{\rtf1\adeflang1025\ansi\ansicpg1252\uc1\adeff0\deff0\stshfdbch0\stshfloch0\stshfhich0\stshfbi0\deflang1033\deflangfe1033\themelang1033\themelangfe0\themelangcs0{\fonttbl{\f0\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f1\fbidi \fswiss\fcharset0\fprq2{\*\panose 020b0604020202020204}Arial;}
{\f2\fbidi \fmodern\fcharset0\fprq1{\*\panose 02070309020205020404}Courier New;}{\f3\fbidi \froman\fcharset2\fprq2{\*\panose 05050102010706020507}Symbol;}{\f10\fbidi \fnil\fcharset2\fprq2{\*\panose 05000000000000000000}Wingdings;}
{\f34\fbidi \froman\fcharset0\fprq2{\*\panose 02040503050406030204}Cambria Math;}{\f37\fbidi \fswiss\fcharset0\fprq2{\*\panose 020f0502020204030204}Calibri;}{\f43\fbidi \fswiss\fcharset0\fprq2{\*\panose 020b0604030504040204}Tahoma;}
{\f62\fbidi \fswiss\fcharset0\fprq2{\*\panose 020b0a04020102020204}Arial Black;}{\f138\fbidi \fswiss\fcharset0\fprq2{\*\panose 020b0502040204020203}Segoe UI;}{\f223\fbidi \froman\fcharset0\fprq2{\*\panose 02020404030301010803}Garamond;}
{\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;}{\fbiminor\f31507\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}{\f550\fbidi \froman\fcharset238\fprq2 Times New Roman CE;}
{\f551\fbidi \froman\fcharset204\fprq2 Times New Roman Cyr;}{\f553\fbidi \froman\fcharset161\fprq2 Times New Roman Greek;}{\f554\fbidi \froman\fcharset162\fprq2 Times New Roman Tur;}{\f555\fbidi \froman\fcharset177\fprq2 Times New Roman (Hebrew);}
{\f556\fbidi \froman\fcharset178\fprq2 Times New Roman (Arabic);}{\f557\fbidi \froman\fcharset186\fprq2 Times New Roman Baltic;}{\f558\fbidi \froman\fcharset163\fprq2 Times New Roman (Vietnamese);}{\f560\fbidi \fswiss\fcharset238\fprq2 Arial CE;}
{\f561\fbidi \fswiss\fcharset204\fprq2 Arial Cyr;}{\f563\fbidi \fswiss\fcharset161\fprq2 Arial Greek;}{\f564\fbidi \fswiss\fcharset162\fprq2 Arial Tur;}{\f565\fbidi \fswiss\fcharset177\fprq2 Arial (Hebrew);}
{\f566\fbidi \fswiss\fcharset178\fprq2 Arial (Arabic);}{\f567\fbidi \fswiss\fcharset186\fprq2 Arial Baltic;}{\f568\fbidi \fswiss\fcharset163\fprq2 Arial (Vietnamese);}{\f570\fbidi \fmodern\fcharset238\fprq1 Courier New CE;}
{\f571\fbidi \fmodern\fcharset204\fprq1 Courier New Cyr;}{\f573\fbidi \fmodern\fcharset161\fprq1 Courier New Greek;}{\f574\fbidi \fmodern\fcharset162\fprq1 Courier New Tur;}{\f575\fbidi \fmodern\fcharset177\fprq1 Courier New (Hebrew);}
{\f576\fbidi \fmodern\fcharset178\fprq1 Courier New (Arabic);}{\f577\fbidi \fmodern\fcharset186\fprq1 Courier New Baltic;}{\f578\fbidi \fmodern\fcharset163\fprq1 Courier New (Vietnamese);}{\f890\fbidi \froman\fcharset238\fprq2 Cambria Math CE;}
{\f891\fbidi \froman\fcharset204\fprq2 Cambria Math Cyr;}{\f893\fbidi \froman\fcharset161\fprq2 Cambria Math Greek;}{\f894\fbidi \froman\fcharset162\fprq2 Cambria Math Tur;}{\f897\fbidi \froman\fcharset186\fprq2 Cambria Math Baltic;}
{\f898\fbidi \froman\fcharset163\fprq2 Cambria Math (Vietnamese);}{\f920\fbidi \fswiss\fcharset238\fprq2 Calibri CE;}{\f921\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr;}{\f923\fbidi \fswiss\fcharset161\fprq2 Calibri Greek;}
{\f924\fbidi \fswiss\fcharset162\fprq2 Calibri Tur;}{\f925\fbidi \fswiss\fcharset177\fprq2 Calibri (Hebrew);}{\f926\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic);}{\f927\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}
{\f928\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);}{\f980\fbidi \fswiss\fcharset238\fprq2 Tahoma CE;}{\f981\fbidi \fswiss\fcharset204\fprq2 Tahoma Cyr;}{\f983\fbidi \fswiss\fcharset161\fprq2 Tahoma Greek;}
{\f984\fbidi \fswiss\fcharset162\fprq2 Tahoma Tur;}{\f985\fbidi \fswiss\fcharset177\fprq2 Tahoma (Hebrew);}{\f986\fbidi \fswiss\fcharset178\fprq2 Tahoma (Arabic);}{\f987\fbidi \fswiss\fcharset186\fprq2 Tahoma Baltic;}
{\f988\fbidi \fswiss\fcharset163\fprq2 Tahoma (Vietnamese);}{\f989\fbidi \fswiss\fcharset222\fprq2 Tahoma (Thai);}{\f1170\fbidi \fswiss\fcharset238\fprq2 Arial Black CE;}{\f1171\fbidi \fswiss\fcharset204\fprq2 Arial Black Cyr;}
{\f1173\fbidi \fswiss\fcharset161\fprq2 Arial Black Greek;}{\f1174\fbidi \fswiss\fcharset162\fprq2 Arial Black Tur;}{\f1177\fbidi \fswiss\fcharset186\fprq2 Arial Black Baltic;}{\f1930\fbidi \fswiss\fcharset238\fprq2 Segoe UI CE;}
{\f1931\fbidi \fswiss\fcharset204\fprq2 Segoe UI Cyr;}{\f1933\fbidi \fswiss\fcharset161\fprq2 Segoe UI Greek;}{\f1934\fbidi \fswiss\fcharset162\fprq2 Segoe UI Tur;}{\f1935\fbidi \fswiss\fcharset177\fprq2 Segoe UI (Hebrew);}
{\f1936\fbidi \fswiss\fcharset178\fprq2 Segoe UI (Arabic);}{\f1937\fbidi \fswiss\fcharset186\fprq2 Segoe UI Baltic;}{\f1938\fbidi \fswiss\fcharset163\fprq2 Segoe UI (Vietnamese);}{\f2780\fbidi \froman\fcharset238\fprq2 Garamond CE;}
{\f2781\fbidi \froman\fcharset204\fprq2 Garamond Cyr;}{\f2783\fbidi \froman\fcharset161\fprq2 Garamond Greek;}{\f2784\fbidi \froman\fcharset162\fprq2 Garamond Tur;}{\f2787\fbidi \froman\fcharset186\fprq2 Garamond Baltic;}
{\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;}{\fhiminor\f31569\fbidi \fswiss\fcharset204\fprq2 Calibri Cyr;}
{\fhiminor\f31571\fbidi \fswiss\fcharset161\fprq2 Calibri Greek;}{\fhiminor\f31572\fbidi \fswiss\fcharset162\fprq2 Calibri Tur;}{\fhiminor\f31573\fbidi \fswiss\fcharset177\fprq2 Calibri (Hebrew);}
{\fhiminor\f31574\fbidi \fswiss\fcharset178\fprq2 Calibri (Arabic);}{\fhiminor\f31575\fbidi \fswiss\fcharset186\fprq2 Calibri Baltic;}{\fhiminor\f31576\fbidi \fswiss\fcharset163\fprq2 Calibri (Vietnamese);}
{\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);}}{\colortbl;\red0\green0\blue0;\red0\green0\blue255;\red0\green255\blue255;\red0\green255\blue0;
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\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 }\noqfpromote {\stylesheet{\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \snext0 \sqformat \spriority0 Normal;}{\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext24 \slink15 \sqformat \spriority9 \styrsid14297275 heading 1;}{\s2\ql \li0\ri0\sl240\slmult0
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\ltrch\fcs0 \f62\fs18\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext24 \slink19 \sqformat \spriority9 heading 5;}{
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\sbasedon0 \snext24 \slink20 \sqformat \spriority9 heading 6;}{\s7\ql \li0\ri0\sb60\widctlpar\brdrt\brdrs\brdrw15\brsp240\brdrcf8 \brdrl\brdrs\brdrw15\brsp240\brdrcf8 \brdrb\brdrs\brdrw15\brsp240\brdrcf8 \brdrr\brdrs\brdrw15\brsp240\brdrcf8 
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\i\f223\fs28\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext24 \slink21 \sqformat \spriority9 heading 7;}{\s8\qc \li0\ri0\sb60\sl-320\slmult0\keepn\widctlpar\brdrt\brdrs\brdrw60 \brdrb\brdrs\brdrw15 
\pvpara\phpg\posx1200\posy0\absw1860\wraparound\aspalpha\aspnum\faauto\outlinelevel7\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \caps\f62\fs14\expnd12\expndtw60\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 
\sbasedon0 \snext24 \slink22 \sqformat \spriority9 heading 8;}{\s9\ql \li0\ri0\sb80\sa60\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel8\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\b\i\f223\fs16\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext24 \slink23 \sqformat \spriority9 heading 9;}{\*\cs10 \additive \ssemihidden \sunhideused \spriority1 Default Paragraph Font;}{\*
