ࡱ> ikfghq` )bjbjqPqP Az::h     aaa8:aD~a >8ff(fff ȗ$vh З:lЗЗ  ff/З^ f fЗ J Ifzf PF+Ua. 0>,Ԙ~II ] ЗЗЗЗЗЗЗRnЗЗЗ>ЗЗЗЗ   Ua   a          fb88Care coverage of Physical Therapy Services is limited. Refer to Chapter II, Section 85.06 for specific limitations. Use the following modifiers when appropriate: TF Intermediate Level of care used for PT Assistants and priced 10% below the Allowance rate GP Services delivered under an outpatient physical therapy plan of care TL - Services delivered under an Individualized Family Service Plan (IFSP) TM - Services delivered under an Individualized Education Plan (IEP) with fb88Care Addendum denoting medical necessity of the service  CODESERVICEUNITMAXIMUM ALLOWANCE97001Physical Therapy Evaluation per evaluation$35.9497002Physical Therapy Re-evaluation (Ongoing therapy) per session$19.4097150 GPTherapeutic procedure(s), group (2 or more individuals)per member per session$11.98THERAPEUTIC MODALITIES SUPERVISED97012Application of a modality to one or more areas; traction, mechanicalper service $6.2497014Application of a modality to one or more areas;per service$5.6197016Application of a modality to one or more areas; vasopneumatic devicesper service$6.2897018Application of a modality to one or more areas; paraffin bathper service$3.0597022Application of a modality to one or more areas; whirlpoolper service$7.0697024Application of a modality to one or more areas; diathermyper service$2.1097026Application of a modality to one or more areas; infraredper service$1.9497028Application of a modality to one or more areas; ultravioletper service$2.62CODESERVICEUNITMAXIMUM ALLOWANCETHERAPEUTIC MODALITIES CONSTANT ATTENDANCE97032Application of a modality to one or more areas; electrical stimulation (manual)15 minutes$6.8897033Application of a modality to one or more areas; iontophoresis15 minutes$9.9097034Application of a modality to one or more areas; contrast baths15 minutes$6.0097035Application of a modality to one or more areas; ultrasound15 minutes$4.8997036Application of a modality to one or more areas; Hubbard tank15 minutes$10.58THERAPEUTIC PROCEDURES97110Therapeutic procedure, one or more areas; therapeutic exercises to develop strength and endurance, range of motion and flexibility15 minutes$11.9397112Neuromuscular re-education of movement, balance, coordination, kinesthetic sense, posture, and proprioception for sitting and/or standing activities15 minutes$12.4697113Aquatic therapy with therapeutic exercises15 minutes$14.3497116Gait training (includes stair climbing)15 minutes$10.4697124Massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion)15 minutes$9.5997140Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions15 minutes$11.15 CODESERVICEUNITMAXIMUM ALLOWANCE97760Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk15 minutes$13.4597761Prosthetic training, upper and/or lower extremity(s)15 minutes$12.0997530Therapeutic activities, direct (one-on-one) patient contact by the provider (use of dynamic activities to improve functional performance)15 minutes$12.6097532Development of cognitive skills to improve attention, memory, problem solving, (includes compensatory training,) direct (one-on-one) patient contact by the provider15 