%PDF-1.4 % 6 0 obj <> endobj xref 6 26 0000000016 00000 n 0000001005 00000 n 0000001082 00000 n 0000001259 00000 n 0000001387 00000 n 0000001770 00000 n 0000001925 00000 n 0000002399 00000 n 0000002511 00000 n 0000003374 00000 n 0000004072 00000 n 0000004914 00000 n 0000005696 00000 n 0000006469 00000 n 0000007266 00000 n 0000007430 00000 n 0000008170 00000 n 0000008963 00000 n 0000009175 00000 n 0000009398 00000 n 0000009618 00000 n 0000013292 00000 n 0000013520 00000 n 0000013722 00000 n 0000013971 00000 n 0000000816 00000 n trailer <]>> startxref 0 %%EOF 31 0 obj <>stream xb``g``ee Y800$ C1/eC\K.M9Ωt k`̔4[1+ 8c endstream endobj 7 0 obj <> endobj 8 0 obj <> endobj 9 0 obj <>/ProcSet[/PDF/Text]/ExtGState<>>> endobj 10 0 obj <> endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <> endobj 14 0 obj <>stream HUn0+"ĐvmQ >5ĭ7.}g(J^8qG޼y39pӦ-F0(QES!R7)j?E}5˭|\ ct'g.s֊ZKM/^S>ʣR>u^Ɛh!$0:)oE^)2  H#=p={a[#E,! Ly=60xiA@HT#nLg!3}g([CHvbNZm KE]JBz# šh9J zs_*l++m~oE#a0ImhY/ͶBLE_KuF Fb:mFTShhy@DV'Dn` *unj d΄@̹6*,!}\2}.F9 ؓѐNA| :>w[rV1ab-#a ۜtONU5kkDCIto@ :AdbK$n`~:jsqiNyr1zvA:-%$rDir})oWdϫeS>u?tӛ9q0+lI5~ VyL~3eپ;=>stream Hj@z=JMvfCM - z0u }>qgW"u5x=oU_ $@@VX2)ezrQT?rEʐPъw>FO7)#E~l.s;DBIX£AL&1qWn]W~^&C& LL[2=뚢y}H󉕕uʆSh~ݒaGВ]jEX Z ֛mpv>stream HUMs0+ͥN0әvzp1LFqvvJ1^u{z,WBr!G1.F!VSh R*w:*C +P6 0DΕ t g$Q𔱂W2έ"&pC _`y( .T{._vaBx>3DBlCPR* [;5mV}´'*HM=*m+ɵ!ZrN$wܠk=Ud2Fy60Ga1 vדSJŰ"hf\"R{Vfb3㦑EBihv6] rn,CZ5y+[;h.+b u5*PFK=X0zM>'k EXn޺ -móVRY\sF7 cWI$jW9lQp_'/Itf6[n\Z:XuPp-*1kZp];Lp_LX.|T8Մa( @u-~̰ϭZ O@oGbFv)L>I9<Ga jVݡ 3c\?Bm endstream endobj 17 0 obj <>stream HMk0؇U7BCm=RB˺ݬi/HW6%Pf$=j^]Y s hl]e_ 銡6cdi(g79|nݮ>BUXu"R[ALim5,`x၁-d+c1a 6P^e+ 7ۂ{2hCɫKGz2P %Hs9X-O*BIShB[HY}Vp5XAJH5*{pxT=[ Wر'LWm!i_U t7աࢠ~ \'U?+ &cӅnzvn\jTZRRGg."I!