\ts11\tsrowd\trftsWidthB3\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblind0\tblindtype3\tsvertalt\tsbrdrt\tsbrdrl\tsbrdrb\tsbrdrr\tsbrdrdgl\tsbrdrdgr\tsbrdrh\tsbrdrv 
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\ltrch\fcs0 \b\i\fs28\loch\f31502\hich\af31502\dbch\af31501 \sbasedon10 \slink2 \slocked \ssemihidden \spriority9 Heading 2 Char;}{\*\cs17 \additive \rtlch\fcs1 \ab\af31503\afs26 \ltrch\fcs0 \b\fs26\loch\f31502\hich\af31502\dbch\af31501 
\sbasedon10 \slink3 \slocked \ssemihidden \spriority9 Heading 3 Char;}{\*\cs18 \additive \rtlch\fcs1 \ab\af31507\afs28 \ltrch\fcs0 \b\fs28\loch\f31506\hich\af31506\dbch\af31505 \sbasedon10 \slink4 \slocked \ssemihidden \spriority9 Heading 4 Char;}{\*
\cs19 \additive \rtlch\fcs1 \ab\ai\af31507\afs26 \ltrch\fcs0 \b\i\fs26\loch\f31506\hich\af31506\dbch\af31505 \sbasedon10 \slink5 \slocked \ssemihidden \spriority9 Heading 5 Char;}{\*\cs20 \additive \rtlch\fcs1 \ab\af31507\afs22 \ltrch\fcs0 
\b\fs22\loch\f31506\hich\af31506\dbch\af31505 \sbasedon10 \slink6 \slocked \ssemihidden \spriority9 Heading 6 Char;}{\*\cs21 \additive \rtlch\fcs1 \af31507\afs24 \ltrch\fcs0 \fs24\loch\f31506\hich\af31506\dbch\af31505 
\sbasedon10 \slink7 \slocked \ssemihidden \spriority9 Heading 7 Char;}{\*\cs22 \additive \rtlch\fcs1 \ai\af31507\afs24 \ltrch\fcs0 \i\fs24\loch\f31506\hich\af31506\dbch\af31505 \sbasedon10 \slink8 \slocked \ssemihidden \spriority9 Heading 8 Char;}{\*
\cs23 \additive \rtlch\fcs1 \af31503\afs22 \ltrch\fcs0 \fs22\loch\f31502\hich\af31502\dbch\af31501 \sbasedon10 \slink9 \slocked \ssemihidden \spriority9 Heading 9 Char;}{
\s24\qj \li0\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext24 \slink25 
Body Text;}{\*\cs25 \additive \rtlch\fcs1 \af0\alang1025 \ltrch\fcs0 \f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\langnp1033\langfenp1033 \sbasedon10 \slink24 \slocked \styrsid4351451 Body Text Char;}{\*\cs26 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 
\fs16 \sbasedon10 \ssemihidden annotation reference;}{\s27\ql \fi-187\li187\ri0\sa120\sl-220\slmult0\widctlpar\tx187\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin187\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sbasedon0 \snext27 \slink28 \ssemihidden annotation text;}{\*\cs28 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \f223\fs16 \sbasedon10 \slink27 \slocked \ssemihidden \styrsid1926954 
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\sbasedon0 \snext45 \slink46 header;}{\*\cs46 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \caps\f62\fs14\expnd12\expndtw60 \sbasedon10 \slink45 \slocked \styrsid7422792 Header Char;}{\s47\qc \li0\ri0\sb60\sl-1440\slmult0
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Macro Text Char;}{\*\cs63 \additive \rtlch\fcs1 \af0 \ltrch\fcs0 \b \sbasedon10 page number;}{\s64\qc \li0\ri0\sb320\sl-1560\slmult0
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{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0\hres0\chhres0 \fi-360\li4320\lin4320 }{\listlevel
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{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'01.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li1440\lin1440 }
{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'02.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li2160\lin2160 }
{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'03.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li2880\lin2880 }
{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'04.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li3600\lin3600 }
{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'05.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li4320\lin4320 }
{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'06.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li5040\lin5040 }
{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'07.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li5760\lin5760 }
{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'08.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li6480\lin6480 }
{\listname ;}\listid706224922}{\list\listtemplateid11589350\listhybrid{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'00.;}{\levelnumbers\'01;}\rtlch\fcs1 
\af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li720\lin720 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'01.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
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\ltrch\fcs0 \hres0\chhres0 \fi-180\li2160\lin2160 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'03.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li2880\lin2880 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'04.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li3600\lin3600 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'05.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-180\li4320\lin4320 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'06.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li5040\lin5040 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'07.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
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\'01o;}{\levelnumbers;}\f2\fbias0\hres0\chhres0 \fi-360\li1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers
;}\f10\fbias0\hres0\chhres0 \fi-360\li2160\lin2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}
\f3\fbias0\hres0\chhres0 \fi-360\li2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0\hres0\chhres0 
\fi-360\li3600\lin3600 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0\hres0\chhres0 
\fi-360\li4320\lin4320 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0\hres0\chhres0 
\fi-360\li5040\lin5040 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0\hres0\chhres0 \fi-360\li5760\lin5760 }
{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0\hres0\chhres0 \fi-360\li6480\lin6480 }{\listname 
;}\listid899174101}{\list\listtemplateid-2006796552\listhybrid{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'00.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li720\lin720 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'01.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li1440\lin1440 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'02.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-180\li2160\lin2160 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'03.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li2880\lin2880 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'04.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li3600\lin3600 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'05.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-180\li4320\lin4320 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'06.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li5040\lin5040 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'07.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
\ltrch\fcs0 \hres0\chhres0 \fi-360\li5760\lin5760 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'08.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 