minutes$10.3897533Sensatory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact by provider15 minutes$11.0297535Self/care/home management training (e.g. activities of daily living (ADL) and compensatory training, meal preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact by provider15 minutes$12.7897542Wheelchair management(eg, assessment, fitting, training)15 minutes$11.67ACTIVE WOUND CARE MANAGEMENT97597Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g. high pressure water jet with/without suction, sharp selective debridement with scissors, scalpel and forceps), with or without topical application(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area less than or equal to 20 square centimetersper service$23.54 CODESERVICEUNITMAXIMUM ALLOWANCE97598Removal of devitalized tissue from wound(s), selective debridement, without anesthesia (e.g. high pressure water jet with/without suction, sharp selective debridement with scissors, scalpel, and forceps), with or without topical application(s), wound assessment, and instruction(s) for ongoing care, may include use of a whirlpool, per session; total wound(s) surface area greater than 20 square centimeters per service$23.5497602Removal of devitalized tissue from wound(s), non-selective debridement, without anesthesia (e.g., wet-to-moist dressings, enzymatic, abrasion), including topical applications(s), wound assessment and instructions(s) for ongoing careper service$16.86TESTS AND MEASUREMENTS97762Check out for orthotic/prosthetic use, established patient15 minutes$13.3197750Physical performance test or measurement (e.g., musculoskeletal, functional capacity), with written report15 minutes$12.3997755Assistive technology assessment (e.g. to restore, augment or compensate for existing function, optimize functional tasks and/or maximize environmental accessibility), direct one-on-one contact by provider, with written report 15 minutes$14.4492605Evaluation for prescription of non-speech-generating augmentative and alternative communication deviceper service$34.2692607Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with patient; first hour60 minutes$61.6792608Evaluation for prescription for speech-generating augmentative and alternative communication device, face-to-face with patient; each additional 30 minutes30 minutes$11.91  CODESERVICEUNITMAXIMUM ALLOWANCEMUSCLE AND RANGE OF MOTION TESTING95831Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunkper service$11.3795832Muscle testing, manual (separate procedure) with report; extremity - hand, with or without comparison with normal sideper service$10.3895833Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding handsper service$16.0795834Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk total evaluation of body, including handsper service$18.9495851Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)per service$7.5195852Range of motion measurements and report (separate procedure); each extremity hand, with or without comparison with normal sideper service$5.84CENTRAL NERVOUS SYSTEM ASSESSMENTS/TESTS (e.g. NEURO-COGNITIVE, MENTAL STATUS, SPEECH TESTING)96110Developmental testing; limited (e.g. Developmental Screening Test II, Early Language Milestone Screen) with interpretation and reportper