3 9.5 Tf 1 0 0 1 325.08 532.08 Tm <737570706F72747320> Tj /F3 9.0 Tf 1 0 0 1 364.68 532.08 Tm <74686520> Tj 1 0 0 1 380.52 532.08 Tm <53747564656E7420> Tj /F3 9.5 Tf 1 0 0 1 416.16 532.08 Tm <4865616C746820> Tj /F3 9.0 Tf 1 0 0 1 447.84 532.08 Tm <616E6420> Tj 1 0 0 1 466.20 532.08 Tm <436F756E73656C696E6720> Tj /F3 9.5 Tf 1 0 0 1 516.60 531.72 Tm <43656E74657220> Tj /F3 8.0 Tf 1 0 0 1 548.28 531.72 Tm <616E64> Tj /F3 8.5 Tf 1 0 0 1 34.20 520.56 Tm <636F7665727320> Tj 1 0 0 1 62.28 520.56 Tm <74686520> Tj 1 0 0 1 77.04 520.56 Tm <636F737420> Tj /F3 9.0 Tf 1 0 0 1 95.40 520.56 Tm <6F6620> Tj /F3 8.5 Tf 1 0 0 1 105.84 520.56 Tm <6D6F737420> Tj /F3 9.0 Tf 1 0 0 1 127.80 520.56 Tm <6D65646963616C20> Tj /F3 8.5 Tf 1 0 0 1 162.36 520.56 Tm <616E6420> Tj 1 0 0 1 179.28 520.20 Tm <636F756E73656C696E6720> Tj 1 0 0 1 225.00 520.56 Tm <736572766963657320> Tj 1 0 0 1 259.20 520.20 Tm <776520> Tj /F3 10.0 Tf 1 0 0 1 273.24 520.20 Tm <6F666665722E20> Tj /F3 8.5 Tf 1 0 0 1 299.88 520.20 Tm <546865726520> Tj /F3 8.0 Tf 1 0 0 1 325.80 520.20 Tm <61726520> Tj /F3 8.5 Tf 1 0 0 1 340.56 520.20 Tm <6D6F6465737420> Tj /F3 8.0 Tf 1 0 0 1 371.88 519.84 Tm <6368617267657320> Tj /F3 9.5 Tf 1 0 0 1 404.64 520.20 Tm <666F7220> Tj /F3 8.0 Tf 1 0 0 1 419.04 519.84 Tm <736F6D6520> Tj /F3 8.5 Tf 1 0 0 1 442.44 519.84 Tm <736572766963657320> Tj /F3 8.0 Tf 1 0 0 1 477.00 519.84 Tm <7375636820> Tj /F3 7.5 Tf 1 0 0 1 497.52 519.84 Tm <617320> Tj /F3 9.0 Tf 1 0 0 1 508.32 519.84 Tm <6C61626F7261746F72792C> Tj /F3 8.5 Tf 1 0 0 1 34.20 508.68 Tm <737570706C6965732C20> Tj 1 0 0 1 71.28 508.68 Tm <6D656469636174696F6E732C20> Tj 1 0 0 1 124.20 508.68 Tm <616E6420> Tj 1 0 0 1 141.12 508.32 Tm <657874656E64656420> Tj /F3 9.5 Tf 1 0 0 1 180.36 508.32 Tm <636F756E73656C696E672E20> Tj /F3 8.5 Tf 1 0 0 1 233.64 508.32 Tm <5768656E20> Tj 1 0 0 1 259.56 508.32 Tm <746865726520> Tj /F3 8.0 Tf 1 0 0 1 281.88 508.32 Tm <61726520> Tj 1 0 0 1 296.64 508.32 Tm <636861726765732C20> Tj /F3 8.5 Tf 1 0 0 1 331.56 508.68 Tm <7061796D656E7420> Tj 1 0 0 1 368.64 507.96 Tm <697320> Tj /F3 8.0 Tf 1 0 0 1 377.64 507.96 Tm <64756520> Tj 1 0 0 1 394.20 507.96 Tm <617420> Tj /F3 8.5 Tf 1 0 0 1 403.92 507.96 Tm <74686520> Tj /F3 9.0 Tf 1 0 0 1 418.68 507.96 Tm <74696D6520> Tj 1 0 0 1 438.84 507.96 Tm <6F6620> Tj 1 0 0 1 449.64 507.96 Tm <736572766963652E20> Tj /F3 10.0 Tf 1 0 0 1 485.28 507.96 Tm <416E7920> Tj /F3 9.0 Tf 1 0 0 1 505.80 507.96 Tm <6368617267657320> Tj /F3 9.5 Tf 1 0 0 1 541.08 507.96 Tm <6C656674> Tj 1 0 0 1 34.20 496.80 Tm <756E7061696420> Tj /F3 10.5 Tf 1 0 0 1 66.24 496.80 Tm <77696C6C20> Tj /F3 8.5 Tf 1 0 0 1 84.24 496.44 Tm <626520> Tj /F3 10.0 Tf 1 0 0 1 96.48 496.44 Tm <666F7277617264656420> Tj /F3 9.5 Tf 1 0 0 1 144.36 496.44 Tm <746F20> Tj /F3 9.0 Tf 1 0 0 1 155.52 496.44 Tm <74686520> Tj /F3 10.0 Tf 1 0 0 1 171.36 496.44 Tm <55414620> Tj 1 0 0 1 194.76 496.44 Tm <427572736172277320> Tj /F3 9.5 Tf 1 0 0 1 234.36 496.44 Tm <4F666669636520> Tj /F3 9.0 Tf 1 0 0 1 262.80 496.44 Tm <617420> Tj 1 0 0 1 273.60 496.44 Tm <74686520> Tj 1 0 0 1 289.80 496.08 Tm <626567696E6E696E6720> Tj /F3 9.5 Tf 1 0 0 1 333.72 496.44 Tm <6F666561636820> Tj /F3 9.0 Tf 1 0 0 1 366.84 496.08 Tm <7765656B20> Tj 1 0 0 1 390.96 496.08 Tm <616C6F6E6720> Tj /F3 10.0 Tf 1 0 0 1 416.88 496.08 Tm <7769746820> Tj /F3 13.5 Tf 1 0 0 1 438.12 496.08 Tm <4920> Tj /F3 9.5 Tf 1 0 0 1 446.04 496.08 Tm <6465736372697074696F6E20> Tj 1 0 0 1 496.08 496.08 Tm <6F6620> Tj /F3 9.0 Tf 1 0 0 1 507.24 496.08 Tm <74686520> Tj /F3 9.5 Tf 1 0 0 1 523.08 496.08 Tm <6E617475726520> Tj /F3 11.0 Tf 1 0 0 1 553.32 495.72 Tm <6F66> Tj /F3 9.0 Tf 1 0 0 1 33.84 484.92 Tm <74686520> Tj /F3 9.5 Tf 1 0 0 1 49.32 484.92 Tm <63687272676520> Tj /F3 8.5 Tf 1 0 0 1 80.64 485.28 Tm <28652E392E20> Tj /F3 9.0 Tf 1 0 0 1 101.16 484.92 Tm <49616220> Tj /F3 10.0 Tf 1 0 0 1 116.64 484.92 Tm <776F726B2C20> Tj /F3 9.5 Tf 1 0 0 1 144.72 484.56 Tm <6D656469636174696F6E2C20> Tj /F3 9.0 Tf 1 0 0 1 196.92 484.92 Tm <6D65646963616C20> Tj /F3 9.5 Tf 1 0 0 1 232.20 484.56 Tm <617070742E20> Tj 1 0 0 1 256.68 484.56 Tm <6F7220> Tj 1 0 0 1 268.56 484.56 Tm <636F756E73656C696E67292E20> Tj /F3 8.5 Tf 1 0 0 1 324.00 484.56 Tm <4F6E636520> Tj /F3 8.0 Tf 1 0 0 1 347.76 484.56 Tm <616E20> Tj /F3 8.5 Tf 1 0 0 1 359.64 484.20 Tm <756E7061696420> Tj 1 0 0 1 389.16 484.56 Tm <63686172676520> Tj 1 0 0 1 418.68 484.56 Tm <697320> Tj /F3 8.0 Tf 1 0 0 1 427.68 484.56 Tm <73656E7420> Tj /F3 9.0 Tf 1 0 0 1 445.68 484.56 Tm <746F20> Tj /F3 8.0 Tf 1 0 0 1 456.12 484.20 Tm <74686520> Tj /F3 11.0 Tf 1 0 0 1 470.52 484.20 Tm <55414920> Tj /F3 9.5 Tf 1 0 0 1 493.20 484.56 Tm <42756E6172277320> Tj /F3 9.0 Tf 1 0 0 1 529.56 484.20 Tm <4F66666963652C20> Tj /F3 8.5 Tf 1 0 0 1 559.08 484.20 Tm <746865> Tj 1 0 0 1 33.84 473.04 Tm <4865616C746820> Tj /F3 8.0 Tf 1 0 0 1 62.64 473.04 Tm <616E6420> Tj /F3 8.5 Tf 1 0 0 1 79.20 472.68 Tm <436F756E73656C696E6720> Tj 1 0 0 1 127.08 472.68 Tm <43656E74807220> Tj /F3 8.0 Tf 1 0 0 1 156.60 472.68 Tm <63616E20> Tj /F3 9.0 Tf 1 0 0 1 172.44 472.68 Tm <6E6F20> Tj /F3 8.5 Tf 1 0 0 1 185.76 472.68 Tm <6C6F6E67657220> Tj /F3 8.0 Tf 1 0 0 1 213.48 472.68 Tm <61636365707420> Tj 1 0 0 1 241.20 473.04 Tm <7061292C726E656E7420> Tj /F3 9.0 Tf 1 0 0 1 277.92 472.68 Tm <666F7220> Tj /F3 8.5 Tf 1 0 0 1 291.60 472.32 Tm <7468617420> Tj /F3 9.0 Tf 1 0 0 1 308.88 472.32 Tm <6368617267652E20> Tj /F3 8.5 Tf 1 0 0 1 343.44 472.68 Tm <54686520> Tj /F3 9.0 Tf 1 0 0 1 361.44 472.68 Tm <427572736172277320> Tj /F3 9.5 Tf 1 0 0 1 397.44 472.32 Tm <4F666669636520> Tj /F3 10.0 Tf 1 0 0 1 425.52 472.68 Tm <77696C6C20> Tj /F3 8.0 Tf 1 0 0 1 443.16 472.68 Tm <73656E6420> Tj /F3 7.5 Tf 1 0 0 1 464.04 472.32 Tm <6120> Tj /F3 10.0 Tf 1 0 0 1 470.88 472.32 Tm <62696C6C20> Tj /F3 8.5 Tf 1 0 0 1 486.72 472.32 Tm <616E6420> Tj 1 0 0 1 503.64 472.68 Tm <7061796D656E7420> Tj /F3 8.0 Tf 1 0 0 1 540.00 472.32 Tm <6D75737420> Tj /F3 8.5 Tf 1 0 0 1 560.88 472.32 Tm <6265> Tj /F3 8.0 Tf 1 0 0 1 33.48 461.16 Tm <6D61646520> Tj /F3 9.0 Tf 1 0 0 1 57.24 460.80 Tm <746F20> Tj /F3 8.5 Tf 1 0 0 1 67.68 460.80 Tm <74686520> Tj /F3 9.0 Tf 1 0 0 1 82.44 461.16 Tm <427572736172277320> Tj /F3 10.0 Tf 1 0 0 1 118.44 460.80 Tm <4F66666963652E20> Tj /F3 8.5 Tf 1 0 0 1 151.56 460.80 Tm <477261646520> Tj /F3 9.0 Tf 1 0 0 1 178.56 460.80 Tm <7265706F72747320> Tj /F3 8.0 Tf 1 0 0 1 209.52 460.80 Tm <616E6420> Tj /F3 9.0 Tf 1 0 0 1 226.08 460.80 Tm <726567697374726174696F6E20> Tj /F3 8.5 Tf 1 0 0 1 273.96 460.80 Tm <6D617920> Tj /F3 8.0 Tf 1 0 0 1 293.04 460.44 Tm <626520> Tj /F3 8.5 Tf 1 0 0 1 304.92 460.44 Tm <64656C6179656420> Tj /F3 10.5 Tf 1 0 0 1 338.76 460.80 Tm <696662696C6C7320> Tj /F3 8.5 Tf 1 0 0 1 366.48 460.80 Tm <72656D61696E20> Tj 1 0 0 1 396.72 460.44 Tm <756E7061696420> Tj 1 0 0 1 426.24 461.16 