ࡱ> a jjbjbYQYQ "3333xdvvvvOOO8NOLO$jPXQnQnQnQNTTdTU4,ڱR,ZɰU(T"JTUUɰWvvnQnQްWWWUZvRnQnQW0vvvvUWW~8"^P GaOVX0$w$WWIOO FORMTEXT CONTRACTOR/NAME OF SCHOOL SCHOOL BASED HEALTH CENTER PHARMACY PROCEDURE MANUAL For Class B Pharmacy License  FORMTEXT Name of School  FORMTEXT Address of SBHC  FORMTEXT City, NM  FORMTEXT Zip (505)  FORMTEXT Phone TABLE OF CONTENTS Consulting Pharmacist 3 Contractor School Based Health Center Mission Statement 4 Contractor School Based Health Center Formulary 5 Memorandum of Agreement 6 Policy and Procedure Dates 7 Policy and Procedures 8 Consultant Pharmacist 8 Authorized Practitioners 9 Purpose and Scope of Pharmacy Services 10 License, Permits and File Location 11 Change in Consultant Pharmacist 12 Receipt and Accountability of Pharmaceuticals 13 Reports 15 Pharmacy Records 16 Security and Access to Medications 17 Reference Materials.18 Labeling 19 Medication Errors/Adverse Drug Reactions 20 Security and Infection Control for Medication Room 21 Medication Storage/Medication Room 22 Exam Rooms and Outdated Drugs 23 Possession of Medications 24 Recalls 25 Refrigerators 26 Multi-dose Vials 27 Emergency Plans 28 Location of Pertinent Items 29 CONSULTING PHARMACIST Consulting Pharmacist Pharmacist, RPh  SHAPE \* MERGEFORMAT CONTACTOR SCHOOL BASED HEALTH CENTER MISSION STATEMENT Evidence has shown that academic success does not happen in isolation from the rest of our students human existence. A commitment to academic excellence and to our students success must include a commitment to each and every students physical and emotional wellness. In todays health care climate, the disparities are glaring and marginalize those most at risk and in need of primary care minorities, self-employed, the unemployed who do not qualify for state health benefits and the poor working class. Access to health care means more than having insurance. It means having the money for a co-pay, transportation and knowledge of the health care system and how to navigate in it. The adolescent children of the above populations and of the insured are also missing from the demographic of those with access to health care for these reasons. Therefore, it is this school districts mission, in cooperation with the Department of Health- Office of School and Adolescent Health, local officials and partnering health agencies, to make a commitment to producing healthy students that have the necessary tools to maximize their academic opportunity and become healthy successful individuals. This will include but not be limited to Early and Periodic Screenings, Diagnosis and Treatment of acute and chronic illness, nutritional deficiencies and mental illness. In addition, we are committed to health education and prevention of obesity, illness, injuries, substance abuse and unplanned teen pregnancies. CONTRACTOR SCHOOL BASED HEALTH CENTER FORMULARY Over the Counter (OTC) Medications [SAMPLE ONLY] Acetaminophen 500mg PO Ibuprofen 200mg PO Mylanta 600mg/5ml PO Stock Medications (Legend Drugs) [SAMPLE ONLY] Albuterol Inhalation Solution 2.5mg/3ml Cephalexin 250mg PO Cephalexin 500mg PO Ciprofloxacin 250mg PO Ciprofloxacin 500mg PO Dexamethasone Sodium Phosphate Injection 4mg/ml Doxycycline 100mg PO EpiPen Erythromycin Ophthalmic Ointment 0.5% Hyoscyamine Sulfate Oral Solution 0.125mg/ml Insulin Lidocaine Metronidazole 500mg PO Prednisone 20mg PO Promethazine Sulfamethoxazole/Trimethaprim 800mg/160mg PO Vaccines [SAMPLE ONLY] Diphtheria, Tetanus & Pertussis (DTaP) Haemophilus Influenza B (Hib) Hepatitis A (HAV) Hepatitis B (HBV) Measles, Mumps & Rubella (MMR) Polio (IPV) Pneumococcal (PCV) MEMORANDUM OF AGREEMENT See attachment for the Memoranda of Agreement (MOA) between the CONTRACTOR Schools and Pharmacist, RPh. POLICY AND PROCEDURE DATES Development Date: __________ Developed By:  FORMTEXT NAME, BSN, RN  FORMTEXT NAME, MSN, RN Revised Date:  FORMTEXT DATE, 2006 Reviewed By:  FORMTEXT NAMEHealth Services Coordinator/SBHC Coordinator Pharmacist, RPh Approved By:  FORMTEXT ContractorSchools Board of Education or Medical Sponsor Superintendent:  FORMTEXT NAME Approved Date: XX/XX/XX POLICY AND PROCEDURES 1. CONSULTANT PHARMACIST Policy This pharmacy shall be operated under the direction of a Consultant Pharmacist. The Consultant Pharmacist will be available to the SBHC during normal operational hours. Procedure The Consultant Pharmacist will assume responsibilities as the Consultant Pharmacist for the Class B-1 Permit Clinic at the Contactor SBHC. The name, address and telephone number of the Consultant Pharmacist will be posted in an area accessible to the SBHC staff. 