service$4.6496111Developmental testing; limited (e.g. Developmental Screening Test II, Early Language Milestone Screen) with interpretation and report extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments (e.g., Bayley Scales of Infant Development) with interpretation and reportper service$56.39     10-144CH. 101 MAINECARE BENEFITS MANUAL CHAPTER III SECTION 85 PHYSICAL THERAPY SERVICES LAST UPDATED 06/29/12  PAGE 5 10-144CH. 101 MAINECARE BENEFITS MANUAL CHAPTER III SECTION 85 PHYSICAL THERAPY SERVICES LAST UPDATED 06/29/12  PAGE \* MERGEFORMAT 1 Effective 06/29/12 Effective 06/29/12 Effective 06/29/12 Effective 06/29/12 Effective 06/29/12 y% & ' ( ) * 7 < N O P U V q r % Ĩ{h{N<<<<#h*h*>*CJOJQJ^JaJ2h*h*>*CJOJQJ^JaJmHnHtHu$h9h*CJaJmH nH sH tH -h9h*5>*CJ\aJmH nH sH tH *h9h*>*CJ\aJmH nH sH tH 6jh9h*>*CJU\aJmHnHsH tH u0jh9h*CJUaJmHnHsH tH u#h*h*5CJOJQJ^JaJ h*h*CJOJQJ^JaJyz S % & ) * / 7 < N $Ifgd* $Ifgd* $$Ifa$gd* $Ifgd*$If @ !`'- h^h`gd*gd* @ !(h.gd*'()N O P V r L<<< @ !`'-$Ifkd$$IfTlr&%,46v 0644 laTr 7' @ !`'-$Ifkd$$IfTlPr&%,46v 0644 laT$ @ !`'-$Ifa$ $ @ !`'-$Ifa$ @ !`'-$If L<<< @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT 9) @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$ $ @ !`'-$Ifa$gd* @ !`'-$Ifgd* @ !`'-$If % J::' @ !`'-$Ifgd* @ !`'-$Ifkd$$IfTlkr&%,46v 0644 laT% < C D !kd$$IfTlyr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$% < F g k l q r HIJKOPWX\]nq޺޺޺޺޺ޟpppZ*h9h*>*CJ\aJmH nH sH tH &h*h*5CJOJQJ\^JaJ4jh*h*CJOJQJU^JaJmHnHu4jh*hoCJOJQJU^JaJmHnHu#h*h*>*CJOJQJ^JaJ#h*h*5CJOJQJ^JaJ h*h*CJOJQJ^JaJ h 96h*CJOJQJ^JaJD E F h i j $ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$gdR $Ifgd* @ !`'-$Ifj k l r J::' @ !`'-$Ifgd* @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT 7' @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$ $ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$If  L<<< @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT    #kd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$     $ @ !`'-$Ifa$ @ !`'-$If ! " ( n L<<< @ !`'-$Ifkd $$IfTlr&%,46v 0644 laTn z #kd $$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$ $ @ !`'-$Ifa$ @ !`'-$If L<<< @ !`'-$Ifkd $$IfTlr&%,46v 0644 laT #kd $$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ $ @ !`'-$Ifa$ @ !`'-$If & L<<< @ !`'-$Ifkd $$IfTlr&%,46v 0644 laT& 2 8 9 #kd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$9 : ; < = > $ @ !`'-$Ifa$ @ !`'-$If> ? @ F L<<< @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT !kd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ $ @ !`'-$Ifa$ @ !`'-$If L<<< @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT #kd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ $ @ !`'-$Ifa$ @ !`'-$If 5J::: @ !`'-$Ifkd$$IfTlkr&%,46v 0644 laT5AGH!kd$$IfTlkr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$HKPX]o$ @ !`'-$Ifa$ @ !`'-$IfopqrL<&&$ @ !`'-$Ifa$gd* @ !`'-$Ifkd$$IfTlr&%,46v 0644 laT4+ $Ifgd*kd$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd* $Ifgd* $Ifgd* $$Ifa$gd* $Ifgd*$)23OU38;GOIJĠĠIJIJątttttĠIJ`'h9h*>*CJaJmH nH sH tH  h*h*CJOJQJ^JaJ4jh*h*CJOJQJU^JaJmHnHu#h*h*>*CJOJQJ^JaJ#h*h*5CJOJQJ^JaJ h*h*CJOJQJ^JaJ$h9h*CJaJmH nH sH tH -h9h*5>*CJ\aJmH nH sH tH $J::'$ @ !`'-$Ifa$ @ !`'-$Ifkd|$$IfTlr&%,46v 0644 laT9) @ !