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{\leveltext\leveltemplateid67698713\'02\'01.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li1800\lin1800 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698715\'02\'02.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li2520\lin2520 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698703\'02\'03.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li3240\lin3240 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698713\'02\'04.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li3960\lin3960 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698715\'02\'05.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li4680\lin4680 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698703\'02\'06.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li5400\lin5400 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698713\'02\'07.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li6120\lin6120 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0
{\leveltext\leveltemplateid67698715\'02\'08.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li6840\lin6840 }{\listname ;}\listid965771259}{\list\listtemplateid-134998944\listhybrid{\listlevel\levelnfc0\levelnfcn0\leveljc0
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\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'01.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li1440\lin1440 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0
\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'02.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li2160\lin2160 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0
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\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'04.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li3600\lin3600 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0
\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'05.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li4320\lin4320 }{\listlevel\levelnfc0\levelnfcn0\leveljc0\leveljcn0\levelfollow0
\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698703\'02\'06.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li5040\lin5040 }{\listlevel\levelnfc4\levelnfcn4\leveljc0\leveljcn0\levelfollow0
\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698713\'02\'07.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-360\li5760\lin5760 }{\listlevel\levelnfc2\levelnfcn2\leveljc2\leveljcn2\levelfollow0
\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698715\'02\'08.;}{\levelnumbers\'01;}\rtlch\fcs1 \af0 \ltrch\fcs0 \hres0\chhres0 \fi-180\li6480\lin6480 }{\listname ;}\listid1128668738}{\list\listtemplateid-247183560
\listsimple{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0\hres0\chhres0 \s59\fi-360\li360\jclisttab\tx360\lin360 }{\listname 
;}\listid1280378370}{\list\listtemplateid-1849686770\listhybrid{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}
\f3\fbias0\hres0\chhres0 \fi-360\li720\lin720 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0\hres0\chhres0 
\fi-360\li1440\lin1440 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0\hres0\chhres0 
\fi-360\li2160\lin2160 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0\hres0\chhres0 
\fi-360\li2880\lin2880 }{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698691\'01o;}{\levelnumbers;}\f2\fbias0\hres0\chhres0 \fi-360\li3600\lin3600 }
{\listlevel\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698693\'01\u-3929 ?;}{\levelnumbers;}\f10\fbias0\hres0\chhres0 \fi-360\li4320\lin4320 }{\listlevel
\levelnfc23\levelnfcn23\leveljc0\leveljcn0\levelfollow0\levelstartat1\lvltentative\levelspace0\levelindent0{\leveltext\leveltemplateid67698689\'01\u-3913 ?;}{\levelnumbers;}\f3\fbias0\hres0\chhres0 \fi-360\li5040\lin5040 }{\listlevel\levelnfc23
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{\sp{\sn sizerelh}{\sv 0}}{\sp{\sn sizerelv}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}{\shptxt \ltrpar \pard\plain \ltrpar\s100\qc \li0\ri0\sl276\slmult1\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid4523523 \rtlch\fcs1 \af1\afs24\alang1025 
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\ltrch\fcs0 \insrsid4523523\charrsid15100590 The Department of Health and Human Services (\'93DHHS\'94
) does not discriminate on the basis of disability, race, color, sex, gender, sexual orientation, age, national origin, religious or political belief, ancestry, familial or marital status, genetic information, association, previous assertion of a claim or
 
right, or whistleblower activity, in admission or access to, or the operation of its policies, programs, services, or activities, or in hiring or employment practices.  This notice is provided as required by and in accordance with Title II of the American
s with Disabilities Act of 1990 (\'93ADA\'94
); Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; Age Discrimination Act of 1975; Title IX of the Education Amendments of 1972; Section 1557 of the Affor
dable Care Act; the fb88 Human Rights Act; Executive Order Regarding State of fb88 Contracts for Services; and all other laws and regulations prohibiting such discrimination.  Questions, concerns, complaints or requests for additional information regard
ing the ADA and }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\insrsid4523523\charrsid15100590 hiring or employment practices}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4523523\charrsid15100590 
 may be forwarded to the DHHS ADA/EEO Coordinators at 11 State House Station, Augusta, fb88 04333-0011; 207-287-4289 (V); 207-287-1871(V); or fb88 Relay 711 (TTY).  Questions, concerns, complaints or requests 
for additional information regarding the ADA and }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\insrsid4523523\charrsid15100590 programs, services, or activities}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4523523\charrsid15100590 
 may be forwarded to the DHHS ADA/Civil Rights Coordinator, at 11 State House Station, Augusta, fb88 04333-0011; 207-287-5014 (V); fb88 Relay 711 (TTY); or }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5271939  HYPERLINK "mail
to:ADA-CivilRights.DHHS@maine.gov" }}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \cs90\ul\cf2\insrsid4523523\charrsid15100590 ADA-CivilRights.DHHS@maine.gov}}}\sectd \ltrsect
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.  Civil rights complaints may also be filed with the U.S. Department of Health and Human Services, Office of Civil Rights, by phone at 800-368-1019 or 800-537-7697 (TDD); by mail to 200 I
ndependence Avenue, SW, Room 509, HHS Building, Washington, D.C. 20201; or electronically at }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5271939  HYPERLINK "https://ocrportal.hhs.gov/ocr/portal/lobby.jsf" }}{\fldrslt {\rtlch\fcs1 
\af0 \ltrch\fcs0 \cs90\ul\cf2\insrsid4523523\charrsid15100590 https://ocrportal.hhs.gov/ocr/portal/lobby.jsf}}}\sectd \ltrsect
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. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA/Civil Rights Coordinator.  This notice is available in alternate formats, upon request.

