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{\f34\fbidi \froman\fcharset0\fprq2{\*\panose 02040503050406030204}Cambria Math;}{\f36\fbidi \froman\fcharset0\fprq2{\*\panose 02040503050406030204}Cambria;}
{\f37\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri{\*\falt Century Gothic};}{\f39\fbidi \fswiss\fcharset0\fprq2{\*\panose 020b0604030504040204}Tahoma;}{\f40\fbidi \fswiss\fcharset0\fprq2{\*\panose 020b0604030504040204}Verdana;}
{\f41\fbidi \fswiss\fcharset0\fprq0{\*\panose 00000000000000000000}Arial-BoldMT;}{\f42\fbidi \fswiss\fcharset0\fprq0{\*\panose 00000000000000000000}ArialMT;}{\flomajor\f31500\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
{\fdbmajor\f31501\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fhimajor\f31502\fbidi \froman\fcharset0\fprq2{\*\panose 02040503050406030204}Cambria;}
{\fbimajor\f31503\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\flominor\f31504\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
{\fdbminor\f31505\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\fhiminor\f31506\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri{\*\falt Century Gothic};}
{\fbiminor\f31507\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f458\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\f459\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\f461\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\f462\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\f463\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\f464\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\f465\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\f466\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\f468\fbidi \fswiss\fcharset238\fprq2 Arial CE;}{\f469\fbidi \fswiss\fcharset204\fprq2 Arial Cyr;}
{\f471\fbidi \fswiss\fcharset161\fprq2 Arial Greek;}{\f472\fbidi \fswiss\fcharset162\fprq2 Arial Tur;}{\f473\fbidi \fswiss\fcharset177\fprq2 Arial (Hebrew);}{\f474\fbidi \fswiss\fcharset178\fprq2 Arial (Arabic);}
{\f475\fbidi \fswiss\fcharset186\fprq2 Arial Baltic;}{\f476\fbidi \fswiss\fcharset163\fprq2 Arial (Vietnamese);}{\f798\fbidi \froman\fcharset238\fprq2 Cambria Math CE;}{\f799\fbidi \froman\fcharset204\fprq2 Cambria Math Cyr;}
{\f801\fbidi \froman\fcharset161\fprq2 Cambria Math Greek;}{\f802\fbidi \froman\fcharset162\fprq2 Cambria Math Tur;}{\f805\fbidi \froman\fcharset186\fprq2 Cambria Math Baltic;}{\f806\fbidi \froman\fcharset163\fprq2 Cambria Math (Vietnamese);}
{\f818\fbidi \froman\fcharset238\fprq2 Cambria CE;}{\f819\fbidi \froman\fcharset204\fprq2 Cambria Cyr;}{\f821\fbidi \froman\fcharset161\fprq2 Cambria Greek;}{\f822\fbidi \froman\fcharset162\fprq2 Cambria Tur;}
{\f825\fbidi \froman\fcharset186\fprq2 Cambria Baltic;}{\f826\fbidi \froman\fcharset163\fprq2 Cambria (Vietnamese);}{\f828\fbidi \fswiss\fcharset238\fprq2 Calibri CE{\*\falt Century Gothic};}
{\f829\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr{\*\falt Century Gothic};}{\f831\fbidi \fswiss\fcharset161\fprq2 Calibri Greek{\*\falt Century Gothic};}{\f832\fbidi \fswiss\fcharset162\fprq2 Calibri Tur{\*\falt Century Gothic};}
{\f835\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic{\*\falt Century Gothic};}{\f836\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese){\*\falt Century Gothic};}{\f848\fbidi \fswiss\fcharset238\fprq2 Tahoma CE;}
{\f849\fbidi \fswiss\fcharset204\fprq2 Tahoma Cyr;}{\f851\fbidi \fswiss\fcharset161\fprq2 Tahoma Greek;}{\f852\fbidi \fswiss\fcharset162\fprq2 Tahoma Tur;}{\f853\fbidi \fswiss\fcharset177\fprq2 Tahoma (Hebrew);}
{\f854\fbidi \fswiss\fcharset178\fprq2 Tahoma (Arabic);}{\f855\fbidi \fswiss\fcharset186\fprq2 Tahoma Baltic;}{\f856\fbidi \fswiss\fcharset163\fprq2 Tahoma (Vietnamese);}{\f857\fbidi \fswiss\fcharset222\fprq2 Tahoma (Thai);}
{\f858\fbidi \fswiss\fcharset238\fprq2 Verdana CE;}{\f859\fbidi \fswiss\fcharset204\fprq2 Verdana Cyr;}{\f861\fbidi \fswiss\fcharset161\fprq2 Verdana Greek;}{\f862\fbidi \fswiss\fcharset162\fprq2 Verdana Tur;}
{\f865\fbidi \fswiss\fcharset186\fprq2 Verdana Baltic;}{\f866\fbidi \fswiss\fcharset163\fprq2 Verdana (Vietnamese);}{\flomajor\f31508\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\flomajor\f31509\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\flomajor\f31511\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flomajor\f31512\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}
{\flomajor\f31513\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\flomajor\f31514\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flomajor\f31515\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}
{\flomajor\f31516\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fdbmajor\f31518\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbmajor\f31519\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\fdbmajor\f31521\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fdbmajor\f31522\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbmajor\f31523\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\fdbmajor\f31524\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fdbmajor\f31525\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbmajor\f31526\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fhimajor\f31528\fbidi \froman\fcharset238\fprq2 Cambria CE;}{\fhimajor\f31529\fbidi \froman\fcharset204\fprq2 Cambria Cyr;}{\fhimajor\f31531\fbidi \froman\fcharset161\fprq2 Cambria Greek;}{\fhimajor\f31532\fbidi \froman\fcharset162\fprq2 Cambria Tur;}
{\fhimajor\f31535\fbidi \froman\fcharset186\fprq2 Cambria Baltic;}{\fhimajor\f31536\fbidi \froman\fcharset163\fprq2 Cambria (Vietnamese);}{\fbimajor\f31538\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\fbimajor\f31539\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fbimajor\f31541\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fbimajor\f31542\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}
{\fbimajor\f31543\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fbimajor\f31544\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbimajor\f31545\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}
{\fbimajor\f31546\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\flominor\f31548\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\flominor\f31549\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\flominor\f31551\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\flominor\f31552\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\flominor\f31553\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\flominor\f31554\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\flominor\f31555\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\flominor\f31556\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}
{\fdbminor\f31558\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fdbminor\f31559\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\fdbminor\f31561\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}
{\fdbminor\f31562\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fdbminor\f31563\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}{\fdbminor\f31564\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}
{\fdbminor\f31565\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fdbminor\f31566\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\fhiminor\f31568\fbidi \fswiss\fcharset238\fprq2 Calibri CE{\*\falt Century Gothic};}
{\fhiminor\f31569\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr{\*\falt Century Gothic};}{\fhiminor\f31571\fbidi \fswiss\fcharset161\fprq2 Calibri Greek{\*\falt Century Gothic};}
{\fhiminor\f31572\fbidi \fswiss\fcharset162\fprq2 Calibri Tur{\*\falt Century Gothic};}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic{\*\falt Century Gothic};}
{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese){\*\falt Century Gothic};}{\fbiminor\f31578\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}{\fbiminor\f31579\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}
{\fbiminor\f31581\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\fbiminor\f31582\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\fbiminor\f31583\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\fbiminor\f31584\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\fbiminor\f31585\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\fbiminor\f31586\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}}
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{\*\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\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14420608
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs36 \ltrch\fcs0 \b\f1\fs36\cf9\insrsid14119407\charrsid9897198 Bromley }{\rtlch\fcs1 \ab\af1\afs36 \ltrch\fcs0
\b\f1\fs36\cf9\insrsid2056497 Stroke & TIA}{\rtlch\fcs1 \ab\af1\afs36 \ltrch\fcs0 \b\f1\fs36\cf9\insrsid9897198\charrsid9897198 Service}{\rtlch\fcs1 \ab\af1\afs36 \ltrch\fcs0 \b\f1\fs36\cf9\insrsid9265347\charrsid9897198 Referral Form}{\rtlch\fcs1
\ab\af1\afs36 \ltrch\fcs0 \b\f1\fs36\cf9\insrsid13572623\charrsid9897198
\par }\pard \ltrpar\qc \li0\ri0\sb120\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8472773 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \f1\fs22\cf6\insrsid13572623\charrsid2433791 This document contains merged data which appears in
}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \f1\fs22\cf6\insrsid14420608\charrsid2433791 the red framed table at the bottom of the form}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \f1\fs22\cf6\insrsid13572623\charrsid2433791
. Please ensure that irrelevant data is removed.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid15291990 {\rtlch\fcs1 \af1\afs8 \ltrch\fcs0 \f1\fs8\cf9\insrsid15291990\charrsid3036625
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clcbpatraw9 \cellx9984\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9897198\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid15291990\charrsid11601829 Patient Details\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9
\trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clcbpatraw9 \cellx9984\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9
\trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth1149\clshdrawnil \cellx1041\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth3974\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9
\cltxlrtb\clftsWidth3\clwWidth4969\clshdrawnil \cellx9984\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 Title: {\*\bkmkstart P77CBgMt6MadqGTSvqrh}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid11141358\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid11141358\charrsid2433791 {\*\datafield 0002000014000000145037374342674d74364d6164714754537671726800000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P77CBgMt6MadqGTSvqrh}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid11141358\charrsid2433791 Title}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid11141358\charrsid2433791 {\*\bkmkend P77CBgMt6MadqGTSvqrh} }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 First Name: {\*\bkmkstart PxLIbS4MajewWqplMJvs}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 00020000140000001450784c496253344d616a65775771706c4d4a767300000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PxLIbS4MajewWqplMJvs}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Given Name}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend PxLIbS4MajewWqplMJvs} }{\rtlch\fcs1 \ab\af1\afs20
\ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell Surname: {\*\bkmkstart PPRrsOd6EsyVDMcjocQr}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20
\ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 00020000140000001450505272734f643645737956444d636a6f63517200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PPRrsOd6EsyVDMcjocQr}}}}}{\fldrslt {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Surname}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend PPRrsOd6EsyVDMcjocQr} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829
\trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth1149\clshdrawnil \cellx1041\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth3974\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9
\cltxlrtb\clftsWidth3\clwWidth4969\clshdrawnil \cellx9984\row \ltrrow}\trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9
\trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth5123\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth1957\clshdrawnil \cellx6972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9
\cltxlrtb\clftsWidth3\clwWidth1365\clshdrawnil \cellx8337\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth1647\clshdrawnil \cellx9984
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid15291990\charrsid2433791 NHS Number: {\*\bkmkstart PXo1AAb75vrKMuWxuccm}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 00020000140000001450586f31414162373576724b4d7557787563636d00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PXo1AAb75vrKMuWxuccm}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 NHS Number}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend PXo1AAb75vrKMuWxuccm} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell Date of Birth: {\*\bkmkstart PnVG5GtxCuIhSUdidEXB}}{\field\fldedit{\*\fldinst {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield
000200001400000014506e56473547747843754968535564696445584200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PnVG5GtxCuIhSUdidEXB}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 Date of Birth}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791