Tm <70657220> Tj /F3 9.0 Tf 1 0 0 1 441.36 460.80 Tm <42757273617220> Tj 1 0 0 1 470.88 461.16 Tm <706F6C69636965732E> Tj 0.00 Tc 1 0 0 1 33.84 437.40 Tm <53747564656E7420> Tj /F3 9.5 Tf 1 0 0 1 69.48 437.40 Tm <494423> Tj 0.00 Tc /F3 10.0 Tf 1 0 0 1 209.16 437.40 Tm <4920> Tj /F3 9.0 Tf 1 0 0 1 215.28 437.40 Tm <616772656520> Tj /F3 10.0 Tf 1 0 0 1 241.20 437.04 Tm <6C6F20> Tj /F3 9.0 Tf 1 0 0 1 252.36 437.04 Tm <7265636569768020> Tj /F3 8.5 Tf 1 0 0 1 284.40 437.04 Tm <736572766963657320> Tj /F3 9.0 Tf 1 0 0 1 320.04 437.04 Tm <617420> Tj 1 0 0 1 330.84 437.04 Tm <74686520> Tj 1 0 0 1 347.04 437.04 Tm <53747564656E7420> Tj /F3 9.5 Tf 1 0 0 1 382.32 437.04 Tm <4865616C746820> Tj /F3 9.0 Tf 1 0 0 1 414.00 437.04 Tm <616E6420> Tj 1 0 0 1 432.72 437.04 Tm <436F756E73656C696E6720> Tj /F3 9.5 Tf 1 0 0 1 482.76 436.68 Tm <43656E7465722E> Tj 0.00 Tc /F3 9.0 Tf 1 0 0 1 33.84 401.76 Tm <5369676E6174756520> Tj 1 0 0 1 73.80 401.76 Tm <6F6620> Tj /F3 8.5 Tf 1 0 0 1 84.60 401.76 Tm <53747564656E7420> Tj /F3 9.0 Tf 1 0 0 1 117.00 402.48 Tm <286F7220> Tj /F3 8.5 Tf 1 0 0 1 131.40 401.76 Tm <726570726573656E74617469766529> Tj 0.00 Tc 1 0 0 1 357.12 401.40 Tm <44617465> Tj 0.00 Tc /F3 9.0 Tf 1 0 0 1 33.48 366.12 Tm <5369676E6168726520> Tj 1 0 0 1 73.44 366.12 Tm <6F66506172656E7420> Tj 1 0 0 1 111.96 366.12 Tm <6F7220> Tj 1 0 0 1 123.12 366.12 Tm <477561726469616E> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 357.12 366.12 Tm <44617465> Tj 0.00 Tc /F3 11.0 Tf 1 0 0 1 159.12 340.56 Tm <41634B4E6F774C457063454D454E5420> Tj /F3 10.0 Tf 1 0 0 1 270.00 340.56 Tm <6F4620> Tj /F3 12.0 Tf 1 0 0 1 285.48 340.56 Tm <4E6F7272634520> Tj /F3 10.0 Tf 1 0 0 1 326.88 340.56 Tm <6F4620> Tj /F3 11.0 Tf 1 0 0 1 342.36 340.56 Tm <5052727641637920> Tj 1 0 0 1 389.88 340.56 Tm <505241637272634573> Tj /F3 8.5 Tf 1 0 0 1 33.12 316.44 Tm <506C6561736520> Tj /F3 9.0 Tf 1 0 0 1 62.28 316.44 Tm <72657669657720> Tj /F3 10.0 Tf 1 0 0 1 92.52 316.44 Tm <6F757220> Tj /F3 9.0 Tf 1 0 0 1 110.16 316.44 Tm <4E6F7469638020> Tj /F3 9.5 Tf 1 0 0 1 140.04 316.44 Tm <6F6620> Tj 1 0 0 1 151.20 316.44 Tm <5072697661637920> Tj /F3 9.0 Tf 1 0 0 1 186.84 316.44 Tm <50726163746963657320> Tj /F3 10.5 Tf 1 0 0 1 227.88 316.44 Tm <6361726566756C6C792E20> Tj /F3 9.0 Tf 1 0 0 1 273.24 316.44 Tm <596F7520> Tj /F3 10.0 Tf 1 0 0 1 292.68 316.44 Tm <77696C6C20> Tj /F3 8.0 Tf 1 0 0 1 310.32 316.08 Tm <626520> Tj /F3 9.5 Tf 1 0 0 1 322.20 316.80 Tm <676976696E6720> Tj /F3 8.0 Tf 1 0 0 1 350.28 316.08 Tm <757320> Tj /F3 9.0 Tf 1 0 0 1 361.80 316.08 Tm <696E666F726D6174696F6E20> Tj /F3 8.5 Tf 1 0 0 1 410.76 316.08 Tm <61626F757420> Tj /F3 9.0 Tf 1 0 0 1 435.24 316.44 Tm <796F757273656C66616E6420> Tj 1 0 0 1 487.08 316.44 Tm <796F757220> Tj /F3 8.5 Tf 1 0 0 1 507.96 316.08 Tm <6865616C746820> Tj /F3 8.0 Tf 1 0 0 1 534.96 315.72 Tm <616E64> Tj /F3 8.5 Tf 1 0 0 1 32.76 305.28 Tm <706572736F6E616C20> Tj /F3 8.0 Tf 1 0 0 1 68.76 304.56 Tm <6E6565647320> Tj 1 0 0 1 93.96 304.56 Tm <616E6420> Tj /F3 8.5 Tf 1 0 0 1 110.52 304.92 Tm <776520> Tj 1 0 0 1 124.56 304.92 Tm <77616E7420> Tj /F3 9.0 Tf 1 0 0 1 146.16 305.28 Tm <796F7520> Tj 1 0 0 1 163.80 304.56 Tm <746F20> Tj /F3 8.5 Tf 1 0 0 1 174.24 304.56 Tm <756E6465727374616E6420> Tj /F3 9.0 Tf 1 0 0 1 220.32 304.92 Tm <686F7720> Tj /F3 8.5 Tf 1 0 0 1 239.76 304.92 Tm <776520> Tj 1 0 0 1 253.80 304.56 Tm <7265636F726420> Tj /F3 9.0 Tf 1 0 