`'-$Ifkdy$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$IfZL<<) @ !`'-$Ifgd* @ !`'-$Ifkdr$$IfTlr&%,46v 0644 laTZekl#kdk$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$lmnopq$ @ !`'-$Ifa$ @ !`'-$IfqrsyL<<) @ !`'-$Ifgd* @ !`'-$Ifkdd$$IfTlr&%,46v 0644 laT#kd]$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$IfL<<) @ !`'-$Ifgd* @ !`'-$IfkdV$$IfTlr&%,46v 0644 laT#$#kdO$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$%&'()$ @ !`'-$Ifa$ @ !`'-$If)*+1nL<<) @ !`'-$Ifgd* @ !`'-$IfkdH$$IfTlr&%,46v 0644 laTny#kdA $$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$IfL<<&$ @ !`'-$Ifa$gd* @ !`'-$Ifkd:!$$IfTlr&%,46v 0644 laT!kd3"$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$ @ !`'-$Ifa$$ @ !`'-$Ifa$gd* @ !`'-$If3J::' @ !`'-$Ifgd* @ !`'-$Ifkd6#$$IfTlr&%,46v 0644 laT3>EFG7' @ !`'-$Ifkd3$$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$GHIJK$ @ !`'-$Ifa$ @ !`'-$IfKLMSL<<) @ !`'-$Ifgd* @ !`'-$Ifkd6%$$IfTlr&%,46v 0644 laT#kd/&$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$If3L<<< @ !`'-$Ifkd('$$IfTlr&%,46v 0644 laT3>EF#kd!($$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$FGHIJK$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$IfKLMS{L<<< @ !`'-$Ifkd)$$IfTlr&%,46v 0644 laT{#kd*$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$IfL<<< @ !`'-$Ifkd +$$IfTlr&%,46v 0644 laT  #kd,$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ $ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$IfL<<< @ !`'-$Ifkd,$$IfTlr&%,46v 0644 laT!kd-$$IfTlr&%,46v 0644 laT$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfJH?33 $$Ifa$gd* $Ifgd*kd.$$IfTlYr&%,46v 0644 laT:* @ !`'-$Ifkd/$$IfTlrV,F$+d5v 0644 la0T $Ifgd* $Ifgd*x$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfL<<< @ !`'-$Ifkd0$$IfTlrV,F$+d5v 0644 la0T9) @ !`'-$Ifkd1$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfL<<< @ !`'-$Ifkd2$$IfTlrV,F$,d5\ 0644 la0T9) @ !`'-$Ifkd3$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$w$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfL<<< @ !`'-$Ifkd4$$IfTlrV,F$,d5\ 0644 la0T9) @ !`'-$Ifkd5$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$<GN$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfNOPQRL<<) @ !`'-$Ifgd* @ !`'-$Ifkd6$$IfTlrV,F$,d5\ 0644 la0TRSTU#kd7$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$UV\$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfL<<< @ !`'-$Ifkd8$$IfTlrV,F$,d5\ 0644 la0T9) @ !`'-$Ifkd9$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$$ +2$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$If23456L<<< @ !`'-$Ifkd:$$IfTlrV,F$,d5\ 0644 la0T6789:9) @ !`'-$Ifkd;$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$:@y$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$IfL<<)$ @ !`'-$Ifa$ @ !`'-$Ifkd<$$IfTlrV,F$,d5\ 0644 la0T7' @ !`'-$Ifkd=$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$IfL9)) @ !`'-$If @ !`'-$Ifgd*kd>$$IfTlrV,F$,d5\ 0644 la0T9) @ !`'-$Ifkd?$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$;GN$ @ !`'-$Ifa$gd* $$Ifa$ @ !`'-$Ifgd* @ !`'-$IfNOQTYaJH?33 $$Ifa$gd* $Ifgd*kd@$$IfTlrV,F$,d5\ 0644 la0TOQRSTafx$%-/ƵwcL8&h*h*hJ;FCJOJQJ^JaJ-h9h*hJ;F>*CJaJmH nH sH tH 'h9h*>*CJaJmH nH sH tH &h*h*hJ;FCJOJQJ^JaJ$h9h*CJaJmH nH sH tH -h9h*5>*CJ\aJmH nH sH tH  h*h*CJOJQJ^JaJ4jh*h*CJOJQJU^JaJmHnHu4jh*h 96CJOJQJU^JaJmHnHuhoafxyz:* @ !