{\*\bkmkend PnVG5GtxCuIhSUdidEXB} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell Gender: {\*\bkmkstart Pv1JdXIjMrdod8hFkxGd}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 0002000014000000145076314a6458496a4d72646f643868466b78476400000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pv1JdXIjMrdod8hFkxGd}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Gender}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend Pv1JdXIjMrdod8hFkxGd} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell Age: {\*\bkmkstart P2kyKCjk5DIuml9g63mG}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 00020000140000001450326b794b436a6b354449756d6c396736336d4700000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P2kyKCjk5DIuml9g63mG}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Age}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend P2kyKCjk5DIuml9g63mG} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829
\trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth5123\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth1957\clshdrawnil \cellx6972\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9
\cltxlrtb\clftsWidth3\clwWidth1365\clshdrawnil \cellx8337\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth1647\clshdrawnil \cellx9984\row
\ltrrow}\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clshdrawnil \cellx9984\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 Address: {\*\bkmkstart P5ynB7ubjEbU2e7H4TJu}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield
0002000014000000145035796e423775626a4562553265374834544a7500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P5ynB7ubjEbU2e7H4TJu}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 Home Full Address (single line)}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend P5ynB7ubjEbU2e7H4TJu} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829
\trowd \irow3\irowband3\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clshdrawnil \cellx9984\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid15291990\charrsid2433791 Telephone: (Home)}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkstart PsYR47oUxN8cQCPDNkcv}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 0002000014000000145073595234376f55784e3863514350444e6b637600000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PsYR47oUxN8cQCPDNkcv}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Patient Home Telephone}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend PsYR47oUxN8cQCPDNkcv} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid15291990\charrsid2433791 (Mobile) {\*\bkmkstart PVbKGlgqgWaQynq8HY7z}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20
\ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 0002000014000000145056624b476c677167576151796e71384859377a00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PVbKGlgqgWaQynq8HY7z}}}}}{\fldrslt {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Patient Mobile Telephone}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend PVbKGlgqgWaQynq8HY7z} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829
\trowd \irow4\irowband4\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clshdrawnil \cellx9984\row \ltrrow}\trowd \irow5\irowband5\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl
\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clcbpatraw9 \cellx9984\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9897198\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid15291990\charrsid11601829 Referral Details\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829 \trowd \irow5\irowband5\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9
\trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clcbpatraw9 \cellx9984\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9
\trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth5123\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth4969\clshdrawnil \cellx9984\pard\plain \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 Date of Referral}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3036625\charrsid2433791
{\*\bkmkstart dH1tFCIqrHOIKxAtnhRG}:}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791
\par {\*\bkmkstart dlnoaZyWIAooDfazAtYI}{\*\bkmkend dH1tFCIqrHOIKxAtnhRG}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 000200001400000014646c6e6f615a795749416f6f4466617a4174594900000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname dlnoaZyWIAooDfazAtYI}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Short date letter merged}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend dlnoaZyWIAooDfazAtYI} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell Form Completed By: {\*\bkmkstart uZgxEVTX4nodihXGpQcm}}{\field\fldedit{\*\fldinst {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield
000200001400000014755a677845565458346e6f64696858477051636d00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname uZgxEVTX4nodihXGpQcm}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 Current User}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791
{\*\bkmkend uZgxEVTX4nodihXGpQcm} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791
\par Referring GP (If form completed on GP's behalf):}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid11032477\charrsid2433791 {\*\bkmkstart FvOSrTXoWEE2mgMM8SqS}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid11032477\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid11032477\charrsid2433791 {\*\datafield 00020000140000001446764f537254586f574545326d674d4d3853715300000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname FvOSrTXoWEE2mgMM8SqS}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid11032477\charrsid2433791 Free Text Prompt}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid11032477\charrsid2433791 {\*\bkmkend FvOSrTXoWEE2mgMM8SqS} }{\rtlch\fcs1 \ab\af1\afs20
\ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 {\*\bkmkstart Text35}}{\field\flddirty{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid16524986\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid16524986\charrsid2433791 {\*\datafield 00000000140000000654657874333500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text35}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\lang1024\langfe1024\noproof\insrsid16524986\charrsid2433791 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15291990\charrsid2433791 {\*\bkmkend Text35}\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025
\ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829 \trowd \irow6\irowband6\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl
\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth5123\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth4969\clshdrawnil \cellx9984\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 {\*\bkmkstart\bkmkcolf0\bkmkcoll1 OI3p5kcqpxDbGvAnJDDo}Surgery: {\*\bkmkstart OzYalfOcfINu3Nd9jKIH}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield
0002000014000000144f7a59616c664f6366494e75334e64396a4b494800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OzYalfOcfINu3Nd9jKIH}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 Organisation Name}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend OzYalfOcfINu3Nd9jKIH} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell National Practice Code: {\*\bkmkstart OS3UtH2CLOzncq9fOCC7}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield
0002000014000000144f533355744832434c4f7a6e637139664f43433700000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OS3UtH2CLOzncq9fOCC7}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 Organisation National Practice Code}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend OS3UtH2CLOzncq9fOCC7} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829
\trowd \irow7\irowband7\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth5123\clshdrawnil \cellx5015\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth4969\clshdrawnil \cellx9984\row \ltrrow}\trowd \irow8\irowband8\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr
\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil \cellx6300\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth3684\clshdrawnil \cellx9984\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3036625\charrsid2433791 {\*\bkmkend OI3p5kcqpxDbGvAnJDDo}Address: {\*\bkmkstart OIimXzDEWkX5pULOf7Tj}}{\field\fldedit{\*\fldinst {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid3036625\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid3036625\charrsid2433791 {\*\datafield
0002000014000000144f49696d587a4445576b583570554c4f6637546a00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OIimXzDEWkX5pULOf7Tj}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid3036625\charrsid2433791 Organisation Full Address (single line)}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid3036625\charrsid2433791 {\*\bkmkend OIimXzDEWkX5pULOf7Tj} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3036625\charrsid2433791 \cell Telephone: {\*\bkmkstart OVPmb7epqVT5vxbQkOWP}}{\field\fldedit{\*\fldinst {
\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid3036625\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid3036625\charrsid2433791 {\*\datafield
0002000014000000144f56506d6237657071565435767862516b4f575000000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OVPmb7epqVT5vxbQkOWP}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid3036625\charrsid2433791 Organisation Telephone Number}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid3036625\charrsid2433791 {\*\bkmkend OVPmb7epqVT5vxbQkOWP} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3036625\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid3036625\charrsid11601829
\trowd \irow8\irowband8\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil \cellx6300\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth3684\clshdrawnil \cellx9984\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 Email: {\*\bkmkstart OlqSbg65mtLiplCXqaeA}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 0002000014000000144f6c7153626736356d744c69706c43587161654100000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OlqSbg65mtLiplCXqaeA}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Organisation E-mail Address}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend OlqSbg65mtLiplCXqaeA} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell Fax: {\*\bkmkstart OpNQUWNxSb3GCLI4Ejar}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 FORMTEXT }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\datafield 0002000014000000144f704e5155574e7853623347434c4934456a617200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OpNQUWNxSb3GCLI4Ejar}}}}}{\fldrslt {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f1\fs20\cf9\insrsid15948638\charrsid2433791 Organisation Fax Number}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf9\insrsid15948638\charrsid2433791 {\*\bkmkend OpNQUWNxSb3GCLI4Ejar} }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid15291990\charrsid2433791 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \fs20\cf9\insrsid15291990\charrsid11601829
\trowd \irow9\irowband9\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt85\trpaddb57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth6408\clshdrawnil \cellx6300\clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr
\brdrs\brdrw10\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth3684\clshdrawnil \cellx9984\row }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9597011 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8743519
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\abslock255\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2243483 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid4149718 \sect }\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\sectunlocked1\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj \ltrrow\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb
\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-80\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2243483\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9
\cellx9984\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpara\phmrg\posnegy-80\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2243483\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid7363166 About this Form}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid2321533\charrsid11601829 \cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf9\insrsid2321533\charrsid11601829 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9
\trbrdrv\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-80\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2243483\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9
\cellx9984\row \ltrrow}\trowd \irow1\irowband1\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv
\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-80\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2243483\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx9984
\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\pvpara\phmrg\posnegy-80\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2433791\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid7363166\charrsid12912433 This form should be used for all referrals }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid3632912 to Princess Royal University Hospital }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid14290474\charrsid12912433
where stroke or transient ischaemic attack is suspected.}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid14290474\charrsid12912433 Unless given}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid3632912
directly to ambulance staff, this form}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\lang2057\langfe1033\langfenp1033\insrsid14290474\charrsid12912433 should be emailed to }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0
\f42\fs18\cf2\insrsid14290474\charrsid14290474 HYPERLINK "mailto:kch-tr.pruh}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf2\insrsid14290474\charrsid14290474 -}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf2\insrsid14290474\charrsid14290474
