ࡱ> %` bjbj"x"x @@|I .( $ , TTTL,, V ƴLҵ(sUuUuUuUuUuUuU$Xh@[xU h^UL L U...L sU.sU..z[I: ^ 'T %,Tʶ,GMjUdBVVMv[['T[ 'T.UUpV, , , mz+, , , z, , , L L L L L L  Sample Informed Consent Form( Consent Form Study Title  Why sign this document? To be in this study, sign this document. Why are you doing this research study? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What happens if I say yes, I want to be in the study? If you say yes, we will: Ask about [describe survey items, e.g., your health, what you eat, and if you exercise, smoke, or drink alcohol, and what medicines you take]. Give you a form with questions for you to answer. Read the questions out loud and fill out the form with you, if you want. There are no right or wrong answers to these questions. You can skip any question you do not want to answer. How long will the study take? The study will take about [insert time] of your time. What happens if I say no, I do not want to be in the study? No one will treat you differently. You will not be penalized. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher: For studies with no prospect of benefit add: You will not lose any benefits.] The care you get from your doctor will not change. What happens if I say yes, but change my mind later? You can stop being in the study at any time. You will not be penalized. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher:For studies with no prospect of benefit add: You will not lose any benefits.]The care you get from your doctor will not change. Who will see my answers? The only people allowed to see your answers will be the people who work on the study and people who make sure we run our study the right way. [Note to researcher: If there is a study sponsor that will have access to the data, name sponsor here.] Your survey answers, health information, and a copy of this document will be locked in our files. We will not put your answers into your medical record. When we share the results of the study [insert details here, e.g., in medical journals] we will not include your name. We will do our best to make sure no one outside the study will know you are a part of the study. Will it cost me anything to be in the study? No. Will being in this study help me in any way? Being in the study will not help you, but may help people with [insert condition] in the future. Will I be paid for my time? Yes. We will give you [insert amount]. This is to pay you for your time. You will get this money [insert detail, e.g., at the end of the survey today] even if you decide to skip some of the questions. Is there any way being in this study could be bad for me? Yes. There is a chance that: The questions could make you sad or upset. Someone could find out that you were in the study and learn something about you that you did not want them to know. You could have a legal problem if you told us about a crime such as child abuse [list other mandatory reporting required in your state] that we have to report. We will do our best to protect your privacy. [Note to researcher: Insert details on additional risks if relevant to the study, such as: You could have a legal problem if someone outside the study found out that you did something illegal.] [Provide details regarding accommodation or referrals (e.g., for counseling) if relevant to the study.] What if I have questions? Please call the head of the study, [insert name and phone #] if you: Have any questions about the study. Have questions about your rights. Feel you have been injured in any way by being in this study. You can also call the office in charge of research at [insert phone #] to ask questions about this study. Do I have to sign this document? No. You only sign this document if you want to be in the study. What should I do if I want to be in the study? You sign this document. We will give you a copy of the document to keep. By signing the document you are saying: You agree to be in the study. We talked with you about the information in this document and answered all your questions. You know that: You can skip questions you do not want to answer. You can stop answering our questions at any time and nothing will happen to you. You can call the office in charge of research at [insert phone #] if you have any questions about the study or about your rights. _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion Sample HIPAA Authorization Form( Version for investigator who is in the same covered entity as the PHI of interest Permission to Use and Share Your Protected Health Information Study Title Why sign this document? To let the researchers from [insert name of institution or organization] use and share your health information for this study, sign this document. We will give you a copy. Why are you asking for my information? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What information will you use and share for the study? If you say yes, we will: Use and share information from [insert name of institution or organization]. Use and share [describe in detail the information to be used, e.g., entire medical record, information from your record, such as how often you visited the doctor and the reason for your visits, what medicines you take, the results of lab tests, and your medical record number, sex, and date of birth]. The information we are asking to use and share is called Protected Health Information. It is protected by a federal law called the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). In general, we cannot use or share your health information for research without your permission. If you want, we can give you more information about the Privacy Rule. Also, if you have any questions about the Privacy Rule you can speak to our Privacy Officer at [insert phone #]. How will you use and share this information? We will use your information only for the study described in this document. We may share your information with [list anyone other than the researchers who will receive identifiable information. For example, if there is a study sponsor that will have access to the data, name sponsor here]. [Note to researcher: If the information is being shared for any reason other than this research study that also requires a HIPAA authorization, this purpose needs to be described. For example: We may share your name with other people doing research on [insert condition] so they can contact you about being in other research studies.] We will do our best to make sure your information stays private. But, if we share information with people who do not have to follow the Privacy Rule, your information will no longer be protected by the Privacy Rule. Let us know if you have questions about this. What happens if I say no? We will not use or share your information for this study. The care you get from your doctor will not change. What happens if I say yes, but change my mind later? At any time, you can tell us to stop using and sharing health information that can be traced to you. We will stop, except in very limited cases if needed to comply with law, protect your safety, or make sure the research was done properly. If you have any questions about this please ask. [Note to researcher: After permission is revoked, researchers are permitted to use and disclose health information in very limited circumstances that relate to protecting the integrity of the research. For example, such use and disclosure is permitted to account for a subject's withdrawal from the research study, to conduct investigations of scientific misconduct, or to report adverse events.] If you want us to stop, you have to tell us in writing. Write or email [insert name and address and email]. If you have any questions contact [insert name and phone # and email]. If you stop, the care you get from your doctor will not change. How long will my health information be used? We expect our study to take [insert number] years. We will not use or share your information after the study is done. [Note to researcher: If the information is being shared for any reason other than this research, that also requires a HIPAA authorization (e.g., sharing a persons contact information for recruiting to other research projects), include the expiration date for the authorized activity, if different from this expiration date.] What if I have questions? If you have any questions about the study call the head of the study, [insert name and phone #]. Please call if you have: Questions about your rights. Questions about how we will use and share your information. You can also call the office in charge of research at [insert phone #] to ask questions about this study. By signing the document you are letting us use and share your health information for this study. [Add other uses and disclosures referenced above. For example: By signing the document you are giving us permission to contact you about being in other research studies] _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion Sample HIPAA Authorization Form( Version for investigator who is in an institution that is covered by HIPAA but is not the covered entity that has the PHI of interest Permission to Use and Share Your Protected Health Information Study Title Why sign this document? To let your health care providers from [insert name of institution or organization] share your health information with the researchers from [insert name of institution or organization] and to let the researchers use and share your health information for this study, sign this document. We will give you a copy. Why are you asking for my information? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What information will you get from my provider, and use and share for the study? If you say yes, we will: Send this permission form to your health care providers at [insert name of institution or organization]. Get and use [describe in detail the information to be requested and used, e.g., entire medical record, information from your record, such as how often you visited the doctor and the reason for your visits, what medicines you take, the results of lab tests, and your medical record number, sex, and date of birth]. The information we are asking to use and share is called Protected Health Information. It is protected by a federal law called the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). In general, we cannot use or share your health information for research without your permission. If you want, we can give you more information about the Privacy Rule. Also, if you have any questions about the Privacy Rule you can speak to our Privacy Officer at [insert phone #]. How will you use and share my information? We will use your information only for the study described in this document. We may share your information with [list anyone outside the researchers who will receive identifiable information. For example, if there is a study sponsor that will have access to the data, name sponsor here.]. [Note to researcher: If the information is being shared for any reason other than this research study that also requires a HIPAA authorization, this purpose needs to be described. For example: We may share your name with other people doing research on [insert condition] so they can contact you about being in other research studies.] We will do our best to make sure your information stays private. But, if we share information with people who do not have to follow the Privacy Rule, your information will no longer be protected by the Privacy Rule. Let us know if you have questions about this. What happens if I say no? We will not get your information. The care you get from your doctor will not change. What happens if I say yes, but change my mind later? At any time, you can stop letting your health care providers share information with us. You can also tell us to stop using and sharing health information that can be traced to you. We will stop, except in very limited cases if needed to comply with law, protect your safety, or make sure the research was done properly. If you have any questions about this please ask. [Note to researcher: After permission is revoked, researchers are permitted to use and disclose health information in very limited circumstances that relate to protecting the integrity of the research. For example, such use and disclosure is permitted to account for a subject's withdrawal from the research study, to conduct investigations of scientific misconduct, or to report adverse events] If you want us to stop getting and using your information, you have to tell us and your health care provider in writing. If you want us to tell your health care provider for you, let us know and we will do that. Write or email [insert name and address and email]. If you have any questions contact [insert name and phone # and email]. If you stop, the care you get from your doctor will not change. How long will my health information be used? We expect our study to take [insert number] years. After the study is done, your health care provider at [insert name of institution or organization] will no longer share your information with us and we will no longer use or share your information. [Note to researcher: If the information is being shared for any reason other than this research, that also requires a HIPAA authorization (e.g., sharing a persons contact information for recruiting to other research projects), include the expiration date for the authorized activity, if different from this expiration date.] What if I have questions? If you have any questions about the study call the head of the study, [insert name and phone #]. Please call if you have: Questions about your rights. Questions about how we will use and share your information. You can also call the office in charge of research at [insert phone #] to ask questions about this study. By signing the document: You are letting your health care provider share your health information with us. You are letting us use and share your health information for this study. [Add other uses and disclosures referenced above. For example: By signing the document you are giving permission to be contacted about being in other research studies.] _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion Sample HIPAA Authorization Form( Version for investigator who is not in an institution that is covered by HIPAA to get PHI from a covered entity Permission to Get Your Protected Health Information Study Title Why sign this document? To let your health care providers from [insert name of institution or organization] share your health information with the researchers in this study from [insert name of institution or organization], sign this document. We will give you a copy. Why are you asking for my information? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What information will you get from my health care providers? If you say yes, we will: Send this permission form to your health care providers at [insert name of institution or organization]. Get [describe in detail the information to be used, e.g., entire medical record, information from your record, such as how often you visited the doctor and the reason for your visits, what medicines you take, the results of lab tests, and your medical record number, sex, and date of birth]. The information we are asking to get is called Protected Health Information. It is protected by a federal law called the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). In general, your health care provider cannot share your health information for research without your permission. If you want, we can give you more information about the Privacy Rule. We will do our best to make sure your information stays private. But, once your information has been shared with us it will no longer be protected by the Privacy Rule. Let us know if you have questions about this. What happens if I say no? We will not get your information. The care you get from your doctor will not change. What happens if I say yes, but change my mind later? At any time, you can stop letting your health care providers share information with us. But, you have to tell your health care provider in writing. If you want us to tell your health care provider for you, let us know and we will do that. Write or email [insert name and address and email]. If you have any questions contact [insert name and phone # and email]. If you stop, the care you get from your doctor will not change. For how long will my health care provider be allowed to share my information? We expect our study to take [insert number] years. After the study is done, your health care provider at [insert name of institution or organization] will no longer share your information with us. [Note to researcher: Edit this statement if authorization ends at an earlier time.] What if I have questions? If you have any questions about the study call the head of the study, [insert name and phone #]. Please call if you have: Questions about your rights. Questions about how your health care providers will share your information with us. By signing the document you are letting your health care provider share your health information with us. _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion Sample Combined Informed Consent and HIPAA Authorization Form( Version for investigator who is in the same covered entity as the PHI of interest Consent Form and Permission to Use and Share Your Protected Health Information Study Title Why sign this document? To be in this study and let the researchers from [insert name of institution or organization] use and share your health information for this study, sign this document. Why are you doing this research study? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What happens if I say yes, I want to be in the study? If you say yes, we will: Ask about [describe survey items, e.g., your health, what you eat, and if you exercise, smoke, or drink alcohol, and what medicines you take]. Give you a form with questions for you to answer. Read the questions out loud and fill out the form with you, if you want. There are no right or wrong answers to these questions. You can skip any question you do not want to answer. How long will the study take? The study will take about [insert time] of your time. What information will you use and share for the study? If you say yes, we will also: Use and share information from [insert name of institution or organization]. We will use and share [describe in detail the information to be used, e.g., your entire medical record, information from your record how often you visited the doctor and the reason for your visits, what medicines you take, the results of lab tests, and your medical record number, sex, and date of birth]. The information we are asking to use and share is called Protected Health Information. It is protected by a federal law called the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). In general, we cannot use or share your health information for research without your permission. If you want, we can give you more information about the Privacy Rule. Also, if you have any questions about the Privacy Rule you can speak to our Privacy Officer at [insert phone #]. How will you use and share my information? We will use your information only for the study described in this document. We may share your information with [list anyone other than the researchers who will receive identifiable information. For example, if there is a study sponsor that will have access to the data, name sponsor here]. [Note to researcher: If the information is being shared for any reason other than this research study that also requires a HIPAA authorization, this purpose needs to be described. For example: We may share your name with other people doing research on [insert condition] so they can contact you about being in other research studies.] We will do our best to make sure your information stays private. But, if we share information with people who do not have to follow the Privacy Rule, your information will no longer be protected by the Privacy Rule. Let us know if you have questions about this. What happens if I say no? If you say no: We will not use or share your information for this study. No one will treat you differently. You will not be penalized. The care you get from your doctor will not change. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher: For studies with no prospect of benefit add: You will not lose any benefits.] What happens if I say yes, but change my mind later? You can stop being in the study at any time. You will not be penalized. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher: For studies with no prospect of benefit add: You will not lose any benefits.] You can tell us to stop using and sharing health information that can be traced to you. We will stop, except in very limited cases if needed to comply with law, protect your safety, or make sure the research was done properly. If you have any questions about this please ask. [Note to researcher: After permission is revoked, researchers are permitted to use and disclose health information in very limited circumstances that relate to protecting the integrity of the research. For example, such use and disclosure is permitted to account for a subject's withdrawal from the research study, to conduct investigations of scientific misconduct, or to report adverse events.] If you want us to stop, you have to tell us in writing. Write or email [insert name and address and email]. If you have any questions contact [insert name and phone # and email]. If you stop, the care you get from your doctor will not change. Who will see my answers? The only people allowed to see your answers will be the people who work on the study and people who make sure we run our study the right way. [Note to researcher: If there is a study sponsor that will have access to the data, name sponsor here.] Your survey answers, health information, and a copy of this document will be locked in our files. We will not put your answers into your medical record. When we share the results of the study [insert details here, e.g., in medical journals] we will not include your name. We will do our best to make sure no one outside the study will know you are a part of the study. Will it cost me anything to be in the study? No. Will being in this study help me in any way? Being in the study will not help you, but may help people with [insert condition] in the future. Will I be paid for my time? Yes. We will give you [insert amount]. This is to pay you for your time. You will get this money [insert detail, e.g., at the end of the survey today] even if you decide to skip some of the questions. Is there any way being in this study could be bad for me? Yes. There is a chance that: The questions could make you sad or upset. Someone could find out that you were in the study and learn something about you that you did not want them to know. You could have a legal problem if you told us about a crime such as child abuse [list other mandatory reporting required in your state] that we have to report. We will do our best to protect your privacy. [Note to researcher: Insert details on additional risks if relevant to the study, such as: You could have a legal problem if someone outside the study found out that you did something illegal.] [Provide details regarding accommodation or referrals (e.g., for counseling) if relevant to the study.] How long will my health information be used? We expect our study to take [insert number] years. We will not use or share your information after the study is done. [Note to researcher: If the information is being shared for any reason other than this research, that also requires a HIPAA authorization (e.g., sharing a persons contact information for recruiting to other research projects), include the expiration date for the authorized activity, if different from this expiration date.] What if I have questions? If you have any questions about the study call the head of the study, [insert name and phone #]. Please call if you have: Any questions about the study. Questions about your rights. Concerns that you have been injured in any way by being in this study. Questions about how we will use and share your information. You can also call the office in charge of research at [insert phone #] to ask questions about this study. Do I have to sign this document? No. You only sign this document if you want to be in the study. What should I do if I want to be in the study? You sign this document. We will give you a copy. By signing the document you are saying: You agree to be in the study. You are letting us use and share your health information for this study. [Add other uses and disclosures referenced above. For example: You are giving permission to contact you about being in other research studies] We talked with you about the information in this document and answered all your questions. You know that: You can skip questions you do not want to answer. You can stop answering our questions at any time and nothing will happen to you. You can call the office in charge of research at [insert phone #] if you have any questions about the study or about your rights. _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion Sample Combined Informed Consent and HIPAA Authorization Form( Version for investigator who is in an institution that is covered by HIPAA but is not the covered entity that has the PHI of interest Consent Form and Permission to Use and Share Your Protected Health Information Study Title Why sign this document? Sign this document if you want to: Be in this study. Let your health care providers from [insert name of institution or organization] share your health information with the researchers from [insert name of institution or organization]. Let the researchers use and share your health information for this study. Why are you doing this research study? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What happens if I say yes, I want to be in the study? If you say yes, we will: Ask about [describe survey items, e.g., your health, what you eat, and if you exercise, smoke, or drink alcohol, and what medicines you take]. Give you a form with questions for you to answer. Read the questions out loud and fill out the form with you, if you want. There are no right or wrong answers to these questions. You can skip any question you do not want to answer. How long will the study take? The study will take about [insert time] of your time. What information will you use and share for the study? If you say yes, we will also: Send this permission form to your health care providers at [name of institution or organization]. We will use and share [describe in detail the information to be used, e.g., your entire medical record, information from your record how often you visited the doctor and the reason for your visits, what medicines you take, the results of lab tests, and your medical record number, sex, and date of birth]. The information we are asking to use and share is called Protected Health Information. It is protected by a federal law called the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). In general, we cannot use or share your health information for research without your permission. If you want, we can give you more information about the Privacy Rule. Also, if you have any questions about the Privacy Rule you can speak to our Privacy Officer at [insert phone #]. How will you use and share my information? We will use your information only for the study described in this document. We may share your information with [list anyone outside the researchers who will receive identifiable information. For example, if there is a study sponsor that will have access to the data, name sponsor here.]. [Note to researcher: If the information is being shared for any reason other than this research study that also requires a HIPAA authorization, this purpose needs to be described. For example: We may share your name with other people doing research on [insert condition] so they can contact you about being in other research studies.] We will do our best to make sure your information stays private. But, if we share information with people who do not have to follow the Privacy Rule, your information will no longer be protected by the Privacy Rule. Let us know if you have questions about this. What happens if I say no? If you say no: We will not get your information. No one will treat you differently. You will not be penalized. The care you get from your doctor will not change. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher: For studies with no prospect of benefit add: You will not lose any benefits.] What happens if I say yes, but change my mind later? You can stop being in the study at any time. You will not be penalized. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher: For studies with no prospect of benefit add: You will not lose any benefits.] You can stop letting your health care providers share information with us. You can also tell us to stop using and sharing health information that can be traced to you. We will stop, except in very limited cases if needed to comply with law, protect your safety, or make sure the research was done properly. If you have any questions about this please ask. [Note to researcher: After permission is revoked, researchers are permitted to use and disclose health information in very limited circumstances that relate to protecting the integrity of the research. For example, such use and disclosure is permitted to account for a subject's withdrawal from the research study, to conduct investigations of scientific misconduct, or to report adverse events.] If you want us to stop, you have to tell us in writing. Write or email [insert name and address and email]. If you have any questions contact [insert name and phone # and email]. If you stop, the care you get from your doctor will not change. Who will see my answers? The only people allowed to see your answers will be the people who work on the study and people who make sure we run our study the right way. [Note to researcher: If there is a study sponsor that will have access to the data, name sponsor here.] Your survey answers, health information, and a copy of this document will be locked in our files. We will not put your answers into your medical record. When we share the results of the study [insert details here, e.g., in medical journals] we will not include your name. We will do our best to make sure no one outside the study will know you are a part of the study. Will it cost me anything to be in the study? No. Will being in this study help me in any way? Being in the study will not help you, but may help people with [insert condition] in the future. Will I be paid for my time? Yes. We will give you [insert amount]. This is to pay you for your time. You will get this money [insert detail, e.g., at the end of the survey today] even if you decide to skip some of the questions. Is there any way being in this study could be bad for me? Yes. There is a chance that: The questions could make you sad or upset. Someone could find out that you were in the study and learn something about you that you did not want them to know. You could have a legal problem if you told us about a crime such as child abuse [list other mandatory reporting required in your state] that we have to report. We will do our best to protect your privacy. [Note to researcher: Insert details on additional risks if relevant to the study, such as: You could have a legal problem if someone outside the study found out that you did something illegal.] [Provide details regarding accommodation or referrals (e.g., for counseling) if relevant to the study.] How long will my health information be used? We expect our study to take [insert number] years. After the study is done, your health care provider at [insert name of institution or organization] will no longer share your information with us and we will no longer use or share your information. [Note to researcher: If the information is being shared for any reason other than this research, that also requires a HIPAA authorization (e.g., sharing a persons contact information for recruiting to other research projects), include the expiration date for the authorized activity, if different from this expiration date.] What if I have questions? If you have any questions about the study call the head of the study, [insert name and phone #]. Please call if you have: Any questions about the study. Questions about your rights. Concerns that you have been injured in any way by being in this study. Questions about how we will use and share your information. You can also call the office in charge of research at [insert phone #] to ask questions about this study. Do I have to sign this document? No. You only sign this document if you want to be in the study. What should I do if I want to be in the study? You sign this document. We will give you a copy. By signing the document you are saying: You agree to be in the study. You are letting your health care provider share your health information with us. You are letting us use and share your health information for this study. [Add other uses and disclosures referenced above. For example: By signing the document you are giving permission to contact you about being in other research studies.] We talked with you about the information in this document and answered all your questions. You know that: You can skip questions you do not want to answer. You can stop answering our questions at any time and nothing will happen to you. You can call the office in charge of research at [insert phone #] if you have any questions about the study or about your rights. _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion Sample Combined Informed Consent and HIPAA Authorization Form( Version for investigator who is not in an institution that is covered by HIPAA Consent Form and Permission to Get Your Protected Health Information Study Title Why sign this document? To be in this study and let your health care providers from [insert name of institution or organization] share your health information with the researchers in this study from [insert name of institution or organization], sign this document. Why are you doing this research study? We want to learn more about how to help people who have [insert condition]. This study will help us learn more about [insert specifics]. We are asking people like you who have [insert condition] to help us. What happens if I say yes, I want to be in the study? If you say yes, we will: Ask about [describe survey items, e.g., your health, what you eat, and if you exercise, smoke, or drink alcohol, and what medicines you take]. Give you a form with questions for you to answer. Read the questions out loud and fill out the form with you, if you want. There are no right or wrong answers to these questions. You can skip any question you do not want to answer. How long will the study take? The study will take about [insert time] of your time. What information will you get from my health care providers? If you say yes, we will also: Send this permission form to your health care providers at [insert name of institution or organization]. We will get [describe in detail the information to be used, e.g., entire medical record, information from your record how often you visited the doctor and the reason for your visits, what medicines you take, the results of lab tests, and your medical record number, sex, and date of birth]. The information we are asking to get is called Protected Health Information. It is protected by a federal law called the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA). In general, your health care provider cannot share your health information for research without your permission. If you want, we can give you more information about the Privacy Rule. We will do our best to make sure your information stays private. But, once your information has been shared with us it will no longer be protected by the Privacy Rule. Let us know if you have questions about this. What happens if I say no? If you say no: We will not get your information. No one will treat you differently. You will not be penalized. The care you get from your doctor will not change. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] [Note to researcher: For studies with no prospect of benefit add: You will not lose any benefits.] What happens if I say yes, but change my mind later? You can stop being in the study at any time. You will not be penalized. [Note to researcher: For studies with prospect of benefit add: While you would not get the benefit of being in this study, you will not lose any other benefits.] You can stop letting your health care providers share information with us. But, you have to tell your health care provider in writing. If you want us to tell your health care provider for you, let us know and we will do that. Write or email [insert name and address and email]. If you have any questions contact [insert name and phone # and email]. If you stop, the care you get from your doctor will not change. Who will see my answers? The only people allowed to see your answers will be the people who work on the study and people who make sure we run our study the right way. [Note to researcher: If there is a study sponsor that will have access to the data, name sponsor here.] Your survey answers, health information, and a copy of this document will be locked in our files. We will not put your answers into your medical record. When we share the results of the study [insert details here, e.g., in medical journals] we will not include your name. We will do our best to make sure no one outside the study will know you are a part of the study. Will it cost me anything to be in the study? No. Will being in this study help me in any way? Being in the study will not help you, but may help people with [insert condition] in the future. Will I be paid for my time? Yes. We will give you [insert amount]. This is to pay you for your time. You will get this money [insert detail, e.g., at the end of the survey today] even if you decide to skip some of the questions. Is there any way being in this study could be bad for me? Yes. There is a chance that: The questions could make you sad or upset. Someone could find out that you were in the study and learn something about you that you did not want them to know. You could have a legal problem if you told us about a crime such as child abuse [list other mandatory reporting required in your state] that we have to report. We will do our best to protect your privacy. [Note to researcher: Insert details on additional risks if relevant to the study, such as: You could have a legal problem if someone outside the study found out that you did something illegal.] [Provide details regarding accommodation or referrals (e.g., for counseling) if relevant to the study.] How long will my health care provider be allowed to share my information? We expect our study to take [insert number] years. After the study is done, your health care provider at [name of institution or organization] will no longer share your information with us. [Note to researcher: Edit this statement if authorization ends at an earlier time.] What if I have questions? If you have any questions about the study call the head of the study, [insert name and phone #]. Please call if you have: Any questions about the study. Questions about your rights. Concerns that you have been injured in any way by being in this study. Questions about how your health care providers will share your information with us. You can also call the office in charge of research at [insert phone #] to ask questions about this study. Do I have to sign this document? No. You only sign this document if you want to be in the study. What should I do if I want to be in the study? You sign this document. We will give you a copy. By signing the document you are saying: You agree to be in the study. You are letting your health care provider share your health information with us. [Add other uses and disclosures referenced above. For example: By signing the document you are giving permission to contact you about being in other research studies.] We talked with you about the information in this document and answered all your questions. You know that: You can skip questions you do not want to answer. You can stop answering our questions at any time and nothing will happen to you. You can call the office in charge of research at [insert phone #] if you have any questions about the study or about your rights. _______________________________ Your name (please print) _______________________________ _____ Your signature Date If an interpreter was used: _______________________________ Name of interpreter (please print) _______________________________ _____ Signature of Interpreter Date If someone is signing this form for the subject, explain why: _____________________________________ ________________________________ Name of legally responsible person(please print) ________________________________ _____ Signature of person signing for the subject Date Relationship toyou: ________________________________ ________________________________ Name of person conducting the consent discussion (please print) ________________________________ _____ Signature of person conducting the Date consent discussion ( This form is designed for minimal risk, noninterventional research only. ( This form is designed for minimal risk, noninterventional research only. ( This form is designed for minimal risk, noninterventional research only. ( This form is designed for minimal risk, noninterventional research only. ( This form is designed for minimal risk, noninterventional research only. ( This form is designed for minimal risk, noninterventional research only. ( This form is designed for minimal risk, noninterventional research only.       PAGE  PAGE 3  PAGE 4 PAGE 5 PAGE 4 PAGE 8 PAGE 7 PAGE 7 We are asking you to be in a research study. You do not have to be in the study. If you say yes, you can quit the study at any time. Please take as much time as you need to make your choice. Your medical care will not change in any way if you say no. We are asking you to let us use and share your health information in a research study. Your medical care will not change in any way if you say no. We are asking you to let your health care providers share your health information for a research study. We are also asking you to let us use and share your health information for this research study. Your medical care will not change in any way if you say no. We are asking you to let your health care providers share your health information for a research study. Your medical care will not change in any way if you say no. We are asking you to be in a research study. You do not have to be in the study. If you say yes, you can quit the study at any time. Please take as much time as you need to make your choice. Your medical care will not change in any way if you say no. We are asking you to be in a research study. You do not have to be in the study. If you say yes, you can quit the study at any time. Please take as much time as you need to make your choice. Your medical care will not change in any way if you say no. We are asking you to be in a research study. You do not have to be in the study. If you say yes, you can quit the study at any time. Please take as much time as you need to make your choice. Your medical care will not change in any way if you say no. -89:;RSh~  , - W оudUPUAUPUhxO5CJOJQJ^JaJ *hxO *hxOCJOJQJ^JaJ hxO5CJ OJQJ\^JaJ #hxO5>*CJ OJQJ\^JaJ hxOCJOJQJ^JaJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJhxO5>*\#jh"5>*U\mHnHuhxO *hfthxO!hxO5CJ$OJPJQJ^JaJ$ j*h6hxO0J5 hxO5,-9;S}~vbU *]*^gdxO *d]*^gdxO *]*^gdxO T]T^gdxOgdxO$ !T]T^a$gdxO$ !]^a$gdxO9$ $d!%d &d!'d$N!O P!Q$]^a$gdxO +~w x X V & F ` *Eƀʦ]*^gdxO*]*gdxO *]*^gdxOW X h i w x U V w {  D c } ~   * + ȶחח׉׉xxng_ *hQ_hxO *hQ_5 *h="hQ_5 hxO5>*CJ OJQJ^JaJ h.V CJOJQJ^JaJhBCJOJQJ^JaJ hxO5CJ OJQJ\^JaJ #hxO5>*CJ OJQJ\^JaJ hxO5CJOJQJ^JaJhxOCJOJQJ^JaJ *hxOCJOJQJ^JaJ *hxO *hxO5!X C D c QD7DD *]*^gdxO *]*^gdxOV & F ` *Eƀʦ]*^gdxOV & F ` *Eƀʦ]*^gdxO N O OPl6 *]*^gdxO @*]*^gdxO *]*^gdxO *]*^gdxO   M N O mp  ;;}s;e;hxCJOJQJ^JaJ *h="h="5hxOhxOCJ OJQJ^JaJ hxO5>*CJ OJQJ^JaJ hxO5>*CJaJ hxO5hxOCJOJQJ^JaJ *hxOCJOJQJ^JaJ *hxO *hQ_5 *h="hQ_5 *hQ_hQ_5# *hQ_hxOCJOJQJ^JaJ'-.