`'-$IfkdA$$IfTlrV,F$,d5\ 0644 la0T $Ifgd* $Ifgd*z%,$ @ !`'-$Ifa$gdR $$Ifa$ @ !`'-$Ifgd* @ !`'-$If,-./0J::' @ !`'-$Ifgd* @ !`'-$IfkdB$$IfTlerV,F$,d5\ 0644 la0T/013#/7=?V9?<Bo u *!,!-!.!0!=!B!T!U!ɵɣɟmZm$h9h*CJaJmH nH sH tH -h9h*5>*CJ\aJmH nH sH tH 4jh*hoCJOJQJU^JaJmHnHuh4#h*h*5CJOJQJ^JaJ'h9h*>*CJaJmH nH sH tH  h*h*CJOJQJ^JaJ)h9h*hJ;F>*CJmH nH sH tH  h*h*CJOJQJ^JaJ0123-kdC$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd* $$Ifa$34:#/6$ @ !`'-$Ifa$gdR $$Ifa$ @ !`'-$Ifgd* @ !`'-$If6789:L<<)$ @ !`'-$Ifa$ @ !`'-$IfkdD$$IfTlrV,F$,d5\ 0644 la0T:;<=>7' @ !`'-$IfkdE$$IfTlbrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$>?VWX$ @ !`'-$Ifa$ @ !`'-$IfXYZ`L<<) @ !`'-$Ifgd* @ !`'-$IfkdF$$IfTlrV,F$,d5\ 0644 la0T#kdG$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$If&L<<) @ !`'-$Ifgd* @ !`'-$IfkdH$$IfTlrV,F$,d5\ 0644 la0T&189#kdI$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$9:;<=>$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$If>?@F)L<<) @ !`'-$Ifgd* @ !`'-$IfkdJ$$IfTlrV,F$,d5\ 0644 la0T)4;<#kdK$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$<=>?@A$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$IfABCIL9)) @ !`'-$If @ !`'-$Ifgd*kdL$$IfTlrV,F$,d5\ 0644 la0T#kdM$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$$ @ !`'-$Ifa$ @ !`'-$If\ L<<< @ !`'-$IfkdN$$IfTlrV,F$,d5\ 0644 la0T\ g n o #kdO$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$o p q r s t $ @ !`'-$Ifa$ @ !`'-$Ift u v | !J77' @ !`'-$If @ !`'-$Ifgd*kdP$$IfTl rV,F$,d5\ 0644 la0T!"!)!*!#kdQ$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$*!,!/!0!5!=!B!T! $Ifgd* $Ifgd* $$Ifa$gd* $Ifgd*T!U!X!Y!|!J::'$ @ !`'-$Ifa$ @ !`'-$IfkdR$$IfTl rV,F$,d5\ 0644 la0TU!V!W!Y!|!!!!"""#!###a$g$%% %i%l%r%s%&&&&'''''''''ͼ~jb^b^b^b^hjhU&h4h*hU'CJOJQJ^JaJ4jh*hoCJOJQJU^JaJmHnHu h4h*CJOJQJ^JaJ#h*h*5CJOJQJ^JaJ h*h*CJOJQJ^JaJ.jh4CJOJQJU^JaJmHnHu4jh*h 96CJOJQJU^JaJmHnHu$|!}!~!!!9) @ !`'-$IfkdS$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$!!!!!$ @ !`'-$Ifa$ @ !`'-$If!!!!!L<<< @ !`'-$IfkdT$$IfTlrV,F$,d5\ 0644 la0T!!!!#kdU$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$!!!"""$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$If""" ""L<<< @ !`'-$IfkdV$$IfTlrV,F$,d5\ 0644 la0T""""#kdW$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gdR$ @ !`'-$Ifa$""""""$ @ !`'-$Ifa$ @ !`'-$If""""#L<<< @ !`'-$IfkdX$$IfTlrV,F$,d5\ 0644 la0T#####kdY$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$##### #$ @ !`'-$Ifa$ @ !`'-$If #!#"#(##L<<< @ !`'-$IfkdZ$$IfTlrV,F$,d5\ 0644 la0T#####kd[$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$######$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$If####N$L<<< @ !`'-$Ifkd\$$IfTlrV,F$,d5\ 0644 la0TN$Z$`$a$#kd]$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$a$b$c$d$e$f$$ @ !`'-$Ifa$ @ !`'-$Iff$g$h$n$$L<<< @ !`'-$Ifkd^$$IfTlrV,F$,d5\ 0644 la0T$$%%#kd_$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$%%%%%%$ @ !`'-$Ifa$ @ !`'-$If%% % %i%J::'$ @ !`'-$Ifa$ @ !`'-$Ifkd`$$IfTlbrV,F$,d5\ 0644 la0Ti%j%k%l%m%9) @ !`'-$Ifkda$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$m%n%o%p%q%$ @ !`'-$Ifa$ @ !`'-$Ifq%r%t%z%&L<<< @ !`'-$Ifkdb$$IfTlrV,F$,d5\ 0644 la0T& &&&#kdc$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$&&&&&&$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$ @ !