tia@nhs.net" }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf2\insrsid1204811\charrsid14290474 {\*\datafield
00d0c9ea79f9bace118c8200aa004ba90b0200000003000000e0c9ea79f9bace118c8200aa004ba90b560000006d00610069006c0074006f003a006b00630068002d00740072002e0070007200750068002d0074006900610040006e00680073002e006e00650074000000795881f43b1d7f48af2c825dc485276300000000
a5ab000100000000000000d8000063}}}{\fldrslt {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \cs22\f42\fs18\ul\cf2\insrsid14290474\charrsid14290474 kch-tr.pruh}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \cs22\f1\fs18\ul\cf2\insrsid14290474\charrsid14290474 -}{\rtlch\fcs1
\af42\afs18 \ltrch\fcs0 \cs22\f42\fs18\ul\cf2\insrsid14290474\charrsid14290474 tia@nhs.net}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\sectunlocked1\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\f1\fs20\cf17\lang2057\langfe1033\highlight7\langfenp1033\insrsid2433791\charrsid14290474 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025
\ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\cf9\insrsid2321533\charrsid11601829 \trowd \irow1\irowband1\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl
\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-80\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2243483\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx9984\row
\ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv
\brdrs\brdrw10\brdrcf9 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2433791\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt
\brdrs\brdrw10\brdrcf9 \clbrdrl\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clcbpatraw9 \cellx9984\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid2433791\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs26 \ltrch\fcs0
\b\f1\fs26\cf8\insrsid2433791\charrsid14420608 Please }{\rtlch\fcs1 \ab\af1\afs26 \ltrch\fcs0 \b\f1\fs26\cf8\insrsid2433791\charrsid12912433 complete sections }{\rtlch\fcs1 \ab\af1\afs26 \ltrch\fcs0 \b\f1\fs26\cf8\insrsid12912433 1 to 5}{\rtlch\fcs1
\ab\af1\afs26 \ltrch\fcs0 \b\f1\fs26\cf8\insrsid2433791\charrsid12912433 for all patients}{\rtlch\fcs1 \ab\af1\afs26 \ltrch\fcs0 \b\f1\fs26\cf8\insrsid2433791\charrsid14420608 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf9\insrsid2433791\charrsid11601829
\trowd \irow0\irowband0\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw10\brdrcf9 \trbrdrl\brdrs\brdrw10\brdrcf9 \trbrdrb\brdrs\brdrw10\brdrcf9 \trbrdrr\brdrs\brdrw10\brdrcf9 \trbrdrh\brdrs\brdrw10\brdrcf9 \trbrdrv\brdrs\brdrw10\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid2433791\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw10\brdrcf9 \clbrdrl
\brdrs\brdrw10\brdrcf9 \clbrdrb\brdrs\brdrw10\brdrcf9 \clbrdrr\brdrs\brdrw10\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clcbpatraw9 \cellx9984\row }\pard \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid9597011 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid2433791\charrsid9597011
\par {\listtext\pard\plain\ltrpar \rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\f1\cf8\insrsid4149718 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ltrpar\ql \fi-540\li1\ri0\widctlpar
\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\itap0\pararsid14360743 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid4149718 \sect }\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj \ltrrow\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9
\trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9 \cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0 \ltrch\fcs0
\b\f1\cf8\insrsid3491992 \hich\af1\dbch\af0\loch\f1 1.\tab}\pard\plain \ltrpar\ql \fi-540\li1\ri0\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\pararsid14360743\yts23 \rtlch\fcs1 \af0\afs24\alang1025
\ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid3491992 1}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid3491992\charrsid3491992 . Special Requirements}{\rtlch\fcs1 \ab\af1
\ltrch\fcs0 \b\f1\cf8\insrsid9597011\charrsid11601829 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf9\insrsid9597011\charrsid11601829 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9
\trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9 \cellx9984\row \ltrrow}\trowd \irow1\irowband1\lastrow \ltrrow
\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs22 \ltrch\fcs0
\b\f1\fs22\cf9\insrsid3491992\charrsid3491992 \hich\af1\dbch\af0\loch\f1 2.\tab}\pard\plain \ltrpar\ql \fi-539\li0\ri0\sb60\sa60\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin0\pararsid14360743\yts23 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs22 \ltrch\fcs0 \b\f1\fs22\cf9\insrsid3491992\charrsid3491992 \tab }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 010000001400000007436865636b333400000000000000000000000000}
{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check34}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 Patient is immobile\tab \tab }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 010000001400000007436865636b333400000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check34}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 Patient requires hoist
\par {\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 \hich\af1\dbch\af0\loch\f1 3.\tab}\tab }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 010000001400000007436865636b333400000000000000000000000000}
{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check34}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 Patient Transport\tab \tab }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 010000001400000007436865636b333300000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check33}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 Translator (Language?) }{\field\flddirty{\*\fldinst {\rtlch\fcs1
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMTEXT }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 00000000140000000654657874323900000000000000000000000000}
{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text29}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\lang1024\langfe1024\noproof\insrsid3491992\charrsid3491992 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect
\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 \tab }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20
\ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 010000001400000007436865636b333500000000000000000000000000}
{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check35}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 Other }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid3491992 FORMTEXT }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid3491992 {\*\datafield 00000000140000000654657874333000000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text30}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\lang1024\langfe1024\noproof\insrsid3491992\charrsid3491992 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj {\rtlch\fcs1
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid9597011\charrsid2321533 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf9\insrsid9597011\charrsid11601829 \trowd \irow1\irowband1\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl
\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx9984\row {\listtext\pard\plain\ltrpar \rtlch\fcs1 \ab\af0 \ltrch\fcs0
\b\f1\cf8\insrsid4149718 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ltrpar\ql \fi-540\li1\ri0\widctlpar\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\itap0\pararsid14360743 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid4149718 \sect }\sectd \ltrsect\sbknone\linex0\headery709\footery709\endnhere\sectunlocked1\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj \ltrrow\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9
\trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9 \cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0 \ltrch\fcs0
\b\f1\cf8\insrsid9597011\charrsid11601829 \hich\af1\dbch\af0\loch\f1 4.\tab}\pard\plain \ltrpar\ql \fi-540\li1\ri0\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\pararsid14360743\yts23 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid9597011\charrsid11601829 2. }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid3491992 Clinical History }{
\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf8\insrsid3491992\charrsid3491992 (You may alternatively attach relevant consultation notes at section}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf8\insrsid12142071 5.}{\rtlch\fcs1 \ab\af1\afs18
\ltrch\fcs0 \b\f1\fs18\cf8\insrsid3491992\charrsid3491992 )}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid9597011\charrsid11601829 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf9\insrsid9597011\charrsid11601829
\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9 \cellx9984\row \ltrrow}\trowd \irow1\irowband1\ltrrow
\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth2448\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx2340\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9
\clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth7644\clshdrawnil \cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 \hich\af1\dbch\af0\loch\f1 5.
\tab}\pard\plain \ltrpar\ql \fi-539\li0\ri0\sb60\sa60\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin0\pararsid14360743\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 Description of symptoms}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \cell {\listtext
\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \hich\af1\dbch\af0\loch\f1 6.\tab}\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \trowd \irow1\irowband1\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh
\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth2448\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx2340\clvertalt\clbrdrt
\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth7644\clshdrawnil \cellx9984\row \ltrrow{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20
\ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 \hich\af1\dbch\af0\loch\f1 7.\tab}}\pard\plain \ltrpar\ql \fi-539\li0\ri0\sb60\sa60\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin0\pararsid14360743\yts23 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 Duration of symptoms (to complete resolution)}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \cell {\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \hich\af1\dbch\af0\loch\f1 8.\tab}\cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \trowd \irow2\irowband2\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh
\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth2448\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx2340\clvertalt\clbrdrt
\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth7644\clshdrawnil \cellx9984\row \ltrrow{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20
\ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 \hich\af1\dbch\af0\loch\f1 9.\tab}}\pard\plain \ltrpar\ql \fi-539\li0\ri0\sb60\sa60\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin0\pararsid14360743\yts23 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 When did episode(s) occur?}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \cell {\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \hich\af1\dbch\af0\loch\f1 10.\tab}\cell }\pard\plain \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992\charrsid2321533 \trowd \irow3\irowband3\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh
\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth2448\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx2340\clvertalt\clbrdrt
\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth7644\clshdrawnil \cellx9984\row {\listtext\pard\plain\ltrpar \rtlch\fcs1 \ab\af0 \ltrch\fcs0
\b\f1\cf8\insrsid4149718 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ltrpar\ql \fi-540\li1\ri0\widctlpar\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\itap0\pararsid14360743 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid4149718 \sect }\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj \ltrrow\trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9
\trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9 \cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0 \ltrch\fcs0
\b\f1\cf8\insrsid5197885 \hich\af1\dbch\af0\loch\f1 11.\tab}\pard\plain \ltrpar\ql \fi-540\li1\ri0\widctlpar\intbl\jclisttab\tx1\wrapdefault\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\pararsid14360743\yts23 \rtlch\fcs1 \af0\afs24\alang1025
\ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid5197885 3. Consider Alternative Diagnoses}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid3491992 . }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid3491992\charrsid11601829 \cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf9\insrsid3491992\charrsid11601829 \trowd \irow0\irowband0\ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9
\trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid3491992\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9 \cellx9984\row \ltrrow}\trowd \irow1\irowband1\lastrow \ltrrow
\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl
\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx9984\pard\plain \ltrpar
\ql \li1\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1\pararsid3491992\yts23 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid3491992 Isolated dizziness, isolated vertigo without cranial nerve signs, confusion without dysphasia, amnesia, bilateral sensation loss, seizures, loss of consciousness are UNLIK}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf9\insrsid543360 E}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 LY to be symptoms of stroke or TIA so you should consider alternative diagnoses and/or referral pathways.