>( 殭{1s;KfA36R\MˏU!y>stream H=o0w ]AWHcM!24* 4 2֖ YA;{Б s2('}sxfYfvߴX?ei:9k9}Hi] oY., D R OB\Z ;$Aڎ0~i3z=e8(hfq5 ((Ps]gܕ7] RONMyg:{N4`uRuϛ[QtfID# 7r-gsPf,QdXFI\7^U}=SK͔9 %(uVgDL+;iVc|6@p~&5U)uZ=Ay'X7dG-'_ۖuAz].CrHբ]SPBF1$Bx<&#s:;X@ VQ̖*mi;mՖf]ǂԵ#3BykNH VPݯxf^Tؒ8=;O9會\kt]4,Hhdi`NR9EU{d2~^/LU룪 zkzboaDGW\`ޘFZgV>L~Տ=5RttT=ϣOƽ9- %3 )OOu4OS`:٠Z endstream endobj 19 0 obj <>stream HKo@#HvAAXx4qQWyPwf~ny<0e.Z.CwۖkZE8ͪ&Ki}0VxB&%XLp6c83{D/iE#OMȼ=î^ @_A9U *a~e͆]~MNeg"uh a@ y /)o c1™b? C,}َ4dewNNcU ?bv5rJaSfY/3}4'{:Żn&)]U\S $nFv:c$Ey2(pԾ#?JiP9˯[1ud18ĞaK/qt^s(k6owz_="5[UKͯ7uS eln Lv=[׬]v)> endobj 21 0 obj <>stream HMo@+qq P9 !8D+i9{fzC)g+ՅOH#g}Q\^ۮv6ްUXiT?uiXJ3!8|Xw)zF!GeaQ}Y>4,:޼JazFns_EeX$$Hc, 5-Ouw3BJ3tE! bEpl5r!J=(L4`#v{l5:LbJiy;SH~9UngosUX|奆&K Tףhh ڸMQ7GRPyS b4DOmЂV΂@43 ޯ0!gŔ'$Ƴ\)iJDCQ:2M7y/J)"4T kd*X}ۢ*N=N `RJszR%v?>}NtہN&{@^mdGDuS8vG)aUQR֜vx~lc9TsL.R*?px)- 44XN[8̗K~v&ή.Ke>FtΔqiRBJIIn[EFq:p #I endstream endobj 22 0 obj <>stream HTMo0 W(3' P;zh"ߏdIvAM=j>"XОIeL F10!]-4<Ǎny!Y+@X)4(e koZ5[zy_j0|S*~B4c&:8<]S:v*ӹ۱ĩ$_qCDDm?#jō̠_PLgT0K{BƙsTA0r󳨬kbY.QK=|a_V)(b7mnX<|Jnuw=m궋"u:J-(-)0G\ *Baύ qkJTՑm^Ħ:)YqH,}(5I۾S@ЖO-#rR*'!UJ @bvB5HBF5/"tpMif[ȌRJb_M~4~AS*V4ѫ5*RҚ#1$`eG1ʁ֧QRUXqk1an@˹U XV$(Ct|[]K<{ }]d٧{x0b跄C ]/t3TJsukoGz=^'nf$#Fe7?܎= >|dÔvvYgdA:T_u| endstream endobj 23 0 obj <> endobj 24 0 obj <> endobj 25 0 obj <> endobj 26 0 obj <>stream hX}xTՙ9 I !$`n:$i2B&L!03$$HLB4 Z KcVJހk!Z}]e+Hjy,$wf}vy}܏3Ĉ(徂HW? "Ui^—=_9T: SK{km%JZ ~^;yD1oӾ{WJįwv#+cusÿڦG^$zi~ E? Gԥ%T"|wclq.+=+Hi DWˡz1ޠ5{)BRVҌʤtJ-˶xJ9TƺBi==bbrZHߦ+ @(DG1:EOB31b>eVTC>䰅Nju7Mi:L/;,dkƿ+hfa4wcKb/+uil Cb`ScquC >,glv<4` +FN䷒6b,]f X;{}'mZoM:=kcq 1(Aw}.