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\ltrch\fcs0 \insrsid4523523\charrsid15100590 The Department of Health and Human Services (\'93DHHS\'94
) does not discriminate on the basis of disability, race, color, sex, gender, sexual orientation, age, national origin, religious or political belief, ancestry, familial or marital status, genetic information, association, previous assertion of a claim or
 
right, or whistleblower activity, in admission or access to, or the operation of its policies, programs, services, or activities, or in hiring or employment practices.  This notice is provided as required by and in accordance with Title II of the American
s with Disabilities Act of 1990 (\'93ADA\'94
); Title VI of the Civil Rights Act of 1964, as amended; Section 504 of the Rehabilitation Act of 1973, as amended; Age Discrimination Act of 1975; Title IX of the Education Amendments of 1972; Section 1557 of the Affor
dable Care Act; the fb88 Human Rights Act; Executive Order Regarding State of fb88 Contracts for Services; and all other laws and regulations prohibiting such discrimination.  Questions, concerns, complaints or requests for additional information regard
ing the ADA and }{\rtlch\fcs1 \af0 \ltrch\fcs0 \i\ul\insrsid4523523\charrsid15100590 hiring or employment practices}{\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4523523\charrsid15100590 
 may be forwarded to the DHHS ADA/EEO Coordinators at 11 State House Station, Augusta, fb88 04333-0011; 207-287-4289 (V); 207-287-1871(V); or fb88 Relay 711 (TTY).  Questions, concerns, complaints or requests 
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 may be forwarded to the DHHS ADA/Civil Rights Coordinator, at 11 State House Station, Augusta, fb88 04333-0011; 207-287-5014 (V); fb88 Relay 711 (TTY); or }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5271939  HYPERLINK "mail
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.  Civil rights complaints may also be filed with the U.S. Department of Health and Human Services, Office of Civil Rights, by phone at 800-368-1019 or 800-537-7697 (TDD); by mail to 200 I
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. Individuals who need auxiliary aids for effective communication in program and services of DHHS are invited to make their needs and preferences known to the ADA/Civil Rights Coordinator.  This notice is available in alternate formats, upon request.

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\fs22\lang1024\langfe1024\loch\af31506\hich\af31506\dbch\af31505\noproof\insrsid7409277 
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5271939  HYPERLINK \\l "_Toc510418417" }}{\fldrslt {\rtlch\fcs1 \af1 \ltrch\fcs0 \cs90\ul\cf2\lang1024\langfe1024\noproof\insrsid7409277\charrsid3632763 REQUIRED POLICIES AND PROCEDURES}{
\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 \tab }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277  PAGEREF _Toc510418417 \\h }{\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\webhidden\insrsid7409277 {\*\datafield 08d0c9ea79f9bace118c8200aa004ba90b02000000080000000e0000005f0054006f006300350031003000340031003800340031003700000098}}}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 
\lang1024\langfe1024\noproof\webhidden\insrsid7409277 6}}}\sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj }}\sectd \ltrsect
\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\lang1024\langfe1024\loch\af31506\hich\af31506\dbch\af31505\noproof\insrsid7409277 
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5271939  HYPERLINK \\l "_Toc510418418" }}{\fldrslt {\rtlch\fcs1 \af1 \ltrch\fcs0 \cs90\ul\cf2\lang1024\langfe1024\noproof\insrsid7409277\charrsid3632763 
FORMS REQUIRED BY DEEP FOR SERVICE PROVISION}{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 \tab }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 
 PAGEREF _Toc510418418 \\h }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 {\*\datafield 08d0c9ea79f9bace118c8200aa004ba90b02000000080000000e0000005f0054006f0063003500310030003400310038003400310038000000ec}}}{\fldrslt 
{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 7}}}\sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj }}
\sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\lang1024\langfe1024\loch\af31506\hich\af31506\dbch\af31505\noproof\insrsid7409277 
\par }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5271939  HYPERLINK \\l "_Toc510418419" }}{\fldrslt {\rtlch\fcs1 \af1 \ltrch\fcs0 \cs90\ul\cf2\lang1024\langfe1024\noproof\insrsid7409277\charrsid3632763 APPENDIX A \endash 
 FORMS TO BE INCLUDED WITH THIS MANUAL}{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 \tab }{\field{\*\fldinst {\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277  PAGEREF _Toc510418419 
\\h }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 {\*\datafield 08d0c9ea79f9bace118c8200aa004ba90b02000000080000000e0000005f0054006f006300350031003000340031003800340031003900000002}}}{\fldrslt {\rtlch\fcs1 \af0 
\ltrch\fcs0 \lang1024\langfe1024\noproof\webhidden\insrsid7409277 8}}}\sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj }}\sectd \ltrsect
\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\lang1024\langfe1024\loch\af31506\hich\af31506\dbch\af31505\noproof\insrsid7409277 
\par }\pard\plain \ltrpar\s87\ql \li0\ri0\sl320\slmult0\widctlpar\tqr\tldot\tx10080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2388730 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 }}\pard\plain \ltrpar\s87\ql \li0\ri0\sl320\slmult0\widctlpar\tqr\tldot\tx10080\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2388730 \rtlch\fcs1 \af0\afs20\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 \sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\headery960\footery960\endnhere\sectdefaultcl\sectrsid10573250\sftnbj {\rtlch\fcs1 \af1 \ltrch\fcs0 
\insrsid6250757\charrsid4487545 \sect }\sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\sbknone\linex0\endnhere\sectlinegrid360\sectdefaultcl\sectrsid10573250\sftnbj {\headerr \ltrpar \pard\plain \ltrpar\s45\ql \li0\ri0\keep\widctlpar
\tqc\tx4320\tqr\tx8640\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1536886 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \caps\f62\fs14\expnd12\expndtw60\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 
\ltrch\fcs0 \insrsid10827853\charrsid1536886 