\par }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3491992
\par }\pard \ltrpar\ql \li1\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin1\pararsid5197885\yts23 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3491992\charrsid3491992 FORMCHECKBOX }{
\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3491992\charrsid3491992 {\*\datafield 010000001400000007436865636b343000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check40}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\insrsid3491992\charrsid3491992 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\insrsid3491992 }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid3491992 Please acknowledge that you have read this advice before proceeding.}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf9\insrsid5197885\charrsid5197885
\cell }\pard\plain \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1
\ltrch\fcs0 \b\f1\cf9\insrsid3491992\charrsid11601829 \trowd \irow1\irowband1\lastrow \ltrrow\ts23\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh
\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9 \trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clshdrawnil \cellx9984\row }\pard \ltrpar
\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\insrsid14818572 \page }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\insrsid5180280
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv
\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-60\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9
\cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\f1\cf8\insrsid5197885\charrsid5197885 \hich\af1\dbch\af0\loch\f1 12.\tab}\pard \ltrpar\ql \fi-540\li1\ri0\widctlpar\intbl
\jclisttab\tx1\pvpara\phmrg\posnegy-60\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\ls2\adjustright\rin0\lin1\pararsid14360743 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid5197885\charrsid5197885 4. }{\rtlch\fcs1 \ab\af1
\ltrch\fcs0 \b\f1\cf8\insrsid5197885 Risk S}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid5197885\charrsid5197885 tratif}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid5197885 ication}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid5197885\charrsid5197885 . }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf8\insrsid5197885\charrsid5197885 (Please }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf8\insrsid5197885 follow the flow chart below and }{\rtlch\fcs1
\ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf8\insrsid5197885\charrsid5197885 complete the relevant checkboxes)}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid5197885\charrsid5197885 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid5197885\charrsid5197885 \trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl
\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-60\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9
\cellx9984\row \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph108\trrh1760\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6353\clshdrawnil\clhidemark \cellx6245\pard \ltrpar\qj \li0\ri0\sl360\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5180280 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid14696621 Indicate symptoms present}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf18\insrsid5180280\charrsid15211884
\par }\pard \ltrpar\qj \li0\ri0\sa60\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884
FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 {\*\datafield 650000001400000007436865636b343000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check40}\ffdefres0}}
}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 Loss of Power \endash
arm, leg or face Which side? }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 FORMDROPDOWN }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf18\insrsid5180280\charrsid15211884 {\*\datafield 668000001400000000000000000000000000000000001f000300030000000a00060014001a000d506c656173652073656c656374055269676874044c656674}{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20
\ffdefres0{\*\ffl Please select}{\*\ffl Right}{\*\ffl Left}}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf18\insrsid5180280\charrsid15211884
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid14360743 {\shp{\*\shpinst\shpleft8403\shptop657\shpright10522\shpbottom3854\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz3\shplid1026
{\sp{\sn shapeType}{\sv 176}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lTxid}{\sv 65536}}{\sp{\sn hspNext}{\sv 1026}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}
{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 255}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251652608}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar
\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5180280 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af1\afs20
\ltrch\fcs0 \b\f1\fs20\cf6\insrsid5180280\charrsid14696621 Emergency!
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid5180280\charrsid14696621
\par Call emergency ambulance.
\par Give this form to the ambulance crew, or email it if patient is not present e.g. following a telephone consultation.
\par }}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8195\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5180280 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid5180280\charrsid14696621 Emergency!
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid5180280\charrsid14696621
\par Call emergency ambulance.
\par Give this form to the ambulance crew, or email it if patient is not present e.g. following a telephone consultation.
\par }}\dpx8403\dpy657\dpxsize2119\dpysize3197\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor255\dplinecog0\dplinecob0}}}
{\shp{\*\shpinst\shpleft1377\shptop2096\shpright4977\shpbottom3293\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz0\shplid1027{\sp{\sn shapeType}{\sv 110}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 131072}}{\sp{\sn hspNext}{\sv 1027}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251649536}}
{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid3491992\charrsid15211884 Symptoms are still present
\par }}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8192\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid3491992\charrsid15211884 Symptoms are still present
\par }}\dpx1377\dpy2096\dpxsize3600\dpysize1197\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}
{\shp{\*\shpinst\shpleft-82\shptop3771\shpright6415\shpbottom4986\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz1\shplid1028{\sp{\sn shapeType}{\sv 110}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 196608}}{\sp{\sn hspNext}{\sv 1028}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251650560}}
{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar\qc \li357\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0\pararsid5724143
\rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\lang1033\langfe2057\langnp1033\insrsid5724143\charrsid15211884 Patient in AF or on an anticoagulant
\par }}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8193\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\qc \li357\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0\pararsid5724143 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\lang1033\langfe2057\langnp1033\insrsid5724143\charrsid15211884 Patient in AF or on an anticoagulant
\par }}\dpx-82\dpy3771\dpxsize6497\dpysize1215\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}
{\shp{\*\shpinst\shpleft3166\shptop3291\shpright3174\shpbottom3779\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz2\shplid1029{\sp{\sn shapeType}{\sv 0}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn geoLeft}{\sv 0}}{\sp{\sn geoTop}{\sv 0}}{\sp{\sn geoRight}{\sv 8}}{\sp{\sn geoBottom}{\sv 488}}{\sp{\sn pVerticies}{\sv 8;2;(0,0);(8,488)}}{\sp{\sn pSegmentInfo}{\sv 2;4;16384;44032;1;32768}}{\sp{\sn fillOpacity}{\sv 65536}}
{\sp{\sn fillBackOpacity}{\sv 65536}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}
{\sp{\sn lineBackColor}{\sv 16777215}}{\sp{\sn lineType}{\sv 0}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn lidRegroup}{\sv 0}}
{\sp{\sn posrelh}{\sv 2}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251651584}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8194\dppolyline\dppolycount2
\dpptx0\dppty0\dpptx8\dppty488\dpx3166\dpy3291\dpxsize8\dpysize488\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\field\flddirty\fldpriv{\*\fldinst {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 {\*\datafield
010000001400000007436865636b333900000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check39}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 Loss or slurring of Speech
\par }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 {\*\datafield
010000001400000007436865636b343100000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check41}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 Loss of vision / Double Vision
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid14360743 {\shp{\*\shpinst\shpleft3174\shptop1742\shpright3180\shpbottom2096\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz5\shplid1030
{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn posrelv}{\sv 1}}
{\sp{\sn dhgt}{\sv 251654656}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8197\dppolyline\dppolycount2\dpptx6\dppty0\dpptx0\dppty354
\dpx3174\dpy1742\dpxsize6\dpysize354\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf18\insrsid5180280\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 {\*\datafield 010000001400000007436865636b343500000000000000000000000000}
{\*\formfield{\fftype1\fftypetxt0\ffhps20{\*\ffname Check45}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf18\insrsid5180280\charrsid15211884 Unilateral Loss of Sensation Which side? }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 FORMDROPDOWN }{\rtlch\fcs1
\ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\insrsid5180280\charrsid15211884 {\*\datafield 668000001400000000000000000000000000000000001f000300030000000a00060014001a000d506c656173652073656c656374055269676874044c656674}
{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20\ffdefres0{\*\ffl Please select}{\*\ffl Right}{\*\ffl Left}}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf18\insrsid5180280\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5180280\charrsid15211884 \trowd \irow0\irowband0\ltrrow
\ts11\trgaph108\trrh1760\trleft-108\trbrdrt\brdrs\brdrw10 \trbrdrl\brdrs\brdrw10 \trbrdrb\brdrs\brdrw10 \trbrdrr\brdrs\brdrw10 \trbrdrh\brdrs\brdrw10 \trbrdrv\brdrs\brdrw10
\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddt57\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalb\clbrdrt\brdrs\brdrw10 \clbrdrl
\brdrs\brdrw10 \clbrdrb\brdrs\brdrw10 \clbrdrr\brdrs\brdrw10 \cltxlrtb\clftsWidth3\clwWidth6353\clshdrawnil\clhidemark \cellx6245\row \ltrrow}\trowd \irow1\irowband1\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trwWidthA5161\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1192\clshdrawnil\clhidemark \cellx1084\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884 \trowd \irow1\irowband1\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trwWidthA5161\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1192\clshdrawnil\clhidemark \cellx1084\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx5677\tposy3\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3
\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072
\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\pvpara\phpg\posx5677\posy3\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \af0 \ltrch\fcs0
\lang1024\langfe1024\noproof\insrsid14360743 {\shp{\*\shpinst\shpleft199\shptop399\shpright3605\shpbottom399\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz7\shplid1031
{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn posrelv}{\sv 1}}
{\sp{\sn dhgt}{\sv 251656704}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8199\dppolyline\dppolycount2\dpptx0\dppty0\dpptx3406\dppty0
\dpx199\dpy399\dpxsize3406\dpysize0\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf18\insrsid5197885\charrsid15211884 Yes }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\cf18\insrsid5197885\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx5677\tposy3\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3
\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072
\row }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5180280 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf18\insrsid5180280\charrsid15211884
\par
\par }\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4291490 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid4291490\charrsid15211884
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft3266\trftsWidth3\trwWidth932\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind3381\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth932\clshdrawnil\clhidemark \cellx4198\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf18\insrsid5197885\charrsid15211884 No }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\cf18\insrsid5197885\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}
}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884
\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft3266\trftsWidth3\trwWidth932\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind3381\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth932\clshdrawnil\clhidemark \cellx4198\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx7185\tposy98\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1187\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\pvpara\phpg\posx7185\posy98\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf18\insrsid5197885\charrsid15211884 Yes }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 {\*\datafield
01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1
\af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx7185\tposy98\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1187\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072\row }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5180280 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf18\insrsid5180280\charrsid15211884
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\trftsWidth3\trwWidth1187\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4291490\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid4291490 {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid14360743
{\shp{\*\shpinst\shpleft8373\shptop38\shpright10516\shpbottom7421\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz11\shplid1032{\sp{\sn shapeType}{\sv 109}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 262144}}{\sp{\sn hspNext}{\sv 1032}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 812276}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251660800}}
{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2058683 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid3632912
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2058683\charrsid14696621 HIGH RISK \endash URGENT
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2058683 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf19\insrsid2058683\charrsid14696621
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2058683\charrsid3632912 Refer for urgent assessment }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\cf19\insrsid2058683\charrsid3632912 today}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf19\insrsid2058683\charrsid3632912 .