>?OPl7q}~MЪИ{qiahxOCJaJ *h";&hxO *h="h="5h="CJOJQJ^JaJhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ #hxO5>*CJOJQJ\^JaJ *hxO *hxOCJOJQJ^JaJhxOCJOJQJ^JaJ hxO5>*CJ OJQJ^JaJ hB5>*CJ OJQJ^JaJ #67q8[ & F$ ` *7$8$EƀʦH$]*^gdxO*7$8$H$]*^gdxO *]*^gdxON*Eƀ&]*^gdxO-I8+ *]*^gdxO*7$8$H$]*^gdxO[ & F$ ` *7$8$EƀʦH$]*^gdxO[ & F$ ` *7$8$EƀʦH$]*^gdxO()EGM & F'*Eƀm׆]*gdxO *]*^gdxOO*C$Eƀצ]*^gdxO *]*^gdxO&')*DEUhiѿqcRKRqcGc9Gc9h7CJOJQJ^JaJhxO *hxO\ *hxOCJOJQJ\^JaJhxOCJOJQJ^JaJhxOCJOJQJ\^JaJhxOCJ OJQJ^JaJ hxO5>*CJ OJQJ^JaJ hx5>*CJ OJQJ^JaJ hxO>*CJOJQJ^JaJ# *h";&hxOCJOJQJ^JaJ *h";&hxO *h) *hxO>*CJOJQJ^JaJ hxO5>*CJOJQJ^JaJz{ cVVVVVVV *]*^gdxOM & F'*Eƀm׆]*gdxOM & F'*Eƀm׆]*gdxO  FGUVyz{  : ~~~~~~tj\hxOCJOJQJ^JaJhxOCJOJQJhxCJOJQJhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ hxO5>*CJaJ hxO5>*CJ OJQJ^JaJ hxO5>*CJOJQJ^JaJ *hxO *hxOCJOJQJ^JaJh7CJOJQJ^JaJhxOCJOJQJ^JaJhxO$ VW1Z & F 8*dEƀʦ]*^gdxOZ & F 8*dEƀʦ]*^gdxO *]*^gdxO *]*^gdxO:y\ & F @ 8 *dEƀʦ]*^gdxO *d]*^gdxO *]*^`gdxO:E4 T]T^gdxO\ & F @ 8 *dEƀ,ӆ]*^gdxO\ & F @ 8 *dEƀʦ]*^gdxO0IKq,-k ^gdxO^gdxOgdxO ^gdxO ]^gdxO  T]T^gdxO ]^gdxO  v:?@_`a34^_ڹyod_d *hxO *hxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJ jhxO5>*UmHnHuhxO56CJ$OJPJQJ% *hfthxO56CJ$OJPJQJhxO5CJ$OJPJQJ *hxO5 j*h6hxO0J5 hxO5 hC5hxOhxOCJOJQJhxOCJOJQJ^JaJ# >?uv(;=?gdxO ]^gdxO ]^gdxO^gdxO ^gdxO ^gdxO?@ayp*]*gdxO *]*^gdxO *]*^gdxO T]T^gd"$ !]^a$gdxOh^hgdxO<$ I:$d!%d$&d!'d$N!O$P!Q$]^a$gdxO $%&6789bcst0 1 [ \ m n !!""# #8#D#l#m#n#|#}###$ԬԬԬԬ㷬Ԭ{hxO5>*CJOJQJhxO>*CJOJQJhxO5CJ OJQJ *h3h9hxOCJOJQJ *hxOCJOJQJhxO5CJOJQJ# *h~{hxOCJOJQJ^JaJ *hxOh;<CJOJQJhxOCJOJQJhxO5>*CJ OJQJ hxOCJ- _ !!DV & F ` *Eƀm׆]*^gdxOV & F ` *Eƀm׆]*^gdxO *]*^gdxO!""####V & F0 p*Eƀ,ӆ]*^gdxO *]*^gdxO  *]*^gdxO$$$$$$$$%%%%%& &!&"&&&&&*'E'''''' ) ))!)*ͭߞߞߑ߄wm߭^WR *hxO *hxO5 *hxOCJOJQJ^JaJhxOCJ OJQJhx5>*CJ OJQJhxO5>*CJOJQJhxO5>*CJ OJQJhxO>*CJOJQJhxOhxOCJOJQJ^JaJ *h`hxO *h-hxO5# *h-hxOCJOJQJ^JaJhxOCJOJQJ *h-hxO *h-hxOCJOJQJ #$"&QV & F0 p*EƀԦ]*^gdxOV & F0 p*EƀԦ]*^gdxO"&)'*'E''''**Q+R++++ *]*^gdxO *]*^gdxO*]*gdxOV & F0 p*Eƀ,ӆ]*^gdxO **********++++,+M+N+++++++++7,8,K,L,,--ͿͿͲנׂtl`R` *hchxOCJ\aJ *hchxOCJaJ *hsBhxO *hsBhxO5CJaJ# *hsBhxOCJOJQJ^JaJ *h+hxOCJaJ# *h+hxOCJOJQJ^JaJhxO5>*CJ OJQJ *h-hxOCJOJQJhxOCJOJQJhxOCJOJQJ^JaJ# *h-hxOCJOJQJ^JaJ *h-hxO--z-{-|-}-~-------..0.1.2.l.m.n.......:/;/ùØxØxØi[I# *hchxOCJOJQJ^JaJhxOCJOJQJ^JaJhxOCJOJQJ\^JaJh3ICJOJQJ *hchxO *hchxOCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJhxOCJOJQJhxO# *hsBhxOCJOJQJ^JaJ *hsBhxO>*CJaJ *hsBhxOCJaJ *hC AhxOCJaJ+}-~--.2.n.=M & F(*Eƀ,ӆ]*gdxOM & F(*Eƀ,ӆ]*gdxO *]*^gdxO  *]*gdxO *]*^gdxOn...//00!0G0\0^0z00001 ^gdxO^gdxOgdxO ^gdxO ]^gdxO  T]T^gdxO ]^gdxO 8Td]T^gdxO *]*^gdxO;/z////\0]0^0z0000h11111111L2l2m23313233333334ʼʪʪʪʪʪʪʪʦujW% *hfthxO56CJ$OJPJQJhxO5OJPJQJhxO5CJ$OJPJQJ hxO5 *htn&hxO5 j*h6hxO0J5hfthxO5hChxOCJOJQJ^JaJhxOhxOCJOJQJ^JaJhxOCJOJQJhxOCJ\aJ# *hchxOCJOJQJ^JaJ *hchxO *h="hxO 11A1g1h1111122K2L2m2222223 ]^gdxO ]^gdxO ^gdxO ^gdxO^gdxO ^gdxO333333344T5U5}5N6zi <*]*^gdxO *]*^gdxO *]*^gdxO T]T^gd"$ !]^a$gdxO^gdxO;$ 8$d!%d$&d!'d$N!O$P!Q$]^a$gdxO 44444D4E4o4p44444S5T5U5{55555555566.6/6?6@6M6O6P66666"7#72737]8^88ɿӿ|hxO5CJ OJQJhx5>*CJ OJQJhxO5CJOJQJ hxOCJhxO *h`hxO *h`hxOCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJ jhxO5>*UmHnHuhxO56CJ$OJPJQJ,N6O666&7`8a8;V & F ` *Eƀm׆]*^gdxOV & F ` *Eƀm׆]*^gdxO *]*^gdxO*]*gdxO8899 ::?:@:A:O:P:S:~:::;;;;;;a<<<<<<<<<{=====>j>l>>ꪠɘ~tgghxO5>*CJ OJQJhxCJOJQJhxOhxOCJOJQJ^JaJ *h";&hxO *h-hxO *h-hxO5# *h-hxOCJOJQJ^JaJhxO5>*CJOJQJ *h`hxO *h`hxOCJOJQJhxO5CJOJQJhxOCJOJQJhxO>*CJOJQJ&a899R:S:~::V & F0 p*EƀԦ]*^gdxO *]*^gdxO  *]*^gdxO:;<QV & F0 p*Eƀm׆]*^gdxOV & F0 p*Eƀ,ӆ]*^gdxO<==>k>l>>AABB6C7CeCy *]*^gdxO *]*^gdxO  *]*^gdxOV & F0 p*Eƀ,ӆ]*^gdxO >>@@)@AAABBBBBBBBBB4C5C7C8CeCCCCCCCCȶ줜ȤȤwibZ *hhxO hhxO *hC AhxOCJOJQJhxO5>*CJ OJQJhx5>*CJ OJQJ *hlCJOJQJ *hlhl *hC AhxOCJOJQJhxO# *hC AhxOCJOJQJ^JaJ *hC AhxO *ho'hxO5# *ho'hxOCJOJQJ^JaJhxOCJOJQJhxOCJ OJQJCCC]D^D_DrDsDD@EBEEEEEEEEFFF F*CJ OJQJhd *hhxO>*CJOJQJ *h";&hxOCJOJQJ\ *h";&hxOCJOJQJ *hhxO5CJOJQJ *hsBhxOhxOCJOJQJhxO *hhxO *hhxOCJOJQJ"eCEEE=FZFFFGJM & F(*EƀԦ]*gdxOM & F(*EƀԦ]*gdxO *]*^gdxO  *]*gdxOGGGoGGGGGG]H^H_H`HaHHHHHI*IXIIJ'J5J7JXJ]J^JJJJKKuguuuuuuuub hxO5hxOCJOJQJ^JaJhxOCJOJQJhxCJOJQJhxOCJ\aJ# *hhxOCJOJQJ^JaJ *hhxO *hhxO5 *h";&hxO5# *h";&hxOCJOJQJ^JaJhxOCJOJQJ^JaJhxOCJOJQJ\^JaJhxOhxO5>*CJOJQJ!GGGlGG_H5Z & F 8*dEƀԦ]*^gdxOZ & F 8*dEƀԦ]*^gdxO *]*^gdxO*]*gdxO_H`HHHHHHHHI9I_I}I~IIIIJ6J7J ^gdxO^gdxO ^gdxO ]^gdxO  T]T^gdxO ]^gdxOgdxO7J^JJJJJJK)K*KQKyKKKKL ]^gdxO  ]^gdxO ]^gdxO ]^gdxO^gdxO ^gdxO ^gdxOKKKKLLSL^L_L`LwLxLLLLLMM=M>MmMnMŻvi_UG?GUG?GU;hxO *hhxO *hhxOCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJ jhxO5>*UmHnHuhxO56CJ$OJPJQJ% *hfthxO56CJ$OJPJQJhxO5CJ$OJPJQJ hxO5 *hvwhxO5 hlhxOCJOJQJ^JaJ- j*hlhxO0J5CJOJQJ^JaJ#hlhxO5CJOJQJ^JaJLRLSL_LxLnMoMMhNiNNN]gdxO <]^gdxO ]^gdxO ]^gdxO T]T^gd"$ !]^a$gdxO nMoMMMMMMMM N NNNHNINYNZNgNiNjNNNNN'O(O/O0OLPMPNPPPQQsRRRRS S!S"S#SXSYSXTµ՝ふwhxOCJ OJQJhxO5>*CJOJQJhxOhxO>*CJOJQJho'hxOCJOJQJhxO5CJ OJQJhx5>*CJ OJQJhxO5CJOJQJ *hhxO *hhxOCJOJQJhxOCJOJQJhxO5>*CJ OJQJ hxOCJ.N+OOPPPQQQD33  ]^gdxO ]^gdxOV & F ` Eƀ,ӆ]^gdxOV & F ` EƀԦ]^gdxOQQQRRR!S"SYSTTUUVUpVqVVW  ]gdxO ]^gdxO ]^gdxO  ]^gdxOXTYTdTeTzT{TTTTTUUUVUrUsUUUUUUUVV/VmVnVpVVVVVVVWW#W$W%WxWzW۴Ό~v~lhACJOJQJ *h%hxO *h%hxOCJOJQJhxOCJ OJQJ *h%hxOCJOJQJ *h%hxO5CJOJQJ *h%hxO^JaJ *hhxOCJOJQJhxO5>*CJ OJQJhxOhxOCJOJQJ *hhxO *hhxOCJOJQJ(W%WyWzWWWcVI4 8Td]T^gdxO ]^gdxO ]^gdxOM & F(EƀԦ]gdxOM & F(EƀԦ]gdxOzW{WW\X]X^XzXXXXhYYYYYYYYLZlZmZ[[[P[Q[R[[[[[[ŷ׷׷׷׷׷׷׷שpcphxO5CJ$OJPJQJ!hxO5CJ$OJPJQJ^JaJ$ *hhxO5 hxO5 j*h6hxO0J5hlhxO5hChxOCJOJQJmHsHhxOCJOJQJ^JaJhxOhxOCJOJQJ^JaJhxOCJOJQJhxOCJOJQJ\^JaJhxCJOJQJ\^JaJWXXX!XGX\X^XzXXXXYYAYgYhYYYY ^gdxO^gdxOgdxO ^gdxO ]^gdxO  T]T^gdxO ]^gdxOYYZZKZLZmZZZZZZ[[8[9$ $d!%d &d!'d$N!O P!Q$]^a$gdxO ]^gdxO ]^gdxO^gdxO ^gdxO ^gdxO8[R[[[[[\\\\\|kZZZ ]^gdxO T]T^gdd7$ !T]T^a$gdxO !T]T^gdxO$ !]^a$gdxO ]^gdxO9$ $d!%d &d!'d$N!O P!Q$]^a$gdxO [\\\\\K\L\v\w\\\\\$]%]5]6]7]8]a]b]r]s]]]]]]]ö~l[PPhxO5CJOJQJ hxO5CJ OJQJ\^JaJ #hxO5>*CJ OJQJ\^JaJ hxOCJOJQJ^JaJ *h%hxO *h%hxOCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJ#jhxO5>*U\mHnHu$hxO56CJ$OJPJQJ^JaJ$- *hfthxO56CJ$OJPJQJ^JaJ$\]]]^^X & F ` EƀԦ]^gdxO ]gdxO ]^gdxO]]]]^^^^^^^^^^ _________``1`6`X`Ϳxk`VLVhlCJOJQJhxOCJOJQJhxO5CJ OJQJhxO5>*CJ OJQJ hxO5>*CJ OJQJ^JaJ hd7CJOJQJ^JaJhBCJOJQJ^JaJ *h%hxO# *h%hxOCJOJQJ^JaJhxOCJOJQJ^JaJ hxO5CJ OJQJ\^JaJ #hxO5>*CJ OJQJ\^JaJ hxO5CJOJQJ^JaJ^^______O>>>>> ]^gdxOX & F ` EƀԦ]^gdxOX & F ` EƀԦ]^gdxO__`9``aa>X & F ` EƀԦ]^gdxOX & F ` EƀԦ]^gdxO ]^gdxOX`Y`````aa?bKb,c8cdcpcccccccccFdGdddddeeee f fIfJfKfLfffg#gSgTg߻ߜzv߻hxO *ho'hxO *h`hxO *h-hxO *h-hxO5# *h-hxOCJOJQJ^JaJhxO5>*CJOJQJhxOCJOJQJ^JaJhxO5CJOJQJhxO>*CJOJQJhxOCJOJQJ *h%hxO *h%hxOCJOJQJ+abbccc#dsX & F0 pEƀԦ ]^gdxO ]^gdxO ]^gdxO  ]^gdxO#ddLfOX & F0 p*C$EƀԦ ]*^gdxOX & F0 pEƀԦ ]^gdxOLfSgTgng}gg3Q & F1 EƀԦ]gdxO ]^gdxO ]^gdxOX & F0 pEƀԦ ]^gdxOTgng}gg)h*h+h,h?h@hhhhh.i/i1i2igihiiiiiPjSjfjgjjjjjkkkŻŻsa# *ho'hxOCJOJQJ^JaJhxO5>*CJ OJQJhxOCJ OJQJ^JaJ hxO5>*CJaJ# *hlhxOCJOJQJ^JaJ *h%hxO *hhl *hhl5# *h%hxOCJOJQJ^JaJhxOCJOJQJhxOCJOJQJ^JaJ hxO5>*CJ OJQJ^JaJ "gg+h[Q & F1 EƀԦ]gdxOQ & F1 EƀԦ]gdxO+h1i2ihijjZm[mnnQnuc ]^gdxO ]^gdxO 7$8$H$]^gdxO ]^gdxOQ & F1 EƀԦ]gdxO kkkVmWmXmYmZm[mmmmmmmmm n nOnPnQnRnknlnnnooaobo橷~p^TM^ *h="5 *h="h="5# *h`@ahxOCJOJQJ^JaJhxOCJ OJQJ^JaJ hxO5>*CJ OJQJ^JaJ hxO *h`@ahxO *h`@ahxOCJOJQJ *h%hxOCJOJQJhxOCJOJQJhxOCJOJQJ^JaJ# *h%hxOCJOJQJ^JaJ *hxO *h%hxO *ho'hxO *ho'hxO5QnRnlncodoopppq qq;qqqqrrrr 7$8$H$]^gdxO ]^gdxO ]^gdxO ]^gdxO @]^gdxObo'p(pVpWpppqq;qzq{qqqqqqqqqqrrOrPrrrrssttFtItJt]t^tǶukc *h-h- *h-h-5h-CJOJQJ^JaJhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ #hxO5>*CJOJQJ\^JaJ hxO5>*CJ OJQJ^JaJ hB5>*CJ OJQJ^JaJ  *h`@ahxO# *h`@ahxOCJOJQJ^JaJhxOCJOJQJ^JaJ$rszsE\ & F$ ` 7$8$EƀԦH$]^gdxO\ & F$ ` 7$8$EƀԦH$]^gdxOzsttHtIt|| ]^gdxO 7$8$H$]^gdxO\ & F$ ` 7$8$EƀԦH$]^gdxO^t_tt u u u uuusutuuuvuuuuuuvv-vvv]wп򭗈{wiw]Mi=i *h`@ahxOCJOJQJ\ *h`@ahxO5CJOJQJ *hsBhxO^JaJ *h`@ahxOCJOJQJhxOhxO5>*CJ OJQJhxO>*CJOJQJ^JaJ ho'hxOCJOJQJ^JaJ *h"a# *ho'hxOCJOJQJ^JaJ hxO5>*CJOJQJ^JaJhxOCJaJ# *h`@ahxOCJOJQJ^JaJ *h`@ahxO *ho'hxO *h-It u uuuvuu_w{  ]gdxO ]^gdxO ]^gdxOS C$Eƀ_f]^gdxO]w^w_w`wzw{wwwwwwwxxx1x2x3x4xAxyxzx{xxxxxxxx"yDyyyyƼ||kkY#hxO5>*CJ OJQJ\^JaJ hxO5>*CJ OJQJ^JaJ h"CJOJQJh"CJOJQJ^JaJhxOCJOJQJ^JaJhxO *h`@ahxO *h`@ahxOCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJhxO>*CJOJQJ^JaJ h`@ahxO *h`@ahxO^JaJ"_w`w{wwxHQ & F( Eƀ,ӆ]gdxO ]^gdxOS C$Eƀ+#&]^gdxOx4x{x[Q & F( EƀԦ ]gdxOQ & F( Eƀ,ӆ]gdxO{xxx"y#yDyyyyyyz ]^gdxO ]^gdxOQ & F( EƀԦ ]gdxO yz,z0zvzwzxzz{{{a{c{q{{{{&|'|5|6|w|y|z||||}.}D}r}}~A~O~Q~r~w~x~~𶬞⬖ j*h6hxO0J5hfthxO5hChxOhxOCJOJQJ^JaJhxOCJOJQJhxCJOJQJ *h`@ahxO *h="hxO# *h`@ahxOCJOJQJ^JaJhxOCJOJQJ^JaJhxOCJOJQJ\^JaJ.z-zwzH[ & F dEƀԦ]^gdxO[ & F 8dEƀԦ]^gdxOwz{b{c{J4 ]^`gdxO[ & F 8dEƀ,ӆ]^gdxOX & F 8EƀԦ]^gdxOc{r{{{.^ & F @ 8 dEƀԦ]^gdxO^ & F @ 8 dEƀ,ӆ]^gdxO d]^gdxO{x|y|||||||yyhhWJ ^gdxO ]^gdxO  T]T^gdxO ]^gdxO 8Td]T^gdxO^ & F @ 8 dEƀ,ӆ]^gdxO||}0}S}y}}}}}}~P~Q~x~~~~~) ]^gdxO ^gdxO ^gdxO ^gdxO^gdxOgdxO)CDkmʀtttt$ !]^a$gdxO ]^gdxO:$ 8$d!