2. AUTHORIZED PRACTITIONERS Policy All medications (over- the -counter and prescriptives) issued for students of the SBHC shall be prescribed by a licensed practitioner employed by the SBHC and authorized to prescribe under the New Mexico Statutes. Procedure A list of practitioners employed by the SBHC who are authorized to prescribe medications will be maintained on file at the Contractor Schools Administrative Office and the SBH. Each order for medication shall be entered in the medical record and on the daily medication log and is to be signed by the authorized practitioner. A written medication order shall state the patient's name, medical record number, date of order, name of medication, strength, quantity, route of administration, frequency or timing of each dose, and any other information necessary for the proper dispensing of the medication. The medication order shall be properly signed by the practitioner and followed by a name stamp or printed name of the practitioner. 3. PURPOSE AND SCOPE OF PHARMACY SERVICES Purpose To provide competent and judicious pharmaceutical service to clients of the Contractor School Based Health Center (SBHC) pharmacy services shall be provided in accordance with NMAC 16.19.10, and all federal statutes and regulations. Scope Pharmaceutical services provided by the Consultant Pharmacist shall include but will not be limited to: Conducting inspections/consultation every two months (bimonthly) when school is in session on all drug storage areas within the SBHC and providing consultation as needed. Ensuring the delivery of properly labeled medications by the SBHC Providing information to the SBHC concerning drugs, interactions and side effects Maintaining and updating the Pharmacy Policies and Procedures Manual. Destroying outdated drugs. Reviewing Medication Logs and Charts every two months ( bimonthly) for administered or dispensed medications for: Allergies Documentation of medication prescribed Client name and contact information Review ten percent of medical records bimonthly with administered or dispensed medications 4. LICENSE, PERMITS AND FILE LOCATION Policy The pharmacy is licensed as a Class B Clinic as required by the New Mexico Board of Pharmacy. Procedure It shall be the responsibility of the Consultant Pharmacist and Contractor Schools Health Service Coordinator to ensure that the permits and licenses necessary for the legal operation of this pharmacy are applied for and/or renewed in a timely fashion. Class B-1 Clinic Renewed biannually, first renewal will be due 12/31/2007 Renewal notice sent by NM Board of Pharmacy 30 to 60 days prior to expiration date. Fee required is currently $300 or as amended by NM Pharmacy Board The Health Service Coordinator shall post the license when received and a send copy to the Consultant Pharmacist. 5. CHANGE IN CONSULTANT PHARMACIST Policy The SBHC shall establish guidelines for notification to the New Mexico Board of Pharmacy when a change is made in the Consultant Pharmacist. Procedure The New Mexico Board of Pharmacy must be notified in writing within ten (10) working days of a change in the Consultant Pharmacist. The following information must be forwarded to the New Mexico Board of Pharmacy: Clinic name, address, and permit number. Names of the outgoing and incoming consultant pharmacists and their license numbers. Effective date of the change. 6. RECEIPT AND ACCOUNTABILITY OF PHARMACEUTICALS Policy All pharmaceuticals shall be shipped from the manufacturer in a secure manner, which will provide accountability from the pharmacy to the ultimate consumer. Procedure Pharmaceuticals shall be shipped from the supplier pursuant to a valid written purchase order from the SBHC. The supplier for the purpose of this policy is the consulting pharmacist, name of pharmacist. He/she will order from the wholesaler and receive them at the pharmacy location. Product will be shipped to the SBHC and the RPh will repackage into dispensing containers at the SBHC... Legend and OTC Drugs for Stock All legend drugs and OTC drugs shipped to the SBHC for stock must be on the list approved by the Contractor site or school. The invoice from the supplier will be included with the shipment. The SBHC staff must verify the invoice against items received and give the invoice to the Health Services Coordinator to sign and deliver to accounts payable in the business office for processing. The SBHC staff shall notify the business office if items are missing from the shipment. Sample Drugs Drug samples from pharmaceutical representatives may be added to the formulary on consultation with the practitioner and the SBHC consulting pharmacist. A copy of the invoice or receipt from the drug representative for all samples delivered to the SBHC provider will be kept on file for 5 years. Delivery Reports The SBHC staff will sign the couriers delivery sheet and take medications to the pharmacy room. The shipment is checked against the invoice for accuracy. If incorrect the supplier is to be called. If correct then the medications are stored in the appropriate designated areas and locked. The SBHC services staff shall file the invoice, which will be kept for 5 years. Controlled drugs will be delivered to the office of the contracted consulting physician, as per supplier policies, and moved to the pharmacy for secure storage by authorized SBHC staff. Missing Medications If the SBHC staff cannot find a medication that was checked off by the supplier, then the SBHC staff and the supplier must reconcile the discrepancy in the delivery report and the contracted pharmacy is to resend the proper amount. Client Receipt of Medications Each prescription filled for a client should be accompanied by a self-adhesive label with Rx# and a signature line for the client. Each client must sign for every prescription and the Practitioner must initial and date the self-adhesive label, which will then be affixed to the pharmacy log. The pharmacy logs must be kept for 5 years. File Maintenance SBHC staff must maintain copies of invoices, pharmacy logs, missing medication inquiry forms, stock requests with copies of the PO and receipts for 5 years in organized, easily retrievable files. 