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364\charrsid2380364 Weekdays }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3360424 9am \endash 9}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0
\b\f1\fs16\cf19\insrsid2058683\charrsid2380364 pm}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364 Bleep the Registrar
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid3360424 PRUH: 01689 863 000 Bleep 195}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364
\par
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3360424 9pm \endash 9}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364\charrsid2380364 am}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364 &}{\rtlch\fcs1
\af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364\charrsid2380364 Weekends
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364\charrsid2380364 Do not call}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364 (give this form to the patient or ambulance crew, to take to}{\rtlch\fcs1 \af1\afs16
\ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364 E}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364\charrsid2380364 D}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364 )}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0
\f1\fs16\cf19\insrsid2058683\charrsid2380364
\par
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2380364\charrsid3632912 Advise the Patient }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2058683\charrsid3632912
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364
\par They should not drive until assessed at the hospital or clinic.
\par
\par If there was a witness to the event they should accompany them to the appointment.
\par
\par If they experience any further events they should call 999. }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf20\insrsid2058683\charrsid2380364
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf20\insrsid2058683\charrsid14696621
\par }}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8203\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2058683 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid3632912
\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2058683\charrsid14696621 HIGH RISK \endash URGENT
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2058683 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf19\insrsid2058683\charrsid14696621
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2058683\charrsid3632912 Refer for urgent assessment }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\ul\cf19\insrsid2058683\charrsid3632912 today}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf19\insrsid2058683\charrsid3632912 .
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364\charrsid2380364 Weekdays }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3360424 9am \endash 9}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0
\b\f1\fs16\cf19\insrsid2058683\charrsid2380364 pm}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364 Bleep the Registrar
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid3360424 PRUH: 01689 863 000 Bleep 195}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364
\par
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid3360424 9pm \endash 9}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364\charrsid2380364 am}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364 &}{\rtlch\fcs1
\af1\afs16 \ltrch\fcs0 \b\f1\fs16\cf19\insrsid2380364\charrsid2380364 Weekends
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364\charrsid2380364 Do not call}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364 (give this form to the patient or ambulance crew, to take to}{\rtlch\fcs1 \af1\afs16
\ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364 E}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364\charrsid2380364 D}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2380364 )}{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0
\f1\fs16\cf19\insrsid2058683\charrsid2380364
\par
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid3632912
\par }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2380364\charrsid3632912 Advise the Patient }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf19\insrsid2058683\charrsid3632912
\par }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf19\insrsid2058683\charrsid2380364
\par They should not drive until assessed at the hospital or clinic.
\par
\par If there was a witness to the event they should accompany them to the appointment.
\par
\par If they experience any further events they should call 999. }{\rtlch\fcs1 \af1\afs16 \ltrch\fcs0 \f1\fs16\cf20\insrsid2058683\charrsid2380364
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf20\insrsid2058683\charrsid14696621
\par }}\dpx8373\dpy38\dpxsize2143\dpysize7383\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor244\dplinecog100\dplinecob12}}}
{\shp{\*\shpinst\shpleft6415\shptop127\shpright8413\shpbottom127\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz6\shplid1033{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251655680}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}
{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8198\dppolyline\dppolycount2\dpptx0\dppty0\dpptx1998\dppty0\dpx6415\dpy127\dpxsize1998\dpysize0
\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5180280\charrsid15211884 \cell }\pard \ltrpar
\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5180280\charrsid15211884
\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\trftsWidth3\trwWidth1187\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4291490\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh257\trleft-115\tpvpara\tphpg\tposx4309\tposnegy-215\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1200\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid12395322\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1200\clshdrawnil\clhidemark \cellx1085\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\pvpara\phpg\posx4309\posnegy-215\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\absnoovrlp1\pararsid12395322 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf18\insrsid4291490\charrsid15211884 No }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid4291490\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\cf18\insrsid4291490\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid4291490\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid4291490\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh257\trleft-115\tpvpara\tphpg\tposx4309\tposnegy-215\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1200\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tabsnoovrlp1\tblrsid12395322\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1200\clshdrawnil\clhidemark \cellx1085\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh257\trleft-115\tpvpara\tphpg\tposx4310\tposy407\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1200\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1200\clshdrawnil\clhidemark \cellx1085\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\pvpara\phpg\posx4310\posy407\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf18\insrsid5197885\charrsid15211884 No }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 {\*\datafield
01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1
\af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh257\trleft-115\tpvpara\tphpg\tposx4310\tposy407\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1200\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1200\clshdrawnil\clhidemark \cellx1085\row }\pard \ltrpar\ql \li-547\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin-547\itap0\pararsid5180280 {\rtlch\fcs1 \af0 \ltrch\fcs0
\lang1024\langfe1024\noproof\insrsid14360743 {\shp{\*\shpinst\shpleft3180\shptop6432\shpright3180\shpbottom6803\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz16\shplid1034
{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn fAutoTextMargin}{\sv 0}}{\sp{\sn fRotateText}{\sv 0}}{\sp{\sn fFitShapeToText}{\sv 0}}
{\sp{\sn fFitTextToShape}{\sv 0}}{\sp{\sn fColumnLineOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLineUseShapeAnchor}{\sv 0}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fHitTestLine}{\sv 1}}{\sp{\sn lineFillShape}{\sv 1}}
{\sp{\sn fShadow}{\sv 0}}{\sp{\sn fshadowObscured}{\sv 0}}{\sp{\sn f3D}{\sv 0}}{\sp{\sn fc3DMetallic}{\sv 0}}{\sp{\sn fc3DUseExtrusionColor}{\sv 0}}{\sp{\sn fc3DLightFace}{\sv 1}}{\sp{\sn fc3DConstrainRotation}{\sv 1}}
{\sp{\sn fc3DRotationCenterAuto}{\sv 0}}{\sp{\sn fc3DParallel}{\sv 1}}{\sp{\sn fc3DKeyHarsh}{\sv 1}}{\sp{\sn fc3DFillHarsh}{\sv 0}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn fCalloutMinusX}{\sv 0}}{\sp{\sn fCalloutMinusY}{\sv 0}}{\sp{\sn fCalloutDropAuto}{\sv 0}}
{\sp{\sn fCalloutLengthSpecified}{\sv 0}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251665920}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fAllowOverlap}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLeftInsetPen}{\sv 0}}{\sp{\sn fLeftLine}{\sv 0}}
{\sp{\sn fLeftHitTestLine}{\sv 1}}{\sp{\sn lineLeftFillShape}{\sv 1}}{\sp{\sn fTopInsetPen}{\sv 0}}{\sp{\sn fTopLine}{\sv 0}}{\sp{\sn fTopHitTestLine}{\sv 1}}{\sp{\sn lineTopFillShape}{\sv 1}}{\sp{\sn fRightInsetPen}{\sv 0}}
{\sp{\sn fRightLine}{\sv 0}}{\sp{\sn fRightHitTestLine}{\sv 1}}{\sp{\sn lineRightFillShape}{\sv 1}}{\sp{\sn fBottomInsetPen}{\sv 0}}{\sp{\sn fBottomLine}{\sv 0}}{\sp{\sn fBottomHitTestLine}{\sv 1}}
{\sp{\sn lineBottomFillShape}{\sv 1}}{\sp{\sn fColumnLine}{\sv 0}}{\sp{\sn fColumnHitTestLine}{\sv 1}}{\sp{\sn lineColumnFillShape}{\sv 1}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8208\dppolyline\dppolycount2\dpptx0\dppty0
\dpptx0\dppty371\dpx3180\dpy6432\dpxsize0\dpysize371\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf18\insrsid5180280\charrsid15211884
\par }\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5180280 {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid14360743
{\shp{\*\shpinst\shpleft-14\shptop6770\shpright6386\shpbottom8020\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt1\shpz8\shplid1035{\sp{\sn shapeType}{\sv 110}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 327680}}{\sp{\sn hspNext}{\sv 1035}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251657728}}
{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fBehindDocument}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar\qc \li357\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0\pararsid5180280 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf18\lang1033\langfe2057\langnp1033\insrsid5180280\charrsid15211884 2 or more events in the last week
\par }}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\qc \li357\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0\pararsid5180280 \rtlch\fcs1 \af0\afs24\alang1025
\ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf18\lang1033\langfe2057\langnp1033\insrsid5180280\charrsid15211884 2 or more events in the last week
\par }}\dpx-14\dpy6770\dpxsize6400\dpysize1250\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\insrsid5180280\charrsid5180280
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphmrg\tposy8427\tdfrmtxtLeft180\tdfrmtxtRight180\tdfrmtxtBottom200\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5180280\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\clhidemark \cellx1302\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\pvpara\phmrg\posy8427\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5180280 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5180280 Yes }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5180280 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5180280 {\*\datafield
01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1
\af1\afs20 \ltrch\fcs0 \f1\fs20\insrsid5180280 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5180280 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphmrg\tposy8427\tdfrmtxtLeft180\tdfrmtxtRight180\tdfrmtxtBottom200\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5180280\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1417\clshdrawnil\clhidemark \cellx1302\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx7175\tposy40\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3
\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072
\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\pvpara\phpg\posx7175\posy40\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \af0 \ltrch\fcs0
\lang1024\langfe1024\noproof\insrsid14360743 {\shp{\*\shpinst\shpleft127\shptop392\shpright2125\shpbottom392\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz12\shplid1036
{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn posrelv}{\sv 1}}
{\sp{\sn dhgt}{\sv 251661824}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypage\dodhgt8204\dppolyline\dppolycount2\dpptx0\dppty0\dpptx1998\dppty0
\dpx127\dpy392\dpxsize1998\dpysize0\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf18\insrsid5197885\charrsid15211884 Yes }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\cf18\insrsid5197885\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx7175\tposy40\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3
\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072
\row }\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5180280 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\insrsid5180280\charrsid5180280
\par \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph115\trrh257\trleft-115\tpvpara\tphpg\tposx4340\tposy342\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1200\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12395322\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1200\clshdrawnil\clhidemark \cellx1085\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\pvpara\phpg\posx4340\posy342\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid12395322 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid12395322\charrsid15211884 \cell