0 1 281.88 304.92 Tm <796F757220> Tj /F3 8.5 Tf 1 0 0 1 302.40 304.92 Tm <706572736F6E616C20> Tj 1 0 0 1 338.76 304.56 Tm <6865616C746820> Tj /F3 9.0 Tf 1 0 0 1 365.76 304.20 Tm <696E666F726D6174696F6E2C20> Tj 1 0 0 1 417.24 304.20 Tm <686F7720> Tj /F3 8.5 Tf 1 0 0 1 436.68 304.20 Tm <776520> Tj /F3 8.0 Tf 1 0 0 1 450.72 304.20 Tm <61737375726520> Tj /F3 8.5 Tf 1 0 0 1 478.08 304.20 Tm <74686520> Tj 1 0 0 1 493.20 304.20 Tm <736563757269747920> Tj /F3 10.0 Tf 1 0 0 1 526.68 303.84 Tm <6F6674686174> Tj /F3 9.0 Tf 1 0 0 1 33.12 293.04 Tm <696E666F726D6174696F6E20> Tj /F3 8.0 Tf 1 0 0 1 81.72 292.68 Tm <616E642C20> Tj /F3 8.5 Tf 1 0 0 1 100.80 293.04 Tm <6D6F737420> Tj /F3 9.0 Tf 1 0 0 1 122.76 293.04 Tm <696D706F7274616E746C792C20> Tj 1 0 0 1 174.24 293.04 Tm <686F7720> Tj 1 0 0 1 193.68 293.04 Tm <776520> Tj 1 0 0 1 208.08 293.04 Tm <636F6E74726F6C20> Tj /F3 8.5 Tf 1 0 0 1 238.32 293.04 Tm <74686520> Tj /F3 8.0 Tf 1 0 0 1 253.08 292.68 Tm <75736520> Tj /F3 9.5 Tf 1 0 0 1 268.92 292.68 Tm <6F667468617420> Tj 1 0 0 1 297.00 292.68 Tm <696E666F726D6174696F6E2E20> Tj /F3 9.0 Tf 1 0 0 1 351.36 292.68 Tm <576520> Tj /F3 8.5 Tf 1 0 0 1 367.92 292.32 Tm <616269646520> Tj /F3 9.0 Tf 1 0 0 1 391.68 292.32 Tm <627920> Tj /F3 8.5 Tf 1 0 0 1 404.28 292.32 Tm <74686520> Tj 1 0 0 1 419.04 292.68 Tm <6665646572616C20> Tj 1 0 0 1 449.28 292.32 Tm <6C6177732C20> Tj /F3 8.0 Tf 1 0 0 1 472.32 292.32 Tm <737461746520> Tj /F3 8.5 Tf 1 0 0 1 493.20 292.32 Tm <6C61777320> Tj 1 0 0 1 513.36 292.32 Tm <616E64> Tj 1 0 0 1 32.40 281.52 Tm <70726F66657373696F6E616C20> Tj 1 0 0 1 83.52 280.80 Tm <6574686963616C20> Tj 1 0 0 1 112.32 280.80 Tm <7374616E646172647320> Tj 1 0 0 1 153.00 280.80 Tm <7468617420> Tj /F3 9.0 Tf 1 0 0 1 170.28 280.80 Tm <636F6E616F6C20> Tj /F3 8.5 Tf 1 0 0 1 201.24 280.80 Tm <74686520> Tj 1 0 0 1 216.00 281.16 Tm <77617920> Tj 1 0 0 1 234.72 281.16 Tm <776520> Tj 1 0 0 1 248.40 280.80 Tm <68616E646C6520> Tj /F3 9.0 Tf 1 0 0 1 277.56 281.16 Tm <796F757220> Tj 1 0 0 1 298.08 281.16 Tm <7065426F6E616C20> Tj /F3 8.5 Tf 1 0 0 1 334.08 280.80 Tm <6865616C746820> Tj /F3 9.5 Tf 1 0 0 1 361.44 280.44 Tm <696E666F726D6174696F6E2E20> Tj /F3 8.5 Tf 1 0 0 1 415.44 280.80 Tm <546865726520> Tj /F3 8.0 Tf 1 0 0 1 441.36 280.44 Tm <61726520> Tj /F3 8.5 Tf 1 0 0 1 456.12 280.44 Tm <63697263756D7374616E63657320> Tj 1 0 0 1 514.80 280.44 Tm <776865726520> Tj /F3 8.0 Tf 1 0 0 1 541.44 280.08 Tm <776520> Tj /F3 10.5 Tf 1 0 0 1 554.76 280.08 Tm <77696C6C> Tj /F3 8.0 Tf 1 0 0 1 32.40 269.28 Tm <72656C6561736520> Tj /F3 8.5 Tf 1 0 0 1 62.64 269.64 Tm <70726F74656374656420> Tj 1 0 0 1 102.24 269.28 Tm <6865616C746820> Tj /F3 9.0 Tf 1 0 0 1 129.24 269.28 Tm <696E666F726D6174696F6E20> Tj /F3 8.5 Tf 1 0 0 1 178.56 269.28 Tm <796F7520> Tj /F3 9.0 Tf 1 0 0 1 195.84 269.28 Tm <70726F7669646520> Tj /F3 8.0 Tf 1 0 0 1 228.96 268.92 Tm <757320> Tj /F3 9.0 Tf 1 0 0 1 240.12 268.92 Tm <776974686F757420> Tj 1 0 0 1 272.52 269.28 Tm <796F757220> Tj 1 0 0 1 293.40 268.56 Tm <617574686F72697A6174696F6E20> Tj /F3 8.5 Tf 1 0 0 1 348.48 268.56 Tm <6F7220> Tj /F3 9.0 Tf 1 0 0 1 359.28 268.56 Tm <6B6E6F776C6564676520> Tj /F3 8.5 Tf 1 0 0 1 405.36 268.56 Tm <616E6420> Tj /F3 8.0 Tf 1 0 0 1 422.28 268.56 Tm <746865736520> Tj /F3 8.5 Tf 1 0 0 1 445.32 268.56 Tm <736974756174696F6E7320> Tj 1 0 0 1 485.64 268.56 Tm <616E6420> Tj 1 0 0 1 502.92 268.56 Tm <63697263756D7374616E636573> Tj /F3 8.0 Tf 1 0 0 1 32.40 257.40 Tm <61726520> Tj /F3 8.5 Tf 1 0 0 1 47.16 257.40 Tm <6578706C61696E656420> Tj /F3 9.0 Tf 1 0 0 1 88.20 257.40 Tm <696E20> Tj 1 0 0 1 98.28 257.04 Tm <64657461696C20> Tj 1 0 0 1 123.12 257.40 Tm <696E20> Tj /F3 8.5 Tf 1 0 0 1 133.20 257.40 Tm <6F757220> Tj /F3 9.0 Tf 1 0 0 1 149.04 257.40 Tm <4E6F7469636520> Tj /F3 9.5 Tf 1 0 0 1 178.56 257.04 Tm <6F6620> Tj /F3 9.0 Tf 1 0 0 1 189.72 257.04 Tm <5072697661637920> Tj /F3 8.5 Tf 1 0 0 1 222.12 257.40 Tm <5072616374696365732E> Tj /F3 9.0 Tf 1 0 0 1 32.40 234.00 Tm <576520> Tj /F3 9.5 Tf 1 0 0 1 48.96 233.64 Tm <61726520> Tj 1 0 0 1 65.88 233.64 Tm <726571756972656420> Tj /F3 9.0 Tf 1 0 0 1 105.12 233.64 Tm <627920> Tj /F3 9.5 Tf 1 0 0 1 118.08 233.64 Tm <6665646572616C20> Tj /F3 11.0 Tf 1 0 0 1 150.84 233.64 Tm <687720> Tj /F3 9.0 Tf 1 0 0 1 168.48 233.64 Tm <746F20> Tj 1 0 0 1 179.28 233.64 Tm <61736B20> Tj /F3 9.5 Tf 1 0 0 1 196.20 234.00 Tm <796F7520> Tj /F3 9.0 Tf 1 0 0 1 214.56 233.64 Tm <746F20> Tj 1 0 0 1 225.36 233.64 Tm <7369676E20> Tj /F3 9.5 Tf 1 0 0 1 244.80 233.28 Tm <7468697320> Tj 1 0 0 1 263.16 233.28 Tm <666F726D20> Tj 1 0 0 1 286.20 233.28 Tm <61636B6E6F776C656467696E6720> Tj 1 0 0 1 352.44 233.28 Tm <7468617420> Tj /F3 9.0 Tf 1 0 0 1 372.24 233.28 Tm <776520> Tj /F3 8.5 Tf 1 0 0 1 386.64 233.28 Tm <6861766520> Tj /F3 9.0 Tf 1 0 0 1 408.96 233.64 Tm <676976656E20> Tj /F3 9.5 Tf 1 0 0 1 434.16 233.64 Tm <796F7520> Tj /F3 8.5 Tf 1 0 0 1 452.52 232.92 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 460.08 232.92 Tm <6368616E636520> Tj /F3 9.5 Tf 1 0 0 1 492.12 232.92 Tm <746F20> Tj 1 0 0 1 503.28 232.92 Tm <72657669657720> Tj /F3 10.0 Tf 1 0 0 1 533.88 232.56 Tm <6F7572> Tj /F3 9.0 Tf 1 0 0 1 32.40 222.12 Tm <4E6F7469636520> Tj 1 0 0 1 61.92 221.76 Tm <6F6620> Tj /F3 9.5 Tf 1 0 0 1 72.72 222.12 Tm <5072697661637920> Tj /F3 9.0 Tf 1 0 0 1 108.00 222.12 Tm <50726163746963657320> Tj 1 0 0 1 149.40 221.76 Tm <616E6420> Tj /F3 10.0 Tf 1 0 0 1 168.12 221.76 Tm <7468617420> Tj /F3 9.0 Tf 1 0 0 1 188.28 221.76 Tm <776520> Tj 1 0 0 1 202.68 221.76 Tm <6873766520> Tj /F3 9.5 Tf 1 0 0 1 225.00 221.76 Tm <6F66666572656420> Tj 1 0 0 1 257.76 222.12 Tm <796F7520> Tj /F3 8.5 Tf 1 0 0 1 276.12 221.40 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 283.68 221.40 Tm <636F707920> Tj 1 0 0 1 306.00 221.40 Tm <6F6620> Tj 1 0 0 1 316.80 221.40 Tm <74686520> Tj /F3 10.0 Tf 1 0 0 1 332.64 221.40 Tm <4E6F746963652E20> Tj /F3 10.5 Tf 1 0 0 1 367.56 221.40 Tm <496620> Tj /F3 9.0 Tf 1 0 0 1 376.92 221.40 Tm <666F7220> Tj /F3 8.5 Tf 1 0 0 1 390.96 221.40 Tm <616E7920> Tj /F3 8.0 Tf 1 0 0 1 407.52 221.40 Tm <726561736F6E20> Tj /F3 8.5 Tf 1 0 0 1 435.96 221.76 Tm <796F7520> Tj 1 0 0 1 453.24 221.04 Tm <646F20> Tj /F3 9.0 Tf 1 0 0 1 465.84 221.04 Tm <6E6F7420> Tj /F3 8.5 Tf 1 0 0 1 481.32 221.04 Tm <77616E7420> Tj /F3 9.0 Tf 1 0 0 1 502.56 221.04 Tm <746F20> Tj /F3 8.5 Tf 1 0 0 1 513.36 221.04 Tm <7369676E20> Tj 1 0 0 1 532.08 221.04 Tm <7468697320> Tj /F3 9.0 Tf 1 0 0 1 548.64 221.04 Tm <666F726D2C> Tj /F3 8.5 Tf 1 0 0 1 32.04 210.24 Tm <6F6E6520> Tj /F3 10.0 Tf 1 0 0 1 48.96 210.24 Tm <6F666F757220> Tj 1 0 0 1 75.60 210.24 Tm <737461666677696C6C20> Tj /F3 9.0 Tf 1 0 0 1 113.04 209.88 Tm <7369676E20> Tj 1 0 0 1 132.48 210.24 Tm <697420> Tj /F3 8.5 Tf 1 0 0 1 140.04 209.88 Tm <616E6420> Tj /F3 10.5 Tf 1 0 0 1 157.32 210.24 Tm <77696C6C20> Tj /F3 8.5 Tf 1 0 0 1 175.32 209.88 Tm <696E64696361746520> Tj 1 0 0 1 209.16 209.88 Tm <7468617420> Tj 1 0 0 1 226.44 210.24 Tm <796F7520> Tj 1 0 0 1 243.72 209.88 Tm <7765726520> Tj /F3 9.0 Tf 1 0 0 1 265.68 209.52 Tm <6F66666572656420> Tj /F3 8.5 Tf 1 0 0 1 296.64 209.52 Tm <6F757220> Tj /F3 9.0 Tf 1 0 0 1 312.12 209.52 Tm <4E6F7469636520> Tj /F3 9.5 Tf 1 0 0 1 341.64 209.52 Tm <6F665072697661637920> Tj /F3 8.5 Tf 1 0 0 1 385.20 209.52 Tm <50726163746963657320> Tj /F3 8.0 Tf 1 0 0 1 424.08 209.52 Tm <616E6420> Tj /F3 8.5 Tf 1 0 0 1 440.64 209.52 Tm <7468617420> Tj /F3 9.0 Tf 1 0 0 1 457.92 209.52 Tm <796F7520> Tj 1 0 0 1 475.56 209.16 Tm <64696420> Tj /F3 8.5 Tf 1 0 0 1 491.04 209.16 Tm <6E6F7420> Tj 1 0 0 1 506.16 209.16 Tm <77616E7420> Tj /F3 9.0 Tf 1 0 0 1 527.76 208.80 Tm <746F20> Tj /F3 8.0 Tf 1 0 0 1 538.56 208.80 Tm <7369676E20> Tj /F3 9.0 Tf 1 0 0 1 556.56 208.80 Tm <74686973> Tj /F3 10.0 Tf 1 0 0 1 32.40 198.72 Tm <666F726D2E20> Tj /F3 8.5 Tf 1 0 0 1 59.04 198.36 Tm <576520> Tj /F3 8.0 Tf 1 0 0 1 75.24 198.36 Tm <616C736F20> Tj /F3 9.0 Tf 1 0 0 1 93.24 198.72 Tm <7075626C69736820> Tj /F3 8.5 Tf 1 0 0 1 125.28 198.36 Tm <6F757220> Tj /F3 9.0 Tf 1 0 0 1 140.76 198.36 Tm <4E6F7469636520> Tj /F3 9.5 Tf 1 0 0 1 170.64 198.00 Tm <6F665072697661637920> Tj /F3 8.5 Tf 1 0 0 1 214.56 198.36 Tm <50726163746963657320> Tj 1 0 0 1 253.08 198.00 Tm <6F6E20> Tj 1 0 0 1 265.68 198.00 Tm <6F757220> Tj 1 0 0 1 281.16 198.00 Tm <77656220> Tj /F3 8.0 Tf 1 0 0 1 300.24 197.64 Tm <7369746520> Tj 1 0 0 1 316.08 197.64 Tm <617420> Tj /F3 9.0 Tf 1 0 0 1 325.80 197.64 Tm <7777772E7561662E6564752F63686320> Tj /F3 8.5 Tf 1 0 0 1 397.80 197.28 Tm <616E6420> Tj 1 0 0 1 414.72 197.28 Tm <746865726520> Tj /F3 8.0 Tf 1 0 0 1 437.76 197.64 Tm <697320> Tj 1 0 0 1 446.40 197.28 Tm <6120> Tj /F3 8.5 Tf 1 0 0 1 453.60 197.28 Tm <636F707920> Tj /F3 9.5 Tf 1 0 0 1 475.20 197.28 Tm <6F6674686520> Tj /F3 9.0 Tf 1 0 0 1 500.40 197.28 Tm <4E6F7469636520> Tj /F3 9.5 Tf 1 0 0 1 530.28 196.92 Tm <6F6650726976616379> Tj /F3 8.5 Tf 1 0 0 1 32.04 186.84 Tm <50726163746963657320> Tj 1 0 0 1 70.20 186.84 Tm <706F7374656420> Tj 1 0 0 1 99.00 186.48 Tm <6F6E20> Tj /F3 7.5 Tf 1 0 0 1 111.24 186.48 Tm <6120> Tj /F3 9.5 Tf 1 0 0 1 118.08 186.84 Tm <7075626C69636C7920> Tj /F3 8.5 Tf 1 0 0 1 153.72 186.48 Tm <61636365737369626C6520> Tj /F3 9.0 Tf 1 0 0 1 196.92 186.12 Tm <62756C6C6574696E20> Tj /F3 8.5 Tf 1 0 0 1 229.68 186.12 Tm <626F61726420> Tj 1 0 0 1 254.88 186.12 Tm <6865726520> Tj /F3 8.0 Tf 1 0 0 1 274.68 186.12 Tm <617420> Tj /F3 8.5 Tf 1 0 0 1 284.04 185.76 Tm <74686520> Tj 1 0 0 1 298.80 185.76 Tm <43656E7465722E> Tj /F3 9.5 Tf 1 0 0 1 32.40 163.08 Tm <4920> Tj /F3 9.0 Tf 1 0 0 1 38.16 162.72 Tm <61636B6E6F776C6564676520> Tj /F3 9.5 Tf 1 0 0 1 95.40 163.44 Tm <28696E6469636174656420> Tj 1 0 0 1 140.76 162.36 Tm <627920> Tj /F3 9.0 Tf 1 0 0 1 154.08 162.36 Tm <6D7920> Tj /F3 9.5 Tf 1 0 0 1 169.56 162.36 Tm <7369676E617475726520> Tj /F3 9.0 Tf 1 0 0 1 212.40 162.36 Tm <62656C6F772920> Tj /F3 9.5 Tf 1 0 0 1 243.00 162.36 Tm <7468617420> Tj /F3 11.0 Tf 1 0 0 1 262.80 162.36 Tm <4920> Tj /F3 9.0 Tf 1 0 0 1 269.28 162.00 Tm <6861766520> Tj /F3 8.5 Tf 1 0 0 1 291.96 162.00 Tm <6265656E20> Tj /F3 9.5 Tf 1 0 0 1 313.92 162.00 Tm <6F66666572656420> Tj /F3 8.5 Tf 1 0 0 1 347.04 162.00 Tm <6120> Tj 1 0 0 1 354.60 161.64 Tm <6368616E636520> Tj /F3 10.0 Tf 