7. REPORTS Policy The Consultant Pharmacist shall prepare and submit required reports in a timely and accurate fashion. Procedure The following reports will be submitted on a regular basis: The Consultant Pharmacist's Inspection Report is a record of the bimonthly inspection of all areas where medication is stored in this SBHC. This report is submitted to the Contractor Consolidated Schools Health Services Coordinator or Medical sponsor within 10 (ten) days of the inspection. The original must be filed at the SBHC in the pharmacy files. Deficiencies/discrepancies will be noted on the bimonthly consultant report and discussed with the Practitioner and Health Service Coordinator prior to leaving the facility. If deficiencies are not corrected before the next bimonthly inspection, the Practitioner, Health Service Coordinator and Consultant Pharmacist will develop a Corrective Action Plan. The Corrective Action Plan will be kept on file for 5 years. 8. PHARMACY RECORDS Policy Retention of pharmacy records shall be in accordance with applicable laws, statues, and regulations. Procedure All pharmacy records pertaining to this permitted clinic shall be filled in a readily retrievable file at the SBHC. Records must be available for inspection by the Consultant Pharmacist, Board of Pharmacy Inspectors, and others authorized to access these records. If there is any question concerning access to these records, the Consultant Pharmacist or the Contractor or Medical Sponsor School Health Services Coordinator shall be notified. Records shall be maintained as follows: Medication Drug Logs 5 years Medication Administration Logs 5 years Daily Temperature Logs 5 years Bi-monthly Consultant Inspection Reports 5 years Drug destruction/return records 5 years 9. SECURITY AND ACCESS TO MEDICATIONS Policy Access to pharmaceutical and sensitive items must be restricted to authorized personnel. Procedures will be approved by the Consultant Pharmacist to ensure the security of these items. Keys to drug storage areas will be distributed only to individuals who are authorized to have access to drugs and/or sensitive items. Procedure All drugs are under "lock and key. For the purpose of clarification, the term "drugs" and "storage" will be divided into categories, which will be referred to in subsequent sections of this chapter. Drugs will be divided into two categories: OTC Drugs: These are over-the-counter (non-prescription) drugs that can be obtained without a prescription. Prescription/Legend Drugs: These are drugs that require a prescription and can be identified by the legend on the label, which states: "Caution, Federal Law Prohibits Dispensing Without a Prescription" or is labeled RX Only. Only the licensed medical providers, including a registered nurse are authorized to have keys for the following areas: Pharmacy Room Exam Room Medicine Cabinets 10. LABELING Policy All medication orders, both legend and OTC, are to be labeled in accordance with all federal and state laws. Only individuals licensed to dispense medications may modify any medication label. Procedure Labels shall be permanently affixed to the outside of the medication container. All medication orders, regardless of the source, are to be labeled as follows: RX number, if applicable Name of practitioner Patient name and Medical Record Number (Last name first) Name and strength of drug Directions for use Quantity dispensed Refills authorized Date dispensed Expiration Date or discard after date (for prescribed medications) Labels shall contain adequate warning instructions, auxiliary labels and any additional information deemed necessary by the practitioner or pharmacist. 10. REFERENCE MATERIALS Policy The Contractor School Based Health Center shall maintain on site current copies of at least one drug reference book. Procedure: Reference materials will be updated annually during the summer. At least one hard copy of a standard drug reference will be maintained in the SBHC. Electronic reference materials will be maintained in the providers office. A copy of the state drug laws and regulations will be present in the SBHC. Refer to the NM Poison Control web site for Professional Education for the Poison Treatment chart. The phone number of the Poison Control Center will be posted. The statewide # is 505-272-2222 or 1-800-222-1222, for the national 24 hour line. 11. MEDICATION ERRORS/ADVERSE DRUG REACTIONS Policy Medication errors and adverse drug reactions shall be reported immediately to the Practitioner and Health Service Coordinator. Procedure Medication errors shall be reported on the appropriate forms. A copy is to be kept in a folder/binder named RX Incident Reports and maintained for five (5) years. Adverse reactions shall be reported to the Practitioner who ordered the drug and documented according to school policy or medical sponsor on the appropriate form. Drug reactions shall also be properly recorded in the patient's medical record. 