`'-$Ifgd* @ !`'-$If&&& &}'J::' @ !`'-$Ifgd* @ !`'-$Ifkdd$$IfTlrV,F$,d5\ 0644 la0T}''''#kde$$IfTlrV,F$,d5\ 0644 la0T$ @ !`'-$Ifa$gd*$ @ !`'-$Ifa$''''''''''''''((((($a$gd*#  P7$d&dNP]^gdsX @ !`'-$ @ !`'-a$$ @ !`'-^a$gd4'( ( ((((((((((((w(((((((((((ɹl]lL!hULQCJOJQJaJmHnHuh<h<CJOJQJaJ%jh<h<CJOJQJUaJh<CJOJQJaJ h*h<h<CJOJQJ!hULQ0JCJOJQJmHnHuh<0JCJOJQJjh<0JCJOJQJUh<h2.h<5OJQJhlCJOJQJaJh>䴳ϴ*<CJOJQJaJ(+(E(Q(R(((((((((((((gd*gdm7$a$gd*#  P7$d&dNP]^gdsX @ !`'-gd*$ @ !`'-a$gd*$ @ !`'-^a$gd*(((((((((((((((((((((((((((()) ))))))))))ıč~~~~~zi h*h*CJOJQJ^JaJhl h*h<CJOJQJaJh 96CJOJQJaJhlCJOJQJaJh>䴳ϴѴ<CJOJQJaJhh<h7{h<6CJOJQJaJh<h<CJOJQJaJ0jh<h<CJOJQJUaJmHnHu'(((((((()) )))))))gd4gd*? 001h0P:p 96= /!"#$% $$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V lP0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V lk0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V ly0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V lk0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V lk0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l06,55555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l06,55555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V l0655555v / / / T$$If!vh55555v #v#v#v#v#vv :V lY0655555v / / / T$$If0!vh55555v #v#v#v#v#vv :V l0655555v / / / a0T$$If0!vh55555v #v#v#v#v#vv :V l0655555v / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V le0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V lb0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l 0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l 06,55555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V lb0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T$$If0!vh55555\ #v#v#v#v#v\ :V l0655555\ / / / a0T 0\@\ Normal5$7$8$9DH$$CJOJQJ^J_HaJmH sH tH |@| * Heading 1,$ @ !`'-5$7$8$9D@&H$#>*CJOJQJ^JaJmHsHtH@ * Heading 22$$ @ !`'-5$7$8$9D@&H$a$&5CJOJQJ\^JaJmHsHtH@ * Heading 32$$ @ !`'-5$7$8$9D@&H$a$#>*CJOJQJ^JaJmHsHtHDA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List D@D  Header  !^JmHsHtHD @D  0Footer  !^JmHsHtHzz  Table Grid7:V05$7$8$9DH$BO!B H@q Char Char4CJOJQJ^JaJBO1B H@q0 Char Char3CJOJQJ^JaJ6U@A6 H@q Hyperlink >*B*phbB@Rb H@q Body Texth5$7$8$9DH$]hCJOJQJ^JmHsHtH6Oa6 H@q Char Char2CJaJFV@qF l_|FollowedHyperlink >*B*phb>@b *Title$5$7$8$9DH$a$&5CJOJQJ\^JaJmHsHtH8O8 * Char Char1 5CJ\6O6 * Char Char7>*aJ8O8 * Char Char6 5\aJ6O6 * Char Char5>*aJ2)@2 * Page Number^JT@T R Balloon Text CJOJQJ^JaJmHsHtH@O@ R Char CharCJOJQJ^JaJ(=Qeg!(=Qegj!zyz S%&)*/7<NOPVr%<CDEFhijklr !"(nz&289:;<=>?@F5AGHKPX]opqrZeklmnopqrsy#$%&'()*+1ny3 > E F G H I J K L M S    3 > E F G H I J K L M S {          x w <GNOPQRSTUV\$ +23456789:@y;GNOQTYafxyz%,-./01234:#/6789:;<=>?&189:;<=>?@F)4;<=>?@ABCI\gnopqrstuv|")*,/05=BTUXY|}~  !"(NZ`abcdefghn  ijklmnopqrtz  }     + E Q R !! !!!!!!0000000000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 00 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0@0I00@0I00@0I00@0I00@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0I00?0000000000000000000  % O/U!'() =~N r % D j   n & 9 > 5HoZlq$)n3GK3FK{ NRU26:Naz,036:>&9>)<A\ o t !*!T!|!!!!!""""## ####N$a$f$$%%i%m%q%&&&}''(()!"#$%&'()*+,-./0123456789:;<>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}) !!