1 0 0 1 386.28 161.64 Tm <746F20> Tj /F3 9.0 Tf 1 0 0 1 397.80 161.64 Tm <7265616420> Tj 1 0 0 1 419.40 161.64 Tm <386E6420> Tj /F3 9.5 Tf 1 0 0 1 438.12 161.64 Tm <72657669657720> Tj /F3 9.0 Tf 1 0 0 1 469.08 161.64 Tm <74686520> Tj 1 0 0 1 484.92 161.64 Tm <4E6F7469636520> Tj /F3 10.0 Tf 1 0 0 1 514.80 161.28 Tm <6F6650726976616379> Tj /F3 9.0 Tf 1 0 0 1 32.04 151.20 Tm <50726163746963657320> Tj /F3 9.5 Tf 1 0 0 1 72.72 150.84 Tm <617420> Tj /F3 9.0 Tf 1 0 0 1 83.88 150.84 Tm <74686520> Tj /F3 9.5 Tf 1 0 0 1 99.72 150.84 Tm <55414620> Tj 1 0 0 1 122.76 150.84 Tm <53747564656E7420> Tj 1 0 0 1 158.76 150.84 Tm <4865616C746820> Tj /F3 9.0 Tf 1 0 0 1 190.08 150.48 Tm <616E6420> Tj 1 0 0 1 208.80 150.84 Tm <436F756E73656C696E6720> Tj /F3 9.5 Tf 1 0 0 1 258.84 150.48 Tm <43656E74657220> Tj /F3 9.0 Tf 1 0 0 1 290.52 150.12 Tm <6174726420> Tj /F3 11.0 Tf 1 0 0 1 309.24 150.48 Tm <4920> Tj /F3 8.5 Tf 1 0 0 1 315.72 150.48 Tm <6861798020> Tj 1 0 0 1 338.04 150.48 Tm <6265656E20> Tj /F3 9.5 Tf 1 0 0 1 360.36 150.12 Tm <6F66666572656420> Tj /F3 8.5 Tf 1 0 0 1 393.48 150.12 Tm <6120> Tj /F3 9.0 Tf 1 0 0 1 401.04 150.12 Tm <636F70792E> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 32.04 115.56 Tm <5369676E617475726520> Tj /F3 9.0 Tf 1 0 0 1 72.00 115.56 Tm <6F6620> Tj /F3 8.5 Tf 1 0 0 1 82.80 115.56 Tm <53747564656E7420> Tj /F3 9.0 Tf 1 0 0 1 115.20 116.28 Tm <286F7220> Tj /F3 8.5 Tf 1 0 0 1 129.60 115.56 Tm <726570726573656E74617469766529> Tj 0.00 Tc 1 0 0 1 31.68 80.28 Tm <5369676E617475726520> Tj /F3 9.0 Tf 1 0 0 1 71.64 80.28 Tm <6F6620> Tj /F3 8.0 Tf 1 0 0 1 82.44 80.28 Tm <506172656E7420> Tj /F3 8.5 Tf 1 0 0 1 110.16 80.28 Tm <6F7220> Tj /F3 9.0 Tf 1 0 0 1 120.96 80.28 Tm <477561726469616E> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 354.96 79.56 Tm <44617465> Tj 0.00 Tc /F3 34.0 Tf 1 0 0 1 263.88 727.20 Tm <495A3146> Tj 0.00 Tc /F3 9.0 Tf 1 0 0 1 264.60 718.56 Tm <554E495645525349545920> Tj /F3 7.5 Tf 1 0 0 1 322.56 718.56 Tm <4F46> Tj /F3 17.0 Tf 1 0 0 1 264.60 706.32 Tm <414C41534B41> Tj /F3 12.0 Tf 1 0 0 1 264.24 698.40 Tm <4641495242414E4B53> Tj 0.00 Tc /F3 8.5 Tf 1 0 0 1 355.32 114.84 Tm <44617465> Tj 0.00 Tc /F3 15.0 Tf 1 0 0 1 232.56 36.00 Tm <632F686C2F2F726E2F2F2A20> Tj /F3 13.0 Tf 1 0 0 1 297.00 32.04 Tm <2F6E40552F572E> Tj 0.00 Tc /F3 6.0 Tf 1 0 0 1 48.60 20.52 Tm <6C20> Tj /F3 7.0 Tf 1 0 0 1 52.20 20.88 Tm <2D32332D3230323020> Tj /F3 7.5 Tf 1 0 0 1 83.52 20.52 Tm <4D3A2F46726F6E7420> Tj /F3 8.0 Tf 1 0 0 1 114.12 20.52 Tm <4F66746963742F6E6F726D79436F726C2A643666642C66666C355020> Tj /F3 6.0 Tf 1 0 0 1 217.08 24.48 Tm <656D65726F727220> Tj /F3 4.5 Tf 1 0 0 1 241.92 24.48 Tm <616E6420> Tj /F3 7.0 Tf 1 0 0 1 252.00 24.48 Tm <80647563693636722C6D6E7275746F6E20> Tj /F3 5.5 Tf 1 0 0 1 310.32 24.12 Tm <616E642E70726368696269697320> Tj 1 0 0 1 345.24 24.48 Tm <695B8073617220> Tj 1 0 0 1 360.72 24.12 Tm <6469736372696D692E6172696F6E20> Tj /F3 6.0 Tf 1 0 0 1 397.80 24.12 Tm <2E7361696E7372> Tj /F3 5.0 Tf 1 0 0 1 229.32 17.28 Tm <616E7920> Tj /F3 5.5 Tf 1 0 0 1 239.76 17.28 Tm <696E646976696475616C20> Tj /F3 7.5 Tf 1 0 0 1 266.76 17.28 Tm <2A767920> Tj /F3 3.0 Tf 1 0 0 1 280.44 16.92 Tm <6420> Tj /F3 5.5 Tf 1 0 0 1 283.68 17.28 Tm <6C61735C6120> Tj 1 0 0 1 297.36 16.92 Tm <6564752F6E6F6E64442E6E6D276E612720> Tj /F3 6.0 Tf 1 0 0 1 346.68 17.28 Tm <696F6E2F> Tj ET endstream endobj 6 0 obj << /Type /Font /Subtype /Type1 /BaseFont /Helvetica /Encoding /WinAnsiEncoding >> endobj 7 0 obj << /Length 8 0 R >> stream 907-474-70439o7-474-5777faxuaf-sh-cc@alaska.eduwww. ualed u^hc Student Health and Counseling CenterP.O. 8ox 759580, r 788 Yu kon Drive I Fanbanks, Alask a 99775-Se8o Welcome to the Ӱ Student Health and Counseling Center. Our professionally trained staffprovides services in the areas ofmedical care, counseling health education and student health insurance.Our aim is to provide you with excellent professional care. If you have questions about the services you receive or have any problemswith services at the Health and Counseling center, please discuss these matters with your service provider or the Director of StudentHealth and Counseling.The Ӱ Health Center Fee you paid as part ofyour universi{ fees supports the Student Health and Counseling Center andcovers the cost of most medical and counseling services we offer. There are modest charges for some services such as laboratory,supplies, medications, and extended counseling. When there are charges, payment is due at the time of service. Any charges leftunpaid will be forwarded to the Ӱ Bursar's Office at the beginning ofeach week along with I description of the nature ofthe chrrge (e.9. Iab work, medication, medical appt. or counseling). Once an unpaid charge is sent to the UAI Bunar's Office, theHealth and Counseling Centr can no longer accept pa),rnent for that charge. The Bursar's Office will send a bill and payment must bemade to the Bursar's Office. Grade reports and registration may be delayed ifbills remain unpaid per Bursar policies. Student ID# I agree lo receiv services at the Student Health and Counseling Center. Signatue of Student (or representative) Date Signahre ofParent or Guardian Date AcKNowLEpcEMENT oF NorrcE oF PRrvAcy PRAcrrcEsPlease review our Notic of Privacy Practices carefully. You will be giving us information about yourselfand your health andpersonal needs and we want you to understand how we record your personal health information, how we assure the security ofthatinformation and, most importantly, how we control the use ofthat information. We abide by the federal laws, state laws andprofessional ethical standards that conaol the way we handle your peBonal health information. There are circumstances where we willrelease protected health information you provide us without your authorization or knowledge and these situations and circumstancesare explained in detail in our Notice of Privacy Practices.We are required by federal hw to ask you to sign this form acknowledging that we have given you a chance to review ourNotice of Privacy Practices and that we hsve offered you a copy of the Notice. If for any reason you do not want to sign this form,one ofour staffwill sign it and will indicate that you were offered our Notice ofPrivacy Practices and that you did not want to sign thisform. We also publish our Notice ofPrivacy Practices on our web site at www.uaf.edu/chc and there is a copy ofthe Notice ofPrivacyPractices posted on a publicly accessible bulletin board here at the Center.I acknowledge (indicated by my signature below) that I have been offered a chance to read 8nd review the Notice ofPrivacyPractices at the Ӱ Student Health and Counseling Center atrd I hay been offered a copy. 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