\par }}\pard\plain \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11352880 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \i\f1\insrsid11352880\charrsid4487545 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid7864615 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 \page }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 
{\*\bkmkstart _Toc510418414}P}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid4487545 ROGRAM GOVERNANCE}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 {\*\bkmkend _Toc510418414}
\par }\pard\plain \ltrpar\s31\qj \li0\ri0\sl-849\slmult0\keepn\widctlpar\pvpara\dxfrtext60\dfrmtxtx60\dfrmtxty0\wraparound\dropcapli3\dropcapt1\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7864615 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \caps\f1\fs114\dn10\insrsid7864615\charrsid4487545 M}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs114\dn10\insrsid7864615\charrsid4487545 
\par }\pard \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7864615 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 aine Revised Statutes granted authority to the Office of }
{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8409289 Behavioral Health }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 to administer the Driver Education and Evaluation Program.  See: }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid7864615\charrsid14224890 5 MRSA, Part 25, \'a7 521, \'a7\'a75}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid14224890  located at:
\par }\pard \ltrpar\s31\qc \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14224890 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid14224890\charrsid14224890 http://www.mainelegislature.org/legis/statutes/5/ti
tle5sec20072.html}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 
\par }\pard \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7864615 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 
Guidance for the administration of the DEEP program is located at }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid14224890 Chapter 2, Driver Education and Evaluation Policy and Procedures Manual}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\cs90\f1\insrsid14224890\charrsid14224890  located at: 
\par }\pard \ltrpar\s31\qc \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14224890 {\rtlch\fcs1 \af1 \ltrch\fcs0 \cs90\f1\ul\insrsid14224890\charrsid14224890 
http://www.maine.gov/dhhs/samhs/osa/deep/DEEPChapter2-July12007.pdf}{\rtlch\fcs1 \af1 \ltrch\fcs0 \cs90\f1\ul\insrsid14224890 
\par }\pard \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7864615 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7864615\charrsid4487545 As a provider, it i
s imperative you read and understand the expectations and requirements to perform evaluation and treatment services to DEEP clients.  Your signed application stipulates that you have read this manual as a requirement of becoming certified as a DEEP provid
er.
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid7864615 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \b\i\f1\fs24\insrsid7864615\charrsid4487545 At any time, statutes, rules, regulations, policies, procedures, and forms are subject to change. You will be notified of any changes that affect your provision of DEEP Services.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \i\f1\insrsid7864615\charrsid4487545 \page }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\i\f1\fs32\expnd-5\expndtw-25\cf15\kerning28\insrsid7864615\charrsid4487545 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid7864615 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 {\*\bkmkstart _Toc510418415}H}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid4487545 O
W TO USE THIS POLICY AND PROCEDURES MANUAL}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880 {\*\bkmkend _Toc510418415}
\par }\pard\plain \ltrpar\s24\qj \li0\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4487545 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4487545\charrsid4487545 
\par }\pard\plain \ltrpar\s31\qj \li0\ri0\sl-1322\slmult0\keepn\widctlpar\pvpara\posnegy-238\absh-1322\dxfrtext60\dfrmtxtx60\dfrmtxty0\wraparound\dropcapli5\dropcapt1\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid4487545 \rtlch\fcs1 
\af0\afs20\alang1025 \ltrch\fcs0 \f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \caps\f1\fs167\dn19\insrsid11352880\charrsid4487545 C}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\fs167\dn19\insrsid11352880\charrsid4487545 
\par }\pard \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11352880 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 hapter 2 }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid13324457 - t}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 he }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13324457 Driver Education And Evaluation Program }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 
Policies and Procedures Manual requires policies and procedures for many components of DEEP program provision.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13324457 DEEP requests you use}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 
 this document as a template to incorporate your program specific policies and procedures to augment those required of the DEEP program.  Th}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13324457 is template includes the }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid11352880\charrsid4487545 required components }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid13324457 to ensure compliance to the standards.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 This manual provides latitude for certai
n policies and procedures to be entered that reflect your organization\rquote s existing policies and procedures.  You will be prompted to document your internal policies and procedures in the Section \'93}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid11352880\charrsid9576520 Deep Required Policies and Procedures}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 \'94.  A copy of this manual with ALL prompts complete must be submitted with your application}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\insrsid13324457 /reapplication for certification}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 .
\par }\pard\plain \ltrpar\s24\qj \li0\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid11352880 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 Please do not change or delete the DEEP required components.   