%d$&d 'd$N!O$P Q$]^a$gdxO ]^gdxO ^gdxO ]^gdxO lmyɀʀˀ<=gh́́΁ρЁ|r|r|r|d\d|d\dr|r|V hxOCJ *h`@ahxO *h`@ahxOCJOJQJh*KCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJ jhxO5>*UmHnHu"h"hxO56CJ$OJPJQJ% *h"hxO56CJ$OJPJQJhxO5CJ$OJPJQJ!hxO5CJ$OJPJQJ^JaJ$ hxO5 *hhxO5ʀρEM & F2EƀԦ]gdxOM & F2EƀԦ]gdxO ]^gdxO T]T^gd*KρEOi ]^gdxO ]^gdxOM & F2EƀԦ]gdxOCE}~˂̂MOst"*+dqqqcchCt\CJOJQJ^JaJhBCJOJQJ^JaJhxOCJOJQJ^JaJhxO5CJOJQJ *h`@ahxOCJOJQJ *h`@ahxO# *h`@ahxOCJOJQJ^JaJhxOCJOJQJ hxO5CJ OJQJ\^JaJ #hxO5>*CJ OJQJ\^JaJ #hx5>*CJ OJQJ\^JaJ "i*QV & F ` EƀԦ]^gdxOV & F ` EƀԦ]^gdxO*tu;<t ]^gdxOV & F ` EƀԦ ]^gdxO *+;rt΅υ %&ӈ߈ FdehắǍǍwǍjǍhxO5>*CJOJQJhxO5CJOJQJhxO>*CJOJQJ *h`@ahxOCJOJQJhfjCJOJQJhxOCJOJQJhxO5CJ OJQJhxO5>*CJ OJQJ *h`@ahxO# *h`@ahxOCJOJQJ^JaJhxOCJOJQJ^JaJ hxO5>*CJ OJQJ^JaJ $()bcQD33  ]^gdxO ]^gdxOV & F ` EƀԦ ]^gdxOV & F ` EƀԦ ]^gdxOcFh3V & F0 pEƀԦ]^gdxOV & F0 pEƀԦ ]^gdxO ]^gdxO  ]^gdxOhi|})exBN܌ !$78{sa{s˅ThxO5>*CJOJQJ# *hfjhxOCJOJQJ^JaJ *h-hfj *h-hfj5# *h~{hxOCJOJQJ^JaJhxO5>*CJ OJQJhxO>*CJOJQJhxOCJOJQJhxOhxOCJOJQJ^JaJ *h~{hxO *h`hxO *h-hxO *h-hxO5# *h-hxOCJOJQJ^JaJ h܌QDDD ]^gdxOV & F0 pEƀԦ]^gdxOV & F0 p*Eƀm׆]*^gdxOMcM & F1EƀԦ]gdxOM & F1EƀԦ]gdxOM cVVAVV 7$8$H$]^gdxO ]^gdxOM & F1Eƀ,ӆ]gdxOM & F1Eƀ,ӆ]gdxO qrHITUjkɿmc[mWI[I[II[ *ho'hxOCJOJQJhxO *ho'hxO *ho'hxO5# *ho'hxOCJOJQJ^JaJhxOCJOJQJ *hxOCJOJQJ^JaJ *hxO# *hfjhxOCJOJQJ^JaJ *h~{hxO *h-hfj *h-hfj5# *h~{hxOCJOJQJ^JaJhxOCJOJQJ^JaJhxOCJ OJQJhxO5>*CJ OJQJ BC_)*e7$8$H$]^gdxO ]^gdxO ]^gdxO͕Ε !12BC_uv—ijՓՓpճՓ^ՓՓ#hxO5>*CJOJQJ\^JaJ hB5>*CJ OJQJ^JaJ  *ho'hxO *h="h="5# *ho'hxOCJOJQJ^JaJhxOCJ OJQJ^JaJ hxO5>*CJ OJQJ^JaJ h"5>*CJ OJQJ^JaJ hxOCJOJQJ^JaJhxOhxOCJOJQJ *ho'hxOCJOJQJ$*+eqrϚͻߖzrjbQLjLj *h? hxO5>*CJOJQJ^JaJhxOCJaJ *hQhxO *h-h- *h-h-5# *hQhxOCJOJQJ^JaJh-CJOJQJ^JaJ *ho'hxOhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ #h"5>*CJ OJQJ\^JaJ hxOCJOJQJ^JaJ# *ho'hxOCJOJQJ^JaJ!I[ & F$ ` 7$8$Eƀ,ӆH$]^gdxO[ & F$ ` 7$8$Eƀ,ӆH$]^gdxO!™6OC$Eƀ_f]^gdxO ]^gdxO7$8$H$]^gdxO[ & F$ ` 7$8$EƀԦ H$]^gdxOJ"OC$Eƀ+#&]^gdxO  ]gdxO ]^gdxO ]^gdxOJfgtuޛߛBCDW͜%!"̾̾Դtj\\ *hQhxOCJOJQJhxOCJ OJQJh"5>*CJ OJQJ hQhxO *hQhxOCJOJQJ\ *hQhxO5CJOJQJ *hsBhxO^JaJhxOCJOJQJ *hQhxOCJOJQJ *hQhxOhxOhxO5>*CJ OJQJhxOCJOJQJ hQhxOCJOJQJ^JaJ"?@A\]^kߞ'(KLMnݟߟ;X2־֩{lllZR *h="hxO# *hQhxOCJOJQJ^JaJhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ hxO5>*CJaJ hxO5>*CJ OJQJ^JaJ hxO5>*CJOJQJ *hQhxO *hQhxOCJOJQJh"CJOJQJhxOCJOJQJhxOh"CJOJQJ^JaJhxOCJOJQJ^JaJ "A^cM & F(EƀԦ ]gdxOM & F(EƀԦ ]gdxO^LMncVVMVVV]gdxO ]^gdxOM & F(EƀԦ]gdxOM & F(EƀԦ ]gdxOߟ;Y>Z & F 8dEƀ,ӆ ]^gdxOZ & F 8dEƀԦ ]^gdxO ]^gdxONW & F 8Eƀ,ӆ ]^gdxOZ & F 8dEƀ,ӆ ]^gdxO2:ˢ̢ £أդ u:;yzѵѫáááááááá{n j*h6hxO0J5hfthxO5CJOJQJaJhChxOhxOCJOJQJ^JaJhxOCJOJQJh"CJOJQJh"CJOJQJ^JaJhxOCJOJQJ^JaJhxOCJOJQJ\^JaJ# *hQhxOCJOJQJ^JaJ *hxO *hQhxO(|| d]^gdxO ]^`gdxOZ & F 8dEƀ,ӆ ]^gdxO:E\ & F @ 8 dEƀ,ӆ ]^gdxO\ & F @ 8 dEƀ,ӆ ]^gdxO/HJpob]T^gdxOgdxO ^gdxO ]^gdxO  T]T^gdxO ]^gdxO\ & F @ 8 dEƀ,ӆ ]^gdxO ģ +,j =>tuץإ ]^gdxO ]^gdxO ^gdxO ^gdxO^gdxO ^gdxOإ':;]{ʦܦ6'(P ]^gdxO T]T^gdCt\$ !]^a$gdxO  !t"]^gdxO^gdxO ]^gdxO ]^gdxO ^gdxOz{ɦʦ֦56rs&(NızpbZbpbZbpVD#hxO5>*CJ OJQJ\^JaJ hxO *hQhxO *hQhxOCJOJQJhxOCJOJQJhxOCJ OJQJhxO5>*CJ OJQJ jhxO5>*UmHnHuhxO56CJ$OJPJQJ% *hfthxO56CJ$OJPJQJhxO5CJ$OJPJQJ!hxO5CJ$OJPJQJ^JaJ$ hxO5 *hhxO5hQhxOCJOJQJaJNPŨƨ֨ר!#XZ~"&*-56o|)*56FGIJ裸ϒvveϒ hxO5>*CJ OJQJ^JaJ hCt\CJOJQJ^JaJhBCJOJQJ^JaJ# *hQhxOCJOJQJ^JaJhxOCJOJQJ^JaJ#hxO5>*CJ OJQJ\^JaJ hxO5CJOJQJ *hQhxO *hQhxOCJOJQJhxOCJOJQJ hxO5CJ OJQJ\^JaJ 'P"#Zt5DV & F ` EƀԦ ]^gdxOV & F ` EƀԦ ]^gdxO ]^gdxO5FG ]^gdxOV & F ` EƀԦ ]^gdxO Gޫ߫ -.T`ݯOPQRefg UVXƾƾ޳޳޳ޥޥ|j# *h#hxOCJOJQJ^JaJ *h# *h-h# *h-h#5# *hQhxOCJOJQJ^JaJhxOCJOJQJ^JaJhxO>*CJOJQJ *hQhxO *hQhxOCJOJQJh#CJOJQJhxOCJOJQJhxO5CJ OJQJhxO5>*CJ OJQJ$ 01pqQD33  ]^gdxO ]^gdxOV & F ` EƀԦ ]^gdxOV & F ` EƀԦ ]^gdxOqޯM & F1EƀԦ ]gdxO ]^gdxO  ]^gdxOޯQcM & F1EƀԦ ]gdxOM & F1EƀԦ ]gdxOQXYz{ٳڳ6,-ȵɵѶ7$8$H$]^gdxO ]^gdxOM & F1EƀԦ ]gdxOXYױرwxzlmxyճֳ׳56ĴŴٴ*μΘ}yΘhZμP *h="h="5hxOCJ OJQJ^JaJ hxO5>*CJ OJQJ^JaJ hxOhQhxOCJOJQJ *hQhxOCJOJQJhxOCJOJQJ *hQhxO *h-hMZ> *h-hMZ>5# *hQhxOCJOJQJ^JaJhxOCJOJQJ^JaJhxOCJ OJQJhxO5>*CJ OJQJhxO5>*CJOJQJ*+ Ѷ׶CDTUefMNʹ˹Ƶߵߣߑpbh-CJOJQJ^JaJhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ #hx5>*CJ OJQJ\^JaJ #hxO5>*CJOJQJ\^JaJ hxO5>*CJ OJQJ^JaJ hB5>*CJ OJQJ^JaJ  *hQhxOhxOCJOJQJ^JaJ# *hQhxOCJOJQJ^JaJ$Ѷֶ׶efLMNи[ & F$ ` 7$8$EƀԦ H$]^gdxO7$8$H$]^gdxO ]^gdxO иDI8+ ]^gdxO7$8$H$]^gdxO[ & F$ ` 7$8$EƀԦ H$]^gdxO[ & F$ ` 7$8$EƀԦ H$]^gdxOֺ׺?@6  ]gdxOOC$Eƀ_f]^gdxO ]^gdxO )Ժպֺ׺غ=>?@AHI\ïܓyugugu[K *hhC5CJOJQJ *hhxO^JaJ *hQhxOCJOJQJhxOhCt\5>*CJ OJQJhxO5>*CJ OJQJhxO>*CJOJQJ^JaJ *h2 *h2h2& *hQhxO>*CJOJQJ^JaJ hxO5>*CJOJQJ^JaJhxOCJaJ# *hQhxOCJOJQJ^JaJ *hQhxO *h="h="5\]56STUpqr DESTwƹƯӁsӥi[sӥiӥh"CJOJQJ^JaJhDCJOJQJhDCJOJQJ^JaJhxOCJOJQJ^JaJ *hhxO *hhxOCJOJQJhxOCJOJQJhxOCJ OJQJhx5>*CJ OJQJhxO5>*CJ OJQJhxO *hhxO^JaJ *hhxOCJOJQJ *hhCCJOJQJ 6UrcM & F(EƀԦ]gdxOM & F(EƀԦ]gdxOr xz۾ܾ cVVVVVVV ]^gdxOM & F(EƀԦ]gdxOM & F(EƀԦ]gdxO wxz۾ܾ h׿ؿ}~noghi޳Ф}ФoФФВФeWehxOCJOJQJ^JaJhxOCJOJQJhxCJOJQJ^JaJ *hxO *hhxO *hJhxO# *hhxOCJOJQJ^JaJhxOCJOJQJ\^JaJ#hxO5>*CJ OJQJ\^JaJ hxO5>*CJaJhxOCJOJQJ^JaJ hxO5>*CJ OJQJ^JaJ hxOhxO5>*CJOJQJ" ?@h׿>Z & F 8dEƀ,ӆ]^gdxOZ & F 8dEƀ,ӆ]^gdxO ]^gdxO׿N:: d]^gdxOZ & F 8dEƀ,ӆ]^gdxOW & F 8Eƀ,ӆ]^gdxOoE\ & F @ 8 dEƀ,ӆ]^gdxO\ & F @ 8 dEƀ,ӆ]^gdxOo+,Rgi}}ll_ZQ^gdxgdx ^gdx  T]T^gdx ]^gdx 8]^gdx\ & F @ 8 dEƀ,ӆ]^gdxO Lrs VWx ]^gdx ]^gdx ^gdx ^gdx^gdx ^gdxsWwxghiHIJ)*+,./124578:;=>DEFHIOPǿǿǿǿDZ˱˧˗ hC0JjhC0JU hxO0JjhxO0JUjhxOUmHnHujhGUhGhxO *h6hxO j* *h6hxO0Jh)EShxOCJOJQJhxOCJOJQJ^JaJ9 hI*+-.0134679:<=gdxO ^`gdxO ]^gdx ^gdx=FGHSTUWXcdepqr}~ &`#$gdv9h]h &`#$gdCPQRSUVXY_`abcdeflmnopqrsyz{|}~ʲhxOCJOJQJ^JaJhxO5CJOJQJ^JaJhGh< h<0Jjh<0JUhv9hCjhxOUmHnHuhxO hC0JjhC0JUh)0JmHnHu:/0jk=>DE ]gdxO ]gdxO ,],gdxO T]gdxO=>DE=>?@@Ah)ESh hxOCJOJQJ^JaJhxO5CJOJQJ^JaJhxOhxO5CJOJQJE=>st?@uv ,],gdxO T]gdxO ]gdxO@Avw ^`gdxO ]gdxO ,],gdxO T]gdxO 21h:p / =!"#$% 901hP:pC/ =!"#$% 901hP:pC/ =!"#$% 901hP:pC/ =!"#$% 901hP:pC/ =!"#$% 901hP:pC/ =!"#$% 21h:p</ =!"#$% 901hP:p"/ =!"#$% 21h:p"/ =!"#$% '@@@ xONormalCJ_HaJmH sH tH t@t xO Heading 1)$$ !T@&]T^a$56CJ$OJPJQJ^JaJ$@ xO Heading 2b$$  $d!%d$&d!'d$@&N!O$P!Q$]a$5DA@D Default Paragraph FontRiR  Table Normal4 l4a (k(No List*W@* xOStrong5\6U@6 xO Hyperlink >*B*phFV@F xOFollowedHyperlink >*B* ph<@"< xO Comment TextCJaJX^@2X xO Normal (Web)d dd[$\$CJOJQJaJ4@B4 xOHeader  !4 @R4 xOFooter  !.)@a. xO Page NumberTT@rT xO Block Text ]^ CJOJQJ.X@. xOEmphasis6]fOf xO AbtHead B&$$ 8d@&5CJOJQJaJHB@H xO Body Text 8aJO xOAbtHead A Outlined.$$ & F 8dhx@&5CJ$OJQJaJ`@` xOFootnote Text,F1 (x^`(CJaJVOV xOAbtHead B Outlined & FdPxOx xOAbtHead C Outlined%$$ & F (@&5CJOJQJaJ@&@@ xOFootnote ReferenceH*$O$ xOvolume"O" xOissue"O!" xOpagesO1 xOhitOA xOtiHORH xOsize2%dd[$\$CJOJQJ^JaJHbH B Balloon Text&CJOJQJ^JaJ_1+CPSwyK,w DEFGH DEFGHK@+CSw;N  4 o    [  ,-9;S}~wxXCDcNO O P l 6 7 q - ()Ez{ VW:0IKq,-k >?uv(;=?@a_")*E""Q#R####}%~%%&2&n&&&''((!(G(\(^(z(((())A)g)h)))))**K*L*m******++3++++,,T-U-}-N.O...&/`0a011R2S2~2234556k6l6699::6;7;e;====>Z>>>???l??_@`@@@@@@@@A9A_A}A~AAAAB6B7B^BBBBBBC)C*CQCyCCCCDRDSD_DxDnEoEEhFiFFF+GOHPHIIIIJJJ!K"KYKLLMMVMpNqNNO%OyOzOOOPPP!PGP\P^PzPPPPQQAQgQhQQQQQRRKRLRmRRRRRRSS8SRSSSSSTTTTTUUUVVVWWWWWWWX9XXYYZZ[[[#\\L^S_T_n_}___+`1a2ahabbZe[effQfRflfcgdgghhhi ii;iiiijjjjkzkllHlIl m mumvmm_o`o{oop4p{ppp"q#qDqqqqqqr-rwrsbscsrsssxtyttttttttu0uSuyuuuuuuvPvQvxvvvvvw)wCwDwkwwwwwwmxxxxxxyyyzzEz{{O{i{{*|t|u|||};}<}t}}}()bcFh܄M  BC_)*e!‘J"A^LMnߗ;Y:/HJpě +,j =>tuם؝':;]{ʞܞ6'(P"#Zt5FG 01pqާQXYz{٫ګ6,-ȭɭѮ֮׮efLMNаDֲײ?@6Ur xz۶ܶ ?@h׷۸ܸo+,Rgiɺ Lrsƻǻ VWx hI߾*+-.0134679:<=FGHSTUWXcdepqr}~Կտ/0jk=>DE=>st?@uv@Avw000000-0-0-0-0-0-0-0-0- 0- 0- 0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-$ 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- 0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0-0S0S0S0S0S0S0S0S0S0S0S0S 0S 0S0S0S0S0S0S0S0 0S0 0S0 0S0 0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S( 0S( 0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0S0-0-0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+ 0%+ 0%+0%+0%+0%+0%+0%+0%+0 0%+0 0%+0 0%+0 0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+( 0%+( 0%+0%+0%+0%+0%+ 0%+ 0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0%+0-0C0C0C0C0C0C0C0C0C0C0C0C 0C 0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C( 0C( 0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0C0-0-0-0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS 0KS 0KS 0KS0KS0KS0KS0KS0KS0KS0KS0KS 0KS 0KS0KS0KS0KS0KS0KS0KS0 0KS0 0 KS0 0 KS0 0 KS0KS0KS0KS1 0KS1 0KS1 0KS1 0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS$ 0KS$ 0KS$ 0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS( 0KS( 0KS( 0KS( 0 KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS 0KS 0KS 0KS 0KS0KS0KS 0sKS 0sKS 0sKS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0KS0-0-0-0w0w0w0w0w0w0w2 0w2 0w2 0w0w0w0w0w0w0w 0w 0w 0w0w0w0w0w0w0w0w0w 0w 0 w0w0w0w0w0w0w0 0 w0 0 w0 0w0 0w0w0w0w1 0w1 0w1 0w1 0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w$ 0w$ 0w$ 0w0w0w0w0w0w00w0w0w0w0w0w( 0 w( 0 w( 0 w( 0 w0w0w0w0w0w0w0w0w0w0w 0w 0 w 0 w 0 w 0 w0w0w0w 0™w 0™w 0™w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0w0-0-0-0@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@01 01 0 1 0 1 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@00@00@0@0@0@0( 0( 0( 0( 0@0%@0%@0%@0%@0%@0%@0%@0%@0%@0%@ 0 %@ 0%@ 0%@ 0%@0@0C 0i%C 0i%C 0i%@0%@0%@0%@0%@0@0%@0%@0%@0%@0@0%@0%@0%@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 @0X00@0X00@0X00@0X00@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0@0X00$000000000000000000000@0000000000000000000000000@0@0@0@0@0@0@000UxXcNO - ((;=?aR####}%2&n&&&'())A)))))*****+3++..