12. SECURITY AND INFECTION CONTROL FOR MEDICATION ROOM Policy The medication storage area will be secure and free from contamination. Therapeutic materials will be handled and distributed in such a manner as to prevent contamination and further to prevent contaminated agents from being conveyed to clients or to treatment areas. Procedure Hands will be washed before handling medications and frequently during the day. Counting trays, or equivalent, shall be used to count tablets and capsules. Counter tops, counting trays, and sink will be cleaned frequently with alcohol or disinfectant. Good aseptic technique shall be adhered to at all times when handling pharmaceuticals There will be no unauthorized visitors in the medication room and the door shall be labeled staff only. Personal hygiene shall be maintained by the SBHC staff. Persons displaying signs of infection shall not handle medications, without the appropriate equipment (i.e. mask, gloves, etc.). Contaminated products such as blood and urine shall not be stored in the same storage area as medications; these should be stored in the Lab or other appropriate areas. Sweeping, dusting, trash removal and other light cleaning required for general daily maintenance of medical storage area will be performed by the SBHC staff, or under the direct supervision of the SBHC staff. 13. DRUG STORAGE/MEDICATION ROOM Policy All medications stored in the SBHC shall be stored under proper environmental conditions and shall have adequate control measures. Procedure A temperature log will be kept for the pharmacy room and the refrigerator. Drugs stored at room temperature will be maintained between 68 and 77 degrees F. Refrigerated drugs will be maintained at 36-46 degrees F. Filled Medication Orders ready for client pick-up shall be stored in a secure area in the medication room until signed for by the client. Upon dispensing and upon receipt, these items shall be accounted for on the appropriate forms. Each dose must be signed out and include date, time, clients name, clients medical record number, signature of Practitioner, number dispensed, and balance on hand. A perpetual inventory must be kept on these drugs and will be checked daily by the Practitioner and bimonthly by the Consultant Pharmacist. Discrepancies in the count of these drugs will be reported to the Contractor School or Medical Sponsor Health Service Coordinator and the Consultant Pharmacist. 14. EXAM ROOMS and OUTDATED DRUGS Policy The practitioner shall utilize patient treatment areas to store limited pharmaceutical necessary to treat the immediate needs of the client. Stock must be checked on a regular basis for outdated drugs. Procedure The practitioner may keep a limited amount of pharmaceuticals necessary to treat clients in a locked storage cabinet in the treatment room(s). Practitioners must check medications for signs of deterioration or expired dates before using them. The Consultant Pharmacist will also check this stock on a bi-monthly basis. Any outdated or deteriorated drugs shall be removed from working stock and destroyed by the Consulting Pharmacist. A record of destroyed drugs will be maintained by the clinic. 15. POSSESSION OF MEDICATIONS Policy All medications confiscated from students by security or school staff shall be returned to the SBHC. Procedure In the event that a client must take medication(s) at school, the client must follow the Contractor Schools district policy # as listed in policy and procedure manual. The School Nurse must be notified, in writing, of each student taking medications at school by the students parent/guardian. Administration of medication at school may be done in one of two ways: Self-Administration: May be done if recommended, in writing, by the prescribing practitioner and the parent/guardian. Only the necessary amount of medication may be in the students possession. Administration by the School Nurse: May be done if the students parent/guardian and school personnel determine that the student is incapable of reliable self-administration. The parent/guardian must provide clear and explicit written instructions from the students practitioner for administration of the medication. Over the counter medications are permitted under the following conditions: The students health care provider orders the medication Written parental authorization form is on file with the school nurse Medication is provided by the parent/guardian in the