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\fs32\expnd-5\expndtw-25\cf15\kerning28\insrsid11352880\charrsid4487545 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11352880\charrsid4487545 \page }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs32\expnd-5\expndtw-25\cf15\kerning28\insrsid11352880\charrsid4487545 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid7214741 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6889165\charrsid4487545 {\*\bkmkstart _Toc510418416}B}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid4487545 
ECOMING A DRIVER EDUCATION AND EVALUATION }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11275141\charrsid4487545 (}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6889165\charrsid4487545 DEEP}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11275141\charrsid4487545 )}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6889165\charrsid4487545  P}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid4487545 ROVIDER}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6250757\charrsid4487545 {\*\bkmkend _Toc510418416}
\par }\pard\plain \ltrpar\s33\ql \li0\ri40\sa360\sl240\slmult0\keep\keepn\widctlpar\tx6930\tx7650\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin40\lin0\itap0\pararsid686345 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\i\f223\fs28\expnd-4\expndtw-20\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\expnd0\expndtw0\lang9\langfe1033\langnp9\insrsid686345\charrsid4487545 The
 Driver Education and Evaluation Programs (DEEP) are the legislatively mandated (5 MRSA c.521, Sub-c. V) Operating under the Influence (OUI) countermeasures programs in the state of fb88. The goal of the programs is to lessen the incidence of injury, dis
ability and fatality that results from alcohol and other drug related motor vehicle crashes, and to reduce the risk of re-offense for OUI.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\expnd0\expndtw0\insrsid6250757\charrsid4487545 
\par }\pard\plain \ltrpar\s31\qj \li0\ri0\sl-849\slmult0\keepn\widctlpar\pvpara\dxfrtext60\dfrmtxtx60\dfrmtxty0\wraparound\dropcapli3\dropcapt1\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \caps\f1\fs114\dn10\insrsid6250757\charrsid4487545 t}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs114\dn10\insrsid6250757\charrsid4487545 
\par }\pard \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11275141\charrsid4487545 He Office of }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8409289 
Behavioral Health}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545  (}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8409289 OBH}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 )}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid11275141\charrsid4487545  is tasked with the administration of the DEEP Program.  It is incumbent upon }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8409289 OBH}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11275141\charrsid4487545 
 to certify all providers of evaluation, intervention and treatment components of the Driver Education and Evaluation Program.  In addition, the DEEP Program shall adopt rules requiring continuing education for recertification.
\par }\pard\plain \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14224890 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\fs24\insrsid7422792\charrsid14224890 W}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\insrsid15743479\charrsid14224890 HO CAN BECOME CERTIFIED }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\insrsid1011993\charrsid14224890 AS A DEEP }{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\fs24\insrsid15743479\charrsid14224890 PROVIDER}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\insrsid6250757 
\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\insrsid14224890\charrsid14224890 
\par }\pard\plain \ltrpar\s24\ql \li0\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8872983 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid1273960\charrsid4487545 AGENCIES/PROGRAMS: }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 
licensed by the fb88 Department of Health and Human Services may become a community-based service provider.  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 To do so, the following is required:
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid10946437\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar
\s24\qj \fi-360\li720\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls21\adjustright\rin0\lin720\itap0\pararsid10946437 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 A}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid7422792\charrsid4487545  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 complete }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid5900911\charrsid4487545 A}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 
pplication;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid10946437\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}A }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 signed }{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\insrsid11360626\charrsid4487545 L}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 etter of }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11360626\charrsid4487545 A}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid7422792\charrsid4487545 greement by the Program Administrator}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7634061\charrsid4487545  agreeing to }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid721129\charrsid4487545 the terms contained therein}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 ;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid10946437\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}A}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 
 copy of the active DHHS substance abuse provider license}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 ; and
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid10946437\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Th}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 e current }{\rtlch\fcs1 
\af1 \ltrch\fcs0 \f1\insrsid2309005\charrsid4487545 professional }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 licenses of all staff who will be providing services for the organization.
\par }\pard \ltrpar\s24\qj \li0\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid14297275 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 Licensed, }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid1273960\charrsid4487545 P}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11360626\charrsid4487545 rivate }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid1273960\charrsid4487545 P}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid11360626\charrsid4487545 rovider}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 s}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid1273960\charrsid4487545 : }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7634061\charrsid4487545 To do so, the following is required:}{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\insrsid11360626\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid10946437\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar
\s24\qj \fi-360\li720\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls13\adjustright\rin0\lin720\itap0\pararsid6650870 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 A complete }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid5900911\charrsid4487545 A}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10946437\charrsid4487545 pplication;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid7634061\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7634061\charrsid4487545 
A signed Letter of Agreement agreeing to the terms and conditions contained therein;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid721129\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid721129\charrsid4487545 
A non-refundable fee of $50.00 in check or money order made out to Treasurer, State of fb88;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid721129\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}A copy }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2309005\charrsid4487545 
of current professional license, as well as license as a Certified Clinical Supervisor, if applicable;}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid721129\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid2309005\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2309005\charrsid4487545 
A signed Qualified Service Organization Agreement with a Clinical Supervisor }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10166031\charrsid4487545 OR}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid2309005\charrsid4487545 
 Clinical Supervision within a Peer Supervision Group}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8938986\charrsid4487545 ;}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7422792\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid10166031\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10166031\charrsid4487545 
A signed Qualified Service Organization Agreement for the Person of Authority;}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8938986\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid15094267\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid15094267\charrsid4487545 
Current resume or curriculum vitae;}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid10166031\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid6782755\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6782755\charrsid4487545 L
etters of reference; at least two testifying to clinical ability;}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid15094267\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid6782755\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6782755\charrsid4487545 
A copy of fire escape plan that is posted at the location of services;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid6782755\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}A current fire inspection;
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid6782755\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard \ltrpar
\s24\qj \fi-360\li720\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls13\adjustright\rin0\lin720\itap0\pararsid6782755 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6782755\charrsid4487545 
A written statement from the town/city of adherence to all ordinances; and
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af1\afs20 \ltrch\fcs0 \f3\expnd-1\expndtw-5\insrsid6782755\charrsid4487545 \loch\af3\dbch\af0\hich\f3 \'b7\tab}Insurance
 documentation of comprehensive liability coverage that covers the provider and the client, or the provider and the client through coverage of the site.
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\fs24\insrsid6970730\charrsid4487545 For more information, please contact the DEEP office at (207) 626-8600 or the DEEP website}{\rtlch\fcs1 \af1 \ltrch\fcs0 \cs90\f1\fs24\ul\cf2\insrsid4487545  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\cs90\f1\fs24\insrsid4487545\charrsid4487545 at www.maine.gov/dhhs/samhs/osa/deep/}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\insrsid6970730\charrsid4487545 .}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs24\expnd-7\expndtw-35\kerning28\insrsid6782755\charrsid4487545 

\par }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid15478683\charrsid4487545 \page }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs32\expnd-5\expndtw-25\kerning28\insrsid15478683\charrsid4487545 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid3422555 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 {\*\bkmkstart _Toc510418417}R}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid329754 
EQUIRED POLICIES AND PROCEDURES}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 {\*\bkmkend _Toc510418417}
\par }\pard\plain \ltrpar\s31\qj \li0\ri0\sl-849\slmult0\keepn\widctlpar\pvpara\dxfrtext60\dfrmtxtx60\dfrmtxty0\wraparound\dropcapli3\dropcapt1\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3422555 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \caps\f1\fs114\dn10\insrsid3422555\charrsid4487545 P}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\fs114\dn10\insrsid3422555\charrsid4487545 
\par }\pard \ltrpar\s31\qj \li0\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3422555 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 er the Chapter 2 requirements, every }{\rtlch\fcs1 \af1 
\ltrch\fcs0 \f1\insrsid8683118\charrsid4487545 DEEP }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
provider must have Policies and Procedures Manual for the provision of DEEP Services.  Also required of this document is a table of contents and page numbers.  This manual serves as the Policies and Procedures Manual required by this regulation}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid8683118\charrsid4487545  and th}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid930373\charrsid4487545 is information shall be reviewed with DEEP clients prior to service provision.}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid3422555\charrsid4487545 
\par Please add your internal policies and procedures to the following:
\par {\listtext\pard\plain\ltrpar \s31 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard \ltrpar
\s31\qj \fi-360\li720\ri0\sa240\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls22\adjustright\rin0\lin720\itap0\pararsid3422555 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
How do you/your organization assure access to services for persons with disabilities?  