@  @H 0(  . -(  D  L?"Text Box 2c"`?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK D  L?"Text Box 2c"`?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK D  L?"Text Box 2c"`?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK D  L?"Text Box 2c"`?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK D  L?"Text Box 2c"`?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK D  L?"Text Box 2c"`?PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!H%Gdrs/e2oDoc.xmlSێ }@7vdXqVlSU^~8F ;؛< 3lnVN.tR"4JCA??_(q)ТgMgrA vyg xo$q-s0B2=$e*&Vۈ_ׂu'{da2H>!I^ghoP~¡M%fRcÌ 9\hr8}DVKJ4kQ'{z~:r {4{Fc<∆]AY ]#XMHٽ aGmC:N6!l9npMlZ?XX hI8Ԣ9$@j/=;eɉa St]/_!ҸJd[%偷7TSVz$2p7):#IC%vuA#N,| 2C^{k );G'fPL\[#dqcԏ~PK!/2drs/downrev.xmlLN0DHHܨHTUJmnm!v.pYi4fFL4αt Qz|{F|My}U`݅4B#b !nɢ_8zg7X Q^b52Kq\h0ZN*{v~zFSۛyhaPFY{aGa dY7PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!H%G.drs/e2oDoc.xmlPK-!/2drs/downrev.xmlPK  D   "?D    "?D    "?D    "?D    "? D   "? B S  ?o    &'HI QR,UVr![^t^t/t /O"tN}t qNq t E[E!tdit1#t ^tetrOt_GoBack!! !;>#&   | !33333SS$$%%&(=B77FFHJpp  jj""~C D D D MM11HMOS&+3305YY275:hmoouu#(*.//UW[_rs ll       !!!!!!!    % ' * + 4 5 = > D E L M P R Y Z \ ] e f m n v w w { | !! !!!!!!Tdj`h 8^8`o(hH. ^`hH.  L^ `LhH.  ^ `hH. x^x`hH. HL^H`LhH. ^`hH. ^`hH. L^`LhH.Tdj         s<nh?Vc7~I!+0 R4sV5. @Iob &,H R5^  / QU ~u  vq >  t  T " #@zHnB.J(87U[]$/&0~+dp*TO{~-t)fSo{s B[} 9Ms)0S l&8]L\h,0JRUEn4MW ~ 5!j!)!J!"3# #"h$k$ %7%S%&-&:&M&*'**,*S*8m*n*2+)+(4+#t+,,7&,-, -j'-*-~D-.}T.k.//00#E0 1#1]12H(2Dy3" 4'k4#5T 5J.5K566 96{7H7)7A7Qn7 8B8:V;?;O;a;B=Z/>A>8>???8?;䰪9-5C|8<+D=D$FD|D<$E+EKE(SET]E&FrF|Fp~F GH$HLHQH+XHfHgH;Jj J=KGKhKjKxKWLLL$L5MM N{"N,)N AN^N2O(O$P{P'QULQPQPQ^WQ\QuQ*RSRtSkS_S#S5S:S TT!T_U U:U[Un V#V&V:+VTVWC8WWXsX(Y)Yr4YZkYdZ0ZBHZYZoZ#!\>bw*C"#,津䰪ܳ岹2+#wJwQ\w@xElx(vx#:yGy7{I|l_|5u|1w|}}E}b~Q ~A~c~{j~"\`h7ri=@co o0:dU]YBq}T#Bi :UExV+EPgS"/i ||n Wps}<K EIaQo?u+W NJpV; 'umE2P;RaS%;[.s:$*3Z/&KjBN> OK lvCN$p&]Bf|oXKG\*bhknx6+XsZz5Cxl 1E!<Vf7_qx0]4_/XW> <&T sCY;DwCELNgw%g#  2  6K>.+:`/<v&0QRTO7l Ys^euR~Q4HB'A+L6NU NF[1mxRAXJ4v5=wx'dv|#2<k Mfkr}W(C}N&b7a{!9VYXk8pv[ p+W_.CITPR[(3CFZ^BWw$+|P )I='KrZ;[bjJmMpBKW%,KZ4n \ C_W^p u:VgbUsc 65<@e{ B<q C(B!rFC@^nI0!i?Y g*7 Uu#GH[&)[pS?D[m7B.w 2<>gQsBwO;u>t(_+`w j;3@xJcet@YN|"Yf!%^o-Vt)(@Ohv*C1Drk%&*/7<NOPVr%<CDEFhijklr !"(nz&289:;<=>?@F5AGHKPX]opqrZeklmnopqrsy#$%&'()*+1ny3 > E F G H I J K L M S    3 > E F G H I J K L M S {          x w <GNOPQRSTUV\$ +23456789:@y;GNOQTYafxyz%,-./01234:#/6789:;<=>?&189:;<=>?@F)4;<=>?@ABCI\gnopqrstuv|")*,05=BTUXY|}~  !"(NZ`abcdefghn  ijklmnopqrtz  }!3"""""""@`7!p@UnknownGz Times New Roman5Symbol3& z ArialK,Bookman Old Style5& zaTahoma"V h')' 99"V x42qV HX ?:MaineCare coverage of Physical Therapy Services is limited Peggie.L.Dore don.wismer Oh+'0 4 HT t   <fb88Care coverage of Physical Therapy Services is limitedPeggie.L.Dore Normal.dot don.wismer4Microsoft Office Word@e@iM@)U@J*U՜.+,D՜.+,D hp  #$Dept. of Health and Human Services9 ;fb88Care coverage of Physical Therapy Services is limited TitleP <D_NewReviewCycle  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUWXYZ[\]_`abcdejRoot Entry F Y+UlData f1TableWordDocumentAzSummaryInformation(VDocumentSummaryInformation8^CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q