}\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\langnp1033\langfenp1033\insrsid12395322
\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph115\trrh257\trleft-115\tpvpara\tphpg\tposx4340\tposy342\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth1200\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115
\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12395322\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl
\cltxlrtb\clftsWidth3\clwWidth1200\clshdrawnil\clhidemark \cellx1085\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072\pard \ltrpar\ql \li0\ri0\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3
\clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark \cellx1072\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx4365\tposy157\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark
\cellx1072\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\pvpara\phpg\posx4365\posy157\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf18\insrsid5197885 No}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf18\insrsid5197885\charrsid15211884 }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 FORMCHECKBOX
}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid5197885\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid5197885\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx4365\tposy157\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5197885\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark
\cellx1072\row \ltrrow}\trowd \irow0\irowband0\ltrrow\ts11\trgaph115\trleft-115\trbrdrt\brdrs\brdrw10\brdrcf17 \trbrdrl\brdrs\brdrw10\brdrcf17 \trbrdrb\brdrs\brdrw10\brdrcf17 \trbrdrr\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv
\brdrs\brdrw10\brdrcf17 \tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth3895\clshdrawnil\clhidemark \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\pard \ltrpar\qc \li283\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin283\pararsid5197885 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf17\insrsid5197885\charrsid13907607 Calculate ABCD2 Score\cell Score\cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {
\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\lang1033\langfe1033\highlight7\langnp1033\langfenp1033\insrsid5197885\charrsid5180280 \trowd \irow0\irowband0\ltrrow\ts11\trgaph115\trleft-115\trbrdrt\brdrs\brdrw10\brdrcf17 \trbrdrl\brdrs\brdrw10\brdrcf17
\trbrdrb\brdrs\brdrw10\brdrcf17 \trbrdrr\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv\brdrs\brdrw10\brdrcf17
\tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth3895\clshdrawnil\clhidemark \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\row \ltrrow}\trowd \irow1\irowband1\ltrrow\ts11\trgaph115\trleft-115\trbrdrt\brdrs\brdrw10\brdrcf17 \trbrdrl\brdrs\brdrw10\brdrcf17 \trbrdrb\brdrs\brdrw10\brdrcf17 \trbrdrr
\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv\brdrs\brdrw10\brdrcf17
\tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth453\clshdrawnil\clhidemark \cellx338\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth1282\clshdrawnil\clhidemark \cellx1620\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth2160\clshdrawnil\clhidemark \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin0\pararsid5197885 {
\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5197885\charrsid5180280 A\cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf17\insrsid5197885\charrsid13907607 Age\cell }\pard \ltrpar\qj \li283\ri0\sl360\slmult1
\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin283\pararsid5197885 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\insrsid5197885\charrsid13907607 >60 years\cell }\pard \ltrpar
\qc \li-115\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin-115\pararsid4149718 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf17\insrsid5197885\charrsid13907607 FORMDROPDOWN }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf17\insrsid5197885\charrsid13907607 {\*\datafield
66800000140000000944726f70646f776e320000000000000000000000000023000300030000000a00060014001c000d506c656173652073656c65637407596573203d2031064e6f203d2030}{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox\ffhps20{\*\ffname Dropdown2}\ffdefres0{\*\ffl
Please select}{\*\ffl Yes = 1}{\*\ffl No = 0}}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf17\insrsid5197885\charrsid13907607 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\highlight7\langnp1033\langfenp1033\insrsid5197885\charrsid5180280 \trowd \irow1\irowband1\ltrrow\ts11\trgaph115\trleft-115\trbrdrt\brdrs\brdrw10\brdrcf17 \trbrdrl\brdrs\brdrw10\brdrcf17 \trbrdrb\brdrs\brdrw10\brdrcf17
\trbrdrr\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv\brdrs\brdrw10\brdrcf17
\tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth453\clshdrawnil\clhidemark \cellx338\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth1282\clshdrawnil\clhidemark \cellx1620\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth2160\clshdrawnil\clhidemark \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\row \ltrrow}\pard \ltrpar\qj \li0\ri0\sl360\slmult1
\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5197885\charrsid5180280 B\cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\b\f1\fs20\cf17\insrsid5197885\charrsid13907607 BP\cell }\pard \ltrpar\qj \li283\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin283\pararsid5197885 {\rtlch\fcs1 \af1\afs18
\ltrch\fcs0 \f1\fs18\cf17\insrsid5197885\charrsid13907607 >140 systolic and/or >90 Diastolic\cell }\pard \ltrpar\qc \li-115\ri0\sl360\slmult1
\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin-115\pararsid4149718 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf17\insrsid5197885\charrsid13907607
FORMDROPDOWN }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf17\insrsid5197885\charrsid13907607 {\*\datafield
02800000140000000944726f70646f776e320000000000000000000000000023000300030000000a00060014001c000d506c656173652073656c65637407596573203d2031064e6f203d2030}{\*\formfield{\fftype2\fftypetxt0\ffhaslistbox\ffhps20{\*\ffname Dropdown2}\ffdefres0{\*\ffl
Please select}{\*\ffl Yes = 1}{\*\ffl No = 0}}}}}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\cf17\insrsid5197885\charrsid13907607 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
\f31506\fs20\lang1033\langfe1033\highlight7\langnp1033\langfenp1033\insrsid5197885\charrsid5180280 \trowd \irow2\irowband2\ltrrow\ts11\trgaph115\trleft-115\trbrdrt\brdrs\brdrw10\brdrcf17 \trbrdrl\brdrs\brdrw10\brdrcf17 \trbrdrb\brdrs\brdrw10\brdrcf17
\trbrdrr\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv\brdrs\brdrw10\brdrcf17
\tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth453\clshdrawnil\clhidemark \cellx338\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth1282\clshdrawnil\clhidemark \cellx1620\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth2160\clshdrawnil\clhidemark \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\row \ltrrow}\pard \ltrpar\qj \li0\ri0\sl360\slmult1
\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin0\pararsid5197885 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\insrsid5197885\charrsid5180280 C\cell }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
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\af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\insrsid5197885\charrsid13907607 Duration\cell }\pard \ltrpar\qc \li-115\ri0\sl360\slmult1
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\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\pard \ltrpar\qj \li0\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin0\pararsid5197885 {
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\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin283\pararsid5197885 {\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\insrsid5197885\charrsid13907607 \cell }\pard \ltrpar
\qc \li-115\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin-115\pararsid4149718 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
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\f1\fs18\cf17\insrsid5197885\charrsid13907607 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0
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\trbrdrr\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv\brdrs\brdrw10\brdrcf17
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\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth453\clshdrawnil\clhidemark \cellx338\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth1282\clshdrawnil\clhidemark \cellx1620\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth2160\clshdrawnil \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\row \ltrrow}\trowd \irow6\irowband6\lastrow \ltrrow\ts11\trgaph115\trleft-115\trbrdrt\brdrs\brdrw10\brdrcf17 \trbrdrl\brdrs\brdrw10\brdrcf17 \trbrdrb\brdrs\brdrw10\brdrcf17
\trbrdrr\brdrs\brdrw10\brdrcf17 \trbrdrh\brdrs\brdrw10\brdrcf17 \trbrdrv\brdrs\brdrw10\brdrcf17
\tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
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{\sp{\sn shapeType}{\sv 20}}{\sp{\sn fFlipH}{\sv 1}}{\sp{\sn fFlipV}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn posrelv}{\sv 1}}{\sp{\sn dhgt}{\sv 251659776}}
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\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}}{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf17\insrsid5197885\charrsid13907607 Total ABCD2 Score}{\rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f1\fs20\cf17\insrsid5197885\charrsid13907607 \cell
}\pard \ltrpar\qc \li-115\ri0\sl360\slmult1\widctlpar\intbl\pvpg\phmrg\posy8400\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\nooverflow\faroman\rin0\lin-115\pararsid4149718 {\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf17\insrsid5197885\charrsid13907607 FORMDROPDOWN }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf17\insrsid5197885\charrsid13907607 {\*\datafield
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}{\fldrslt }}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf17\insrsid5197885\charrsid13907607 \cell }\pard \ltrpar
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\tpvpg\tphmrg\tposy8400\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth3\trwWidth8157\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt28\trpaddr115\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid12142071
\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth3895\clshdrawnil\clhidemark \cellx3780\clvertalc\clbrdrt\brdrs\brdrw10\brdrcf17 \clbrdrl\brdrs\brdrw10\brdrcf17 \clbrdrb\brdrs\brdrw10\brdrcf17 \clbrdrr\brdrs\brdrw10\brdrcf17
\cltxlrtb\clNoWrap\clftsWidth3\clwWidth4262\clshdrawnil\clhidemark \cellx8042\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx4408\tposy5511\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14696621\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark
\cellx1072\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\pvpara\phpg\posx4408\posy5511\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14696621 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf18\insrsid14696621 No}{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf18\insrsid14696621\charrsid15211884 }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid14696621\charrsid15211884
FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid14696621\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid14696621\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14696621\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx4408\tposy5511\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14696621\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark
\cellx1072\row \ltrrow}\trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx7425\tposy4438\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14696621\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark
\cellx1072\pard \ltrpar\ql \li0\ri0\sl276\slmult1\widctlpar\intbl\pvpara\phpg\posx7425\posy4438\dxfrtext180\dfrmtxtx180\dfrmtxty0\wraparound\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid14696621 {\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0
\b\f1\fs18\cf18\insrsid14696621\charrsid15211884 Yes }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid14696621\charrsid15211884 FORMCHECKBOX }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0
\f1\fs18\cf18\insrsid14696621\charrsid15211884 {\*\datafield 01000000140000000000000000000000000000000000}{\*\formfield{\fftype1\fftypetxt0\ffhps20\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid14696621\charrsid15211884 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f31506\fs20\cf18\lang1033\langfe1033\langnp1033\langfenp1033\insrsid14696621\charrsid15211884 \trowd \irow0\irowband0\lastrow \ltrrow
\ts11\trgaph115\trrh392\trleft-115\tpvpara\tphpg\tposx7425\tposy4438\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl115\trpaddt58\trpaddb28\trpaddr115\trpaddfl3
\trpaddft3\trpaddfb3\trpaddfr3\tblrsid14696621\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol\tblind0\tblindtype3 \clvertalc\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1187\clshdrawnil\clhidemark
\cellx1072\row }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\insrsid14360743
{\shp{\*\shpinst\shpleft-379\shptop6029\shpright10222\shpbottom8274\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz14\shplid1038{\sp{\sn shapeType}{\sv 1}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 393216}}{\sp{\sn hspNext}{\sv 1038}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 3969654}{\*\hsv \caccentthree\ctint255\cshade191}}
{\sp{\sn fLine}{\sv 1}}{\sp{\sn dhgt}{\sv 251663872}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid7935455 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af41\afs20 \ltrch\fcs0
\b\f41\fs20\cf21\insrsid7935455\charrsid14696621 LOW RISK
\par }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 Prescribe 300mg aspirin stat and then once daily.