\par {\listtext\pard\plain\ltrpar \s31 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 2.\tab}What are your admission policies? 
\par {\listtext\pard\plain\ltrpar \s31 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 3.\tab}How do you make clients aware of you/your organization\rquote 
s philosophies, and rules and regulations which include admission criteria?  
\par {\listtext\pard\plain\ltrpar \s31 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 4.\tab}What are your payment policies?  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\b\i\f1\insrsid3422555\charrsid4487545 Please attach your fee schedule in Appendix A-1.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545   
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid9010644\charrsid4487545 \hich\af1\dbch\af0\loch\f1 5.\tab}}\pard\plain \ltrpar
\s24\qj \fi-360\li720\ri0\sa240\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls22\adjustright\rin0\lin720\itap0\pararsid3422555 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid9010644\charrsid4487545 As a treatment provider, h}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
ow do you determine whether additional evaluation is appropriate?  What is your process to provide services you do not provide?  
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid14557368\charrsid4487545 \hich\af1\dbch\af0\loch\f1 6.\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid14557368\charrsid4487545 As a treatment provider, w}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 hat is your policy and procedure for determining the need for a medical examination?  How do you/your organization refer clients for a medical examination?   }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\b\i\f1\insrsid3422555\charrsid4487545 Please attach your form to collect medical information in Appendix A-2.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 7.\tab}What is your discharge policy and procedure including procedures for planning the client\rquote 
s discharge in consultation with the client, and the indicators to be used in determining successful program completion?}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid329754  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 8.\tab}What is your policy describing methods and procedures used to ens
ure confidentiality of client records in compliance with federal confidentiality regulations, including electronic data/records?  }{\rtlch\fcs1 \af1 \ltrch\fcs0 \b\i\f1\insrsid3422555\charrsid4487545 
Please attach your release of information form in Appendix A-3.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \b\i\f1\insrsid329754   }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 9.\tab}What is your policy and procedures for the disposition of
 client records in case of program closure in compliance with Section F(27)(d) of Chapter 2 and federal regulations, including electronic records, if appropriate?}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid329754  }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid3422555\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s24 \rtlch\fcs1 \af0\afs20 \ltrch\fcs0 \f1\expnd-1\expndtw-5\insrsid6441172 \hich\af1\dbch\af0\loch\f1 10.\tab}}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6441172 How do you ensure c}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid930373\charrsid4487545 lients }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6441172 are provided}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid930373\charrsid4487545  information of screening and testing services for }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid6441172 those }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid930373\charrsid4487545 identified as h}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6441172 igh risk of infectious diseases?}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid930373\charrsid4487545 
  The infectious diseases include, but are not limited to HIV, Tuberculosis, Hepatitis B and Hepatitis C.}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6441172   }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid930373\charrsid4487545 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid930373\charrsid4487545 \page }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \b\f1\fs24\expnd-1\expndtw-5\insrsid930373\charrsid4487545 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid14224890 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 {\*\bkmkstart _Toc510418418}FORMS }{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid995277\charrsid4487545 REQUIRED BY DEEP }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 FOR }{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid995277\charrsid4487545 SERVICE}{\rtlch\fcs1 \af1 \ltrch\fcs0 
\f1\insrsid3422555\charrsid4487545  PROVISION{\*\bkmkend _Toc510418418}
\par }\pard\plain \ltrpar\s3\qc \li0\ri0\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0\pararsid3422555 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\b\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \sect }\sectd \ltrsect
\marglsxn720\margrsxn720\margtsxn720\margbsxn720\psz1\sbknone\linex0\endnhere\sectdefaultcl\sectrsid10573250\sftnbj {\footerr \ltrpar \pard\plain \ltrpar\s40\qc \li0\ri0\keep\widctlpar\brdrt\brdrs\brdrw15\brsp60 
\tqc\tx4320\tqr\tx8640\pvpara\phmrg\posxc\posy0\nowrap\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f62\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\field{\*\fldinst {\rtlch\fcs1 \af0 
\ltrch\fcs0 \cs63\b\insrsid10827853 PAGE  }}{\fldrslt {\rtlch\fcs1 \af0 \ltrch\fcs0 \cs63\b\lang1024\langfe1024\noproof\insrsid13596420 8}}}\sectd \ltrsect\marglsxn720\margrsxn720\margtsxn720\margbsxn720\linex0\endnhere\sectdefaultcl\sftnbj {\rtlch\fcs1 
\af0 \ltrch\fcs0 \cs63\b\insrsid10827853 
\par }\pard \ltrpar\s40\qc \li0\ri0\keep\widctlpar\brdrt\brdrs\brdrw15\brsp60 \tqc\tx4320\tqr\tx8640\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid10827853 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid10827853 
\par }}{\headerf \ltrpar \pard\plain \ltrpar\s45\ql \li0\ri0\keep\widctlpar\tqc\tx4320\tqr\tx8640\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\caps\f62\fs14\expnd12\expndtw60\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid10827853 
\par }}\pard\plain \ltrpar\s3\qc \li0\ri0\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel2\adjustright\rin0\lin0\itap0\pararsid3422555 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\b\f223\fs24\expnd-1\expndtw-5\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid3422555 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545 As a DEEP Provider, you will be required to use the following forms when providing DEEP evaluation and treat
ment services.  These forms conform to the standards of Chapter 2.  You may add additional components to these forms to assist you in providing best practices, but you cannot eliminate those elements in the original form.
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10290068\charrsid4487545 \line See }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3886820\charrsid14698590 www.maine.gov/dhhs/samhs/osa/deep/forms.htm}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid3886820\charrsid4487545  for }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid14698590 DEEP }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10290068\charrsid4487545 forms.