&/`0~22346k6l6699::6;7;e;==??l??_@_A}A~AAB6B7B^BB*CQCyCCCCDLMMVMpNPQQAQQQQQRRRS8SRSSUUVVVWWWX9X[#\\L^}___+`1a2ahabbZefQfRflfcgdgghhhijkzkllHlIl m mumvmm_o`o"q#qDqqyuuuuvPvQvxvvDwkwwwwwmxxyy{O{i{{*|};}<}t}}FhM  !‘J;Y +,j =؝':]{ʞ#Zt5FGާQXYzګ6,-ȭɭѮаDֲײ?@ Lƻǻ +Scp}I00I00Z00VX00X00X00Z00Z00 X00X00X00Z00X0 0X00Z00X00X00Z00X00t,X00X00Z0 0X0 0Z0 0X00tlX00X00X0 0X0 0Z0 0Z0 0Z0 0X0 0Z0 0Z0 0X0 0X0 0I00I00I00Z00X00Z00\X00X00@ 0X00Z0 0 Z0 0Z0 0X0 0X0 0Z00cX00X00X0 0X00cX00X00X00X0 0X00EZX00DX00BX0 0X0 0BZ0 0X0 0Z0&0E'ZX0&0DX0&0BX0 0X0*0E+ZX0*0DX0*0BX0 0K0.0N/I0.0MI0.0KX0 0X0 0I030KK030KI030K4X0 0X0 0Z0 0Z00X00K090I:I090HI090FX0 0 X0 0Z0 0!cX0 0 X0 0 X00X0%0&]X0%0X0%0 X0%0 X00X0X0tYpX0X0sX0X0qI0G0@I0G0@I0G0@I0G0@K0J0@KI0J0?I0J0=X0)0 X0)0Z0)0*]X0)0 X0)0 X00X0-0.\X0-0X0-0 X0-0 X00X0]0]^X0]0\X0]0ZK0X06I0X07I0X07Z0y0vzVX0y0uX0y0sX0F0-Z0F0.Z00jX00X00X0F0-Z0F0.X0F0.GX0F0-X0F0+X00X00jX00X00I0_02K0_03I0_02I0_00Z00X00X00X00{lX00zX00xX0~0YZ0~0ZX0~0ZL,X0~0YX0~0WX00X00Z00X00 jX00X00X00X00Z00Z00Z00X00Z00X00X00X00X00Z00MpX00LX00JX080Z080 9\X080X080X00X0<0 =\X0<0 X0<0X0<0X00I0x0-yI0s0!X0A0 X0A0Z00X00X0]0K0|0I0|0Z0]0Z00GVX00FX00DX0]0Z0]0Z00ajX00`X00^X0]0Z0]0X0]0^X0]0X0]0X00X00\jX00[X00ZI00K00I00X00Z00X00X00X00FllX00EX00CZ00/Z000X000,X00/X00-X00I00K00Z00X$"jX00WX00UX00I00K00K00K00I00Z00X00X00X00X00K00I00I00X0J0X0J0Z0J0K]X0J0X0J0X00X0N0O]X0N0X0N0X0N0@0X00X00I00I00 Z0S0X0S0Z0S0Z000VX00X00X00Z00Z01(#jX01'X01%X00"Z00#X01(%jX01'X01%X00"Z00#X0"1%X00"Z00#X00#t!lX00"X00 X00Z00X00VX00X00X0S0X0S0Z0S0Z01"lX01X01X00X00Z00Z00Z00X00Z00X00Z0S0Z0S0Z0S0T]X0S0X0S0@ d.gX0W0XZX0W0X0W0X0W0@0X00-iX00X00@0U@0@0@0@0@0@0@0 00{Z00@0Z00cZ00K00K00K00 K00 K0 0 K0 0K00K00U *-----::::::GGGGGGTTTTTTaaaaaannnnnn{{{{{{{{{{{{{{{~W $*-;/48>CGKnMXTzW[]X`Tgkbo^t]wyh"2zNGX*\wPgknosuz}~X 6 :?!#"&+n.13N6a8:<eCG_H7JLNQWWY8[\^_a#dLfg+hQnrzsIt_wx{xzwzc{{|)ʀρi*chM!"^إP5qޯQѶи6r ׿o=Ehjlmpqrtvwxy{|~i$&-46:ACGNPT[]ahjnuw~!!!!!!!!@    @x  (  b  3 `#" `? b  3 `#" `? b  3 `#" `? b  3 `#" `? b  3 `#" `? b  3 `#" `? b   3  `#" `? B S  ?(    ;  @4 DRAFTTimes New RomanPowerPlusWaterMarkObject1#" ?  ;  @4 DRAFTTimes New RomanPowerPlusWaterMarkObject2#" ?  ;  @4 DRAFTTimes New RomanPowerPlusWaterMarkObject3#" ?9,_DTxw+#U4&#z4&# 4&#4(# 4&# 4 &# 4 *~! t! t! t OLE_LINK5 OLE_LINK6 OLE_LINK9 OLE_LINK10 OLE_LINK11 OLE_LINK7 OLE_LINK8 OLE_LINK1 OLE_LINK12CC"KRSRSiƪDDMSS}]x GXݽ(9sϾ ++--..013467 (/ #O###***+v..W3f3(:*:::\;^;CCyCCKK}LLRRRS!W-We fmm)w3wwwww{||.mACǝ'.]`׫ ++--..0134673333333333333333333333333333333333333 ,,SDSD`D`DxDxDpp1p2pypzppp*|+|d|q|ϒ56o|ز@ASTpq JJ++vv ++--..013467RSbeor|<<CCEE ++--..0134672**h2bۊR&)bs hy ! 6qP G h0NgJw7," X<"V4#Ơ, })$2\l%'&,hn)&t) ^~2G?/v}/&f$14 tT28q<{4@6^܆S>:3;0<$*s=N^eA\D*ڌZ=FRtRI H0JkQ)QDƶZgR eRdb~9Swʪ:lZpDx [N uapDxa4t4Vb9Id_N-J4eD;Wk>p&k|lsmF{tpH"qf6Bqx*)Q)r";h   ^ `hH.h^`OJQJo(hHh` ` ^` `OJQJ^Jo(hHoh | | ^| `hH.h LL^L`hH.h L^`LhH.h ^`hH.h ^`hH.h L^`LhH.hhh^h`OJQJo(hHvh^`OJQJo(hHh88^8`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHhpp^p`OJQJo(hHh  ^ `OJQJo(hHh@ @ ^@ `OJQJo(hHh  ^ `OJQJo(hHh88^8`OJQJo(hHv ^`hH. L^`LhH. | | ^| `hH. LL^L`hH. L^`LhH. ^`hH. ^`hH. L^`LhH.h` ` ^` `OJQJo(hHh0 0 ^0 `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@@^@`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`CJOJQJaJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHhh^h`OJQJo(hHvh^`OJQJo(hHh8^8`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHhp^p`OJQJo(hHh ^ `OJQJo(hHh@ ^@ `OJQJo(hHh ^ `OJQJo(hH^`CJOJQJo(hHq^`OJQJ^Jo(hHohpp^p`CJOJQJo(hHq@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh^`OJQJo(hH^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHhpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh` ` ^` `OJQJo(hHh0 0 ^0 `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@@^@`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHhhh^h`OJQJo(hHvh^`OJQJo(hHh88^8`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHhpp^p`OJQJo(hHh  ^ `OJQJo(hHh@ @ ^@ `OJQJo(hHh  ^ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH ` ` ^` `OJQJo(hH ^`OJQJ^Jo(hHo pp^p`OJQJo(hH @ @ ^@ `OJQJo(hH ^`OJQJ^Jo(hHo ^`OJQJo(hH ^`OJQJo(hH ^`OJQJ^Jo(hHo PP^P`OJQJo(hHh` ` ^` `OJQJo(hHh0 0 ^0 `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@@^@`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhpp^p`CJOJQJaJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHhDD^D`OJQJo(hHh  ^ `OJQJ^Jo(hHoh  ^ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohTT^T`OJQJo(hHh$$^$`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhpp^p`OJQJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hH^`CJOJQJo(hHq^`OJQJ^Jo(hHopp^p`OJQJo(hH@ @ ^@ `OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hH^`OJQJ^Jo(hHoPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHhpp^p`CJOJQJaJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hHh ^`OJQJo(h^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH^`CJOJQJaJo(hH^`OJQJ^Jo(hHoXX^X`OJQJo(hH((^(`OJQJo(hH^`OJQJ^Jo(hHo^`OJQJo(hH^`OJQJo(hHhh^h`OJQJ^Jo(hHo8"8"^8"`OJQJo(hHh` ` ^` `OJQJo(hHh0 0 ^0 `CJOJQJaJo(hHh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@@^@`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhhh^h`OJQJo(hHvh88^8`OJQJ^Jo(hHoh^`OJQJo(hHh  ^ `OJQJo(hHh  ^ `OJQJ^Jo(hHohxx^x`OJQJo(hHhHH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`CJOJQJo(hHqh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`CJOJQJo(hHqhpp^p`OJQJ^Jo(hHoh@ @ ^@ `OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHhPP^P`OJQJ^Jo(hHoh  ^ `OJQJo(hHh^`CJOJQJo(hHqh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHhhh^h`OJQJo(hHvh^`OJQJo(hHh88^8`OJQJo(hHh^`OJQJo(hHh^`OJQJo(hHhpp^p`OJQJo(hHh  ^ `OJQJo(hHh@ @ ^@ `OJQJo(hHh  ^ `OJQJo(hH DD^D`OJQJo(hH ^`OJQJ^Jo(hHo tt^t`OJQJo(hH DD^D`OJQJo(hH   ^ `OJQJ^Jo(hHo   ^ `OJQJo(hH ^`OJQJo(hH ^`OJQJ^Jo(hHo TT^T`OJQJo(hHhpp^p`OJQJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hHhh^h`OJQJo(hHv^`OJQJo(hH88^8`OJQJo(hH^`OJQJo(hH^`OJQJo(hHpp^p`OJQJo(hH  ^ `OJQJo(hH@ @ ^@ `OJQJo(hH  ^ `OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh  ^ `OJQJo(hHh^`OJQJ^Jo(hHoh!!^!`OJQJo(hHhh^h`OJQJo(hHv^`OJQJo(hH88^8`OJQJo(hH^`OJQJo(hH^`OJQJo(hHpp^p`OJQJo(hH  ^ `OJQJo(hH@ @ ^@ `OJQJo(hH  ^ `OJQJo(hHh ^`hH. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.hpp^p`OJQJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hH0^`0o(.00^`0o(.08^`0o(...x^`xo(.... ^`o( .....  X ^ `Xo( ......   ^ `o(....... 8^`8o(........ `^``o(.........hpp^p`CJOJQJaJo(hHh@ @ ^@ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhPP^P`OJQJo(hHh  ^ `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh pp^p`OJQJo(h @ @ ^@ `OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh ^`OJQJo(h PP^P`OJQJo(h   ^ `OJQJo(oh ^`OJQJo(h   ^ `hH.h^`OJQJo(hHh` ` ^` `OJQJ^Jo(hHoh | | ^| `hH.h LL^L`hH.h L^`LhH.h ^`hH.h ^`hH.h L^`LhH.h` ` ^` `OJQJo(hHh0 0 ^0 `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@@^@`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`CJOJQJo(hHqh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh` ` ^` `OJQJo(hHh0 0 ^0 `OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@@^@`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`CJOJQJaJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hH2y |lNgtT2Q6Id#smZ=F;Wk [2G?/G f6Bq7,f$16qP ZgR<"*<b:lZuaRItpH0Js=s )" A\DeR})$QQ)r<{4n)aS>:%'Y3;&-J4e9S&k4Vb}/22                                                                                                           D                                                     D                 ^K         D                                  !"}                                                                                         D        !"}                                                     D        43dx7).V ="#2Qm23%3;<MZ>LxO)ESs0WCt\Q_fjqplftBG?l3Id7-BDA1C " M X{""aJv9C<[=*K+-036Xdq~@ H2  @UnknownAdam Greene, OGC/CRDDHHSCBrachChristina HeidemipaaschDHHSDHHS20090902T111024370fDHHSGz Times New Roman5Symbol3& z ArialI Arial Unicode MS7&  Verdana5& zaTahoma;Wingdings?5 z Courier New"1h,؆ن&2=&=&!4d2qHX ?xO2Sample Informed Consent Form*CBrachDHHS2                           ! " # $ % & ' ( ) * + , - . / 0 1 Oh+'0 , L X d p| Sample Informed Consent FormCBrach Normal.dotDHHS20Microsoft Office Word@#@fm@j!@Ӟ,=՜.+,0  hp  DHHS&'  Sample Informed Consent Form Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry FM(,1Table\WordDocumentSummaryInformation(DocumentSummaryInformation8CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q