\par Email form to}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621 }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid14290474\charrsid14696621 HYPERLINK "mailto:kch-tr.pruh}{
\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf21\insrsid14290474\charrsid14696621 -}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid14290474\charrsid14696621 tia@nhs.net" }}{\fldrslt {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0
\cs22\f42\fs18\ul\cf21\insrsid14290474\charrsid14696621 kch-tr.pruh}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \cs22\f1\fs18\ul\cf21\insrsid14290474\charrsid14696621 -}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \cs22\f42\fs18\ul\cf21\insrsid14290474\charrsid14696621
tia@nhs.net}}}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid14290474\charrsid14696621
\par }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf21\insrsid7935455\charrsid14696621 }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 If concerned, consider discussing with stroke JCF on}{\rtlch\fcs1 \af42\afs18
\ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621 01689 863 000, }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 bleep 195 or }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0
\f42\fs18\cf21\insrsid7293464\charrsid14696621 with the }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 stroke consultant on-call}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621 .}{
\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621
\par }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621
\par Advise the patient that:}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7293464 {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621
They will be provided with an appointment by telephone usually within 3 working days.}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf21\insrsid7293464\charrsid14696621
\par They should not drive until assessed at the hospital or clinic.
\par If there was a witness to the event they should accompany them to the appointment.
\par If they experience any further events they should call 999.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf21\insrsid7935455\charrsid14696621
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8206\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid7935455 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0
\fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af41\afs20 \ltrch\fcs0 \b\f41\fs20\cf21\insrsid7935455\charrsid14696621 LOW RISK
\par }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 Prescribe 300mg aspirin stat and then once daily.
\par Email form to}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621 }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid14290474\charrsid14696621 HYPERLINK "mailto:kch-tr.pruh}{
\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf21\insrsid14290474\charrsid14696621 -}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid14290474\charrsid14696621 tia@nhs.net" }}{\fldrslt {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0
\cs22\f42\fs18\ul\cf21\insrsid14290474\charrsid14696621 kch-tr.pruh}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \cs22\f1\fs18\ul\cf21\insrsid14290474\charrsid14696621 -}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \cs22\f42\fs18\ul\cf21\insrsid14290474\charrsid14696621
tia@nhs.net}}}\sectd \ltrsect\margtsxn180\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid14818572\sftnbj {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid14290474\charrsid14696621
\par }{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf21\insrsid7935455\charrsid14696621 }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 If concerned, consider discussing with stroke JCF on}{\rtlch\fcs1 \af42\afs18
\ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621 01689 863 000, }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 bleep 195 or }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0
\f42\fs18\cf21\insrsid7293464\charrsid14696621 with the }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621 stroke consultant on-call}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621 .}{
\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621
\par }{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621
\par Advise the patient that:}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7935455\charrsid14696621
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7293464 {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf21\insrsid7293464\charrsid14696621
They will be provided with an appointment by telephone usually within 3 working days.}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf21\insrsid7293464\charrsid14696621
\par They should not drive until assessed at the hospital or clinic.
\par If there was a witness to the event they should accompany them to the appointment.
\par If they experience any further events they should call 999.}{\rtlch\fcs1 \af0 \ltrch\fcs0 \cf21\insrsid7935455\charrsid14696621
\par }}\dpx-379\dpy6029\dpxsize10601\dpysize2245\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor102\dplinecog9\dplinecob0}}}
{\shp{\*\shpinst\shpleft6678\shptop4909\shpright8365\shpbottom4909\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz13\shplid1039{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn dhgt}{\sv 251662848}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8205\dppolyline\dppolycount2
\dpptx0\dppty0\dpptx1687\dppty0\dpx6678\dpy4909\dpxsize1687\dpysize0\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}
{\shp{\*\shpinst\shpleft3338\shptop5380\shpright3338\shpbottom6029\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz15\shplid1040{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn cxstyle}{\sv 0}}{\sp{\sn dhgt}{\sv 251664896}}
{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8207\dppolyline\dppolycount2\dpptx0\dppty0\dpptx0\dppty649\dpx3338\dpy5380\dpxsize0\dpysize649
\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}
{\shp{\*\shpinst\shpleft-14\shptop4449\shpright6678\shpbottom5380\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz4\shplid1041{\sp{\sn shapeType}{\sv 110}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn lTxid}{\sv 458752}}{\sp{\sn hspNext}{\sv 1041}}{\sp{\sn fRecolorFillAsPicture}{\sv 0}}{\sp{\sn fUseShapeAnchor}{\sv 0}}{\sp{\sn lineColor}{\sv 6299648}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn dhgt}{\sv 251653632}}{\sp{\sn fLayoutInCell}{\sv 1}}
{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar\qc \li357\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0\pararsid5180280 \rtlch\fcs1 \af0\afs24\alang1025
\ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf17\lang1033\langfe2057\langnp1033\insrsid5180280\charrsid13907607 ABCD2 Score = 4 or greater
\par }}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8196\dptxbx\dptxlrtb{\dptxbxtext\ltrpar \pard\plain \ltrpar\qc \li357\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin357\itap0\pararsid5180280 \rtlch\fcs1
\af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf17\lang1033\langfe2057\langnp1033\insrsid5180280\charrsid13907607 ABCD2 Score = 4 or greater
\par }}\dpx-14\dpy4449\dpxsize6692\dpysize931\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat1\dplinew15\dplinecor0\dplinecog32\dplinecob96}}}
{\shp{\*\shpinst\shpleft3200\shptop8028\shpright3200\shpbottom8399\shpfhdr0\shpbxcolumn\shpbxignore\shpbypage\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz9\shplid1042{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn fAutoTextMargin}{\sv 0}}{\sp{\sn fRotateText}{\sv 0}}{\sp{\sn fFitShapeToText}{\sv 0}}{\sp{\sn fFitTextToShape}{\sv 0}}{\sp{\sn fColumnLineOK}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn lineEndArrowhead}{\sv 1}}{\sp{\sn fLineUseShapeAnchor}{\sv 0}}
{\sp{\sn fLine}{\sv 1}}{\sp{\sn fHitTestLine}{\sv 1}}{\sp{\sn lineFillShape}{\sv 1}}{\sp{\sn fShadow}{\sv 0}}{\sp{\sn fshadowObscured}{\sv 0}}{\sp{\sn f3D}{\sv 0}}{\sp{\sn fc3DMetallic}{\sv 0}}{\sp{\sn fc3DUseExtrusionColor}{\sv 0}}
{\sp{\sn fc3DLightFace}{\sv 1}}{\sp{\sn fc3DConstrainRotation}{\sv 1}}{\sp{\sn fc3DRotationCenterAuto}{\sv 0}}{\sp{\sn fc3DParallel}{\sv 1}}{\sp{\sn fc3DKeyHarsh}{\sv 1}}{\sp{\sn fc3DFillHarsh}{\sv 0}}{\sp{\sn cxstyle}{\sv 0}}
{\sp{\sn fCalloutMinusX}{\sv 0}}{\sp{\sn fCalloutMinusY}{\sv 0}}{\sp{\sn fCalloutDropAuto}{\sv 0}}{\sp{\sn fCalloutLengthSpecified}{\sv 0}}{\sp{\sn posrelv}{\sv 1}}