=LCz yUŬ}}w/r_VqA|bSG{è7C-j<i-uS/K[w Z;~Nh2qb1,ֳ^=φ) {]y/ |=}Oe^ qT$~)~%THYe+V(W1TZT>9[cdF׈]Fol2) Ǫ ;n'fGdaܙ#ï/ z-]Go:Kgy:[϶ml=:h#f9~|/'?0+, CD''/Oa1"~pLWzJDyRyVyU9S r5'ԟ,Tej ޵qz}b яٻBkl, +PHM!2~;DF6JO%D=k!?Wb}R; G~6| ?s?UPBgyrel~6LV(expLų((.9{3;g]Fų*:y,3`3ф*^8Oi'[tV2q݋'*'~9Ze%v‚\gNW2386{VjIӧMMLO3fr=ڀgt%ӱhQA7 Q60ʹ[-]lk5aZUjvhl&{oLZ4`yݚGo{n7Si˥X!6)dۣte [Mwjz?/Wg5!GNj=iPFV3!Cܑa;5q-&]2Fqx;s'4=x6U=d51|yFm \{PEOC4ߤəYϯᑒMv76)aҏNoQG 769=khti3o ;4%>JMhЙi.)oDeȱ;BB2ir`N%k-pf ^z VCTˤ\jݡ?"UJ,HrL5oкө-b"JZ^n0rt5 Q۠OO {E`m+ySy@jFnhm74vs$̉_=iLgIF:4O8n\_2RԚ&ʣOr턱dt%?[6JS´ZX4cNeݢie[[[ҋ $drop8fɢbi[5vz,)uU)*z[} QB+,GhT]# ˀ(~KW@4_b$JUDJQ.R%)gY&Utz?MΖ>eK-9R\II}!t%j6U["EJ8O[enBM݈<*yXqB;CyI@?PsrWAwNUȵ^|Hk 0Ot=JvMeq+V >P+X ?\l;wb. J6Dk,ae#62be~CmYaQ:QxW(BB@! 4*o>b5ʽ]!4!h&Fk ʁS$& 8瘘fW"ƁjDHwcrҬȳ2y&u$wr_` ҆y 4{>%(+1"K3\iovp48mWEq@:֕յ[]*)) `s ϯ6iڤavUj9nFZ;Zkd5o8 kdu-fMbl6Ŧظlӆ\NyO%(WLe/ot< 8q˽j |W֯iblw 3jlfLoĘsoj̫۬|afzɔԿ yAbeBiK@w~~%;o/P,_5a ҈FLil}פ׋%aU'\[w@ifMr~ dC[Vr-_"Um46 mqU<XP-}#Iaqa,̑$TɈ2⠌X3#z:|[4dj?^>&>ccTtu\R{b.wdTUUI6TM|QU?eDUv+/Jt% v,172,B*Gչ`3Ʊ8@m<1N*jV W_<-E+C3VbK>WsjSuLUBb,jH2ɪʹe$;W+VٯU,VЂ E puM\wd#P+g1\i(m}hInEiF)xӜSQZ@ZV@_J8 jVMn>`_G&3}¨@:7KIxJK kUZC^uW;}:sip*ktЈӽQN]Ҩ\h!0-4H:mʃˑ &2pblM/dQ)Z!EbSZNG}WP?z|yȋh#5ѤzDn=mO#c.P_8R.6fZBǖyk5`$Z endstream endobj 27 0 obj <> endobj 28 0 obj <>/DW 1000/Type/Font>> endobj 29 0 obj <> endobj 30 0 obj <> endobj 1 0 obj <> endobj 2 0 obj <> endobj 3 0 obj <> endobj 4 0 obj <>stream PScript5.dll Version 5.2 2008-01-07T09:30:51-08:00 2008-01-07T09:30:51-08:00 application/pdf Microsoft Word - patient-form.doc smiele Acrobat Distiller 8.1.0 (Windows) uuid:9407e521-072e-4afe-8d03-c836c689833d uuid:8f774db4-cdab-48e9-a547-92449e28e679 endstream endobj 5 0 obj <> endobj xref 0 6 0000000000 65535 f 0000014048 00000 n 0000014082 00000 n 0000014106 00000 n 0000014157 00000 n 0000017829 00000 n trailer <> startxref 116 %%EOF