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  
\par }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid4487545 Provider Certification and Renewal Documents
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10827853\charrsid4487545 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard\plain \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls26\adjustright\rin0\lin720\itap0\pararsid1985160\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid4487545 Application}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9055432 : (Agency and Private Provider)}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid7026420\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10827853\charrsid9055432 \hich\af1\dbch\af0\loch\f1 2.\tab}}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid9055432 Clinical Supervision Agreement (Peer)}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9055432\charrsid9055432  or }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid9055432 Clinical Supervision Agreement}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9055432 
: Private Providers}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid9055432 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10827853\charrsid4487545 \hich\af1\dbch\af0\loch\f1 3.\tab}}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid4487545 DEE}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid9055432 P Policies and Procedures Manual}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914  Template}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9055432 : Private Providers}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid10827853\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10827853\charrsid4487545 \hich\af1\dbch\af0\loch\f1 4.\tab}Letter of Agreement}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9055432 : Agency and Private Providers}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid10827853\charrsid4487545 \hich\af1\dbch\af0\loch\f1 5.\tab}Person of Authority Agreement}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9055432 : Private Providers}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid4487545 
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10827853 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid10827853\charrsid4487545 Provider Service Forms}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid7026420\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3473914 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard\plain \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls32\adjustright\rin0\lin720\itap0\pararsid6441172\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid3473914 DEEP Provider Change of Information Form
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3473914 \hich\af1\dbch\af0\loch\f1 2.\tab}}\pard \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls32\adjustright\rin0\lin720\itap0\pararsid3473914\contextualspace {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914 DEEP Provider }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid3473914\charrsid4487545 Clinical Supervision Log}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid1985160\charrsid4487545 \hich\af1\dbch\af0\loch\f1 3.\tab}}\pard \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls32\adjustright\rin0\lin720\itap0\pararsid6441172\contextualspace {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 DEEP Provider Evaluation Form}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid1985160 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3473914 \hich\af1\dbch\af0\loch\f1 4.\tab}}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914 DEEP Provider Extension of Treatment Request Form}{\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid3473914\charrsid4487545 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3473914 \hich\af1\dbch\af0\loch\f1 5.\tab}}\pard \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls32\adjustright\rin0\lin720\itap0\pararsid3473914\contextualspace {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914 DEEP Provider }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid3473914\charrsid6441172 Special License }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914 Eligibility }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3473914\charrsid6441172 Form
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid1985160\charrsid4487545 \hich\af1\dbch\af0\loch\f1 6.\tab}}\pard \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls32\adjustright\rin0\lin720\itap0\pararsid6441172\contextualspace {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 DEEP Provider Treatment Form
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid1985160 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 \f223\fs16\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 You may use your own forms for the following so long as they comply with the requirement within the regulation:
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard\plain \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls31\adjustright\rin0\lin720\itap0\pararsid1985160\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545 A}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 ssessment: Regulation }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545 F(7)
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 2.\tab}Collection of Medical Information form}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 
: Regulation}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  F(9)
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 3.\tab}Individual Treatment Plan}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 : Regulation}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  F(11)
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 4.\tab}Progress Note Form}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 : Regulation}{\rtlch\fcs1 
\af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  F(13)
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 5.\tab}Aftercare Plan}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 : Regulation}{\rtlch\fcs1 
\af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  F(14)
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 6.\tab}Discharge Summary form}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 : Regulation}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  F(17)
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid3422555\charrsid4487545 \hich\af1\dbch\af0\loch\f1 7.\tab}Confidentiality Statement}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1985160\charrsid4487545 : Regulation}{
\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid3422555\charrsid4487545  F(27)(e)}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid200169\charrsid4487545 {\*\bkmkstart Application}{\*\bkmkstart LOA}\page }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 
\f1\fs24\insrsid200169\charrsid4487545 
\par }\pard\plain \ltrpar\s1\ql \li0\ri0\sb240\sa120\keepn\widctlpar\wrapdefault\aspalpha\aspnum\faauto\outlinelevel0\adjustright\rin0\lin0\itap0\pararsid7214741 \rtlch\fcs1 \af0\afs20\alang1025 \ltrch\fcs0 
\f62\fs32\expnd-5\expndtw-25\cf15\lang1033\langfe1033\kerning28\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid6953531\charrsid4487545 {\*\bkmkstart APPA}{\*\bkmkstart _Toc510418419}{\*\bkmkend Application}{\*\bkmkend LOA}A}{
\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid14224890 PPENDIX A}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid7305536\charrsid4487545 {\*\bkmkend APPA} \endash  F}{\rtlch\fcs1 \af1 \ltrch\fcs0 \f1\insrsid14224890 ORMS TO BE INCLUDED WITH THIS MANUAL}{\rtlch\fcs1 
\af1 \ltrch\fcs0 \f1\insrsid6953531\charrsid4487545 {\*\bkmkend _Toc510418419}
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid6953531\charrsid4487545 \hich\af1\dbch\af0\loch\f1 1.\tab}}\pard\plain \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls23\adjustright\rin0\lin720\itap0\pararsid6441172\contextualspace \rtlch\fcs1 \af0\afs22\alang1025 \ltrch\fcs0 \f31506\fs22\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs24 
\ltrch\fcs0 \f1\fs24\insrsid6953531\charrsid4487545 A copy of your fee schedule}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid14039780\charrsid4487545  }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid1255942\charrsid4487545 
and payment policies }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid14698590 form }{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid14039780\charrsid4487545 which m}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid9267794\charrsid4487545 
ust include a client signature component.}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid6441172 
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid6441172 \hich\af1\dbch\af0\loch\f1 2.\tab}A copy of your me}{\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid8412685\charrsid6441172 dical Information form.
\par {\listtext\pard\plain\ltrpar \s92 \rtlch\fcs1 \af0 \ltrch\fcs0 \f1\insrsid8412685\charrsid4487545 \hich\af1\dbch\af0\loch\f1 3.\tab}}\pard \ltrpar\s92\ql \fi-360\li720\ri0\sa200\sl276\slmult1
\widctlpar\wrapdefault\aspalpha\aspnum\faauto\ls23\adjustright\rin0\lin720\itap0\pararsid8412685\contextualspace {\rtlch\fcs1 \af1\afs24 \ltrch\fcs0 \f1\fs24\insrsid8412685\charrsid4487545 A copy of your release of information form.
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