{\sp{\sn dhgt}{\sv 251658752}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fAllowOverlap}{\sv 1}}{\sp{\sn fPseudoInline}{\sv 0}}{\sp{\sn fLeftInsetPen}{\sv 0}}{\sp{\sn fLeftLine}{\sv 0}}{\sp{\sn fLeftHitTestLine}{\sv 1}}{\sp{\sn lineLeftFillShape}{\sv 1}}
{\sp{\sn fTopInsetPen}{\sv 0}}{\sp{\sn fTopLine}{\sv 0}}{\sp{\sn fTopHitTestLine}{\sv 1}}{\sp{\sn lineTopFillShape}{\sv 1}}{\sp{\sn fRightInsetPen}{\sv 0}}{\sp{\sn fRightLine}{\sv 0}}{\sp{\sn fRightHitTestLine}{\sv 1}}{\sp{\sn lineRightFillShape}{\sv 1}}
{\sp{\sn fBottomInsetPen}{\sv 0}}{\sp{\sn fBottomLine}{\sv 0}}{\sp{\sn fBottomHitTestLine}{\sv 1}}{\sp{\sn lineBottomFillShape}{\sv 1}}{\sp{\sn fColumnLine}{\sv 0}}{\sp{\sn fColumnHitTestLine}{\sv 1}}{\sp{\sn lineColumnFillShape}{\sv 1}}
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\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\insrsid3491992 \page
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\sbknone\linex0\headery709\footery709\endnhere\pgbrdropt32\sectdefaultcl\sectrsid5197885\sftnbj \ltrrow\trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl\brdrs\brdrw20\brdrcf9 \trbrdrb
\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-60\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5185399\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
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\cellx9984{\listtext\pard\plain\ltrpar \intbl\rtlch\fcs1 \ab\af0 \ltrch\fcs0 \b\f1\cf8\insrsid12142071 \hich\af1\dbch\af0\loch\f1 13.\tab}\pard\plain \ltrpar\ql \fi-540\li1\ri0\widctlpar\intbl
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\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid12142071 5}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid12142071\charrsid3491992 .}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid12142071 Additional I}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0
\b\f1\cf8\insrsid12142071\charrsid3491992 nformation}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid12142071 }{\rtlch\fcs1 \ab\af1\afs18 \ltrch\fcs0 \b\f1\fs18\cf8\insrsid12142071\charrsid12142071
( Insert relevant consultation notes or referral letter here)}{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid12142071\charrsid5197885 \cell }\pard \ltrpar\ql \li0\ri0\sa200\sl276\slmult1
\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf8\insrsid12142071\charrsid5197885 \trowd \irow0\irowband0\lastrow \ltrrow\ts11\trgaph108\trleft-108\trbrdrt\brdrs\brdrw20\brdrcf9 \trbrdrl
\brdrs\brdrw20\brdrcf9 \trbrdrb\brdrs\brdrw20\brdrcf9 \trbrdrr\brdrs\brdrw20\brdrcf9 \trbrdrh\brdrs\brdrw20\brdrcf9 \trbrdrv\brdrs\brdrw20\brdrcf9
\tpvpara\tphmrg\tposnegy-60\tdfrmtxtLeft180\tdfrmtxtRight180\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid5185399\tbllkhdrrows\tbllklastrow\tbllkhdrcols\tbllklastcol
\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrs\brdrw20\brdrcf9 \clbrdrl\brdrs\brdrw20\brdrcf9 \clbrdrb\brdrs\brdrw20\brdrcf9 \clbrdrr\brdrs\brdrw20\brdrcf9 \clcbpat9\cltxlrtb\clftsWidth3\clwWidth10092\clpadl57\clpadb57\clpadfl3\clpadfb3\clcbpatraw9
\cellx9984\row }\pard \ltrpar\ql \li0\ri0\sl360\slmult1\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\insrsid3491992 \sect }\sectd \ltrsect
\psz9\sbknone\linex0\headery709\footery709\colsx708\endnhere\titlepg\sectunlocked1\pgbrdropt32\sectlinegrid360\sectdefaultcl\sectrsid5180280\sftnbj \pard\plain \ltrpar\ql \li0\ri0\sl360\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\insrsid3491992
\par
\par
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5731489 {\rtlch\fcs1 \ab\af1\afs28 \ltrch\fcs0 \b\f1\fs28\cf6\insrsid3491992 Patient Summary
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid3491992
\par {\*\bkmkstart T2xbWjeJTP6Cmewcqjnp}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid12912433\charrsid12912433 FORMTEXT }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid12912433\charrsid12912433
{\*\datafield 00020000140000001454327862576a654a545036436d657763716a6e7000000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T2xbWjeJTP6Cmewcqjnp}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\f1\fs20\cf6\insrsid12912433\charrsid12912433 Problems}}}\sectd \ltrsect\psz9\sbknone\linex0\headery709\footery709\colsx708\endnhere\titlepg\sectunlocked1\pgbrdropt32\sectlinegrid360\sectdefaultcl\sectrsid5180280\sftnbj {\rtlch\fcs1 \ab\af1\afs20
\ltrch\fcs0 \f1\fs20\cf6\insrsid12912433\charrsid12912433 {\*\bkmkend T2xbWjeJTP6Cmewcqjnp}
\par {\*\bkmkstart TMUMeyZPSIz17Vyk3n1A}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid12912433\charrsid12912433 FORMTEXT }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid12912433\charrsid12912433
{\*\datafield 000200001400000014544d554d65795a5053497a313756796b336e314100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TMUMeyZPSIz17Vyk3n1A}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\f1\fs20\cf6\insrsid12912433\charrsid12912433 Single Code Entry: O/E - blood pressure reading}}}\sectd \ltrsect
\psz9\sbknone\linex0\headery709\footery709\colsx708\endnhere\titlepg\sectunlocked1\pgbrdropt32\sectlinegrid360\sectdefaultcl\sectrsid5180280\sftnbj {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \f1\fs20\cf6\insrsid12912433\charrsid12912433
{\*\bkmkend TMUMeyZPSIz17Vyk3n1A}
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{\*\datafield 00020000140000001454426b6458524b57594d3853454c49627943436500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TBkdXRKWYM8SELIbyCCe}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
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{\*\datafield 0002000014000000145467547a4a6135385a634b376f4c5441487a473800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TgTzJa58ZcK7oLTAHzG8}}}}}{\fldrslt {\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0
\f1\fs20\cf6\insrsid12912433\charrsid12912433 Allergies}}}\sectd \ltrsect\psz9\sbknone\linex0\headery709\footery709\colsx708\endnhere\titlepg\sectunlocked1\pgbrdropt32\sectlinegrid360\sectdefaultcl\sectrsid5180280\sftnbj {\rtlch\fcs1 \ab\af1\afs20
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\par }{\rtlch\fcs1 \ab\af1\afs20 \ltrch\fcs0 \b\f1\fs20\cf6\insrsid12912433
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\cf6\insrsid3491992
\par
\par
\par }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf13\insrsid3491992 End
\par }{\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf13\insrsid8679505
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid8679505 {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf18\insrsid8679505\charrsid8679505 Email: }{\field\flddirty{\*\fldinst {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0
\f42\fs18\cf18\insrsid8679505\charrsid8679505 HYPERLINK "mailto:kch-tr.pruh}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \f1\fs18\cf18\insrsid8679505\charrsid8679505 -}{\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf18\insrsid8679505\charrsid8679505
tia@nhs.net" }}{\fldrslt {\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \cs22\f42\fs18\ul\cf18\insrsid8679505\charrsid8679505 kch-tr.pruh}{\rtlch\fcs1 \af1\afs18 \ltrch\fcs0 \cs22\f1\fs18\ul\cf18\insrsid8679505\charrsid8679505 -}{\rtlch\fcs1 \af42\afs18
\ltrch\fcs0 \cs22\f42\fs18\ul\cf18\insrsid8679505\charrsid8679505 tia@nhs.net}}}\sectd \ltrsect\psz9\sbknone\linex0\headery709\footery709\colsx708\endnhere\titlepg\sectunlocked1\pgbrdropt32\sectlinegrid360\sectdefaultcl\sectrsid5180280\sftnbj {
\rtlch\fcs1 \af42\afs18 \ltrch\fcs0 \f42\fs18\cf18\insrsid8679505\charrsid8679505
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3491992 {\rtlch\fcs1 \ab\af1 \ltrch\fcs0 \b\f1\cf13\insrsid8679505
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa60\keepn\widctlpar\wrapdefault\nooverflow\faroman\outlinelevel0\rin0\lin0\itap0\pararsid3491992 \rtlch\fcs1 \ab\af40\afs32\alang1025 \ltrch\fcs0
\b\f40\fs32\lang2057\langfe1033\kerning32\cgrid\langnp2057\langfenp1033 {\*\bkmkstart FctueSR4ef3AFFY2fyLQ}{\*\bkmkstart _Toc313950683}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \ab0\af1\afs12 \ltrch\fcs0
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\psz9\sbknone\linex0\headery709\footery709\colsx708\endnhere\titlepg\sectunlocked1\pgbrdropt32\sectlinegrid360\sectdefaultcl\sectrsid5180280\sftnbj {\rtlch\fcs1 \ab0\af1\afs12 \ltrch\fcs0 \b0\fs12\cf8\loch\af1\hich\af1\dbch\af31505\insrsid3491992
{\*\bkmkend FctueSR4ef3AFFY2fyLQ}\hich\af1\dbch\af31505\loch\f1 despatching.]
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14696621 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \fs24\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af0 \ltrch\fcs0
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