original labeled container Medication is an FDA approved drug and is used only for a specified condition Any course of medicine dispensed by the SBHC practitioner that will require administration during school hours will be separately dispensed and labeled for the school RN and the family. The school RN will store school portion of course of treatment according to already existing school guidelines in Policy #. The family/home portion will be given to the student at the end of the school day to take home to parent/guardian. A log of medications stored at the school will be maintained listing: 1. Pharmacy name 2. Prescription Number 3. Patient Name 4. Drug Name, strength, and Quantity 5. Date 6. Name or initials of person completing log 16. RECALLS Policy All drugs recalled by the manufacturer or the FDA shall be promptly removed from the SBHC drug distribution system. This is the responsibility of the Consultant Pharmacist. 17. REFRIGERATORS Policy Refrigerators containing medications shall be maintained under proper conditions of sanitation, temperature, and segregation. The refrigerators shall be inspected quarterly during the Consultant Pharmacist Inspection. Procedure Refrigerators shall be kept clean and defrosted. Those without automatic defrosters shall be defrosted as necessary. No food items including nutritional supplements (Ensure, etc.) may be stored in the refrigerator designated for drug storage. Temperature should be maintained between 36 and 46 degrees Fahrenheit. Due to the frequency of use, it is felt that a malfunction would be immediately apparent. A log will be kept on the refrigerator documenting daily temperature checks, twice per day (am and pm) during SBHC hours of operation. The thermometer should be placed near the center of the refrigerator and read quickly after opening the door. Any apparent malfunction should be reported to the Practitioner and Health Services Coordinator immediately. If refrigerator is expected to be inoperable for more than 24 hours, items should be removed to an operable refrigerator. The Practitioner should make a list of items and quantities moved and notify the Consultant Pharmacist as soon as possible. Upon correction of the problem, the removed items should be returned. They should be checked in using the inventory made at the time of their removal. 18. MULTI-DOSE VIALS Policy No contaminated or deteriorated parenteral drug product shall be used. Procedures will be utilized to prevent contamination. Procedure Multi-dose vials: Shall be dated and initialed when opened. May be used through labeled expiration date or for a period of thirty (28) days from date opened (whichever earlier). Opened vials should be visually inspected for signs of contamination (turbidity, cloudiness, solid impurities, crystal formation, color changes, or changes in viscosity). Opened vials, which are not dated, should be considered outdated and will be removed by the Consultant Pharmacist during the bimonthly inspection. This destruction will be noted in the monthly report. 19. EMERGENCY PLANS Policy The security of and accountability for pharmaceutical medications will be maintained even in the event of emergency situations. Procedure In the event of an emergency, i.e., a fire, flood, or break-in, the Consultant Pharmacist (in conjunction with the Health Services Coordinator) shall be notified by phone immediately. The Practitioner, or designee, will monitor the areas containing medications until the Health Service Coordinator is notified and can make security staff available to secure the area. In the case of fire or flood, if items must be removed from the SBHC, the medications should be placed in sealed boxes (if available) and stored in a secure place until such time that the Consultant Pharmacist can arrive. (Items that must be refrigerated should be placed in a sealed container in a refrigerator in a secure area.) Every effort should be made to insure that no medications are lost, destroyed, or left unattended. 20. LOCATION OF PERTINENT ITEMS Policy To maintain accurate and updated locations of pertinent items Procedure The following is a list where pertinent items are located for Contactor SBHC: Legend Drug stock is kept in the pharmacy room. OTC medications are in the pharmacy room. The SBHC does not have a crash cart. Sharps are in the pharmacy room and treatment rooms. Pertinent phone numbers are kept in a binder at the SBHC front desk. All licenses and permits are posted on cabinets in the pharmacy room. All files pertaining to pharmacy operations are stored in a fire safe filing cabinet in the pharmacy room. Keys for pharmacy room are carried only by licensed medical providers, including registered nurses. Drug fact sheets and information is kept in the clinical pharmacy. Pharmacy statutes are kept in the providers office for reference.      PAGE 4 SAMPLE ONLY    &'ݞ}lVl@*jh @[hZ5OJQJU^J*j6h @[hZ5OJQJU^J hZ5OJQJ^JmHnHu*jh @[hZ5OJQJU^JhZ5OJQJ^JjhZ5OJQJU^J(hZ5CJ OJQJ^JaJ mHnHu2jh @[hZ5CJ OJQJU^JaJ hZ5CJ OJQJ^JaJ &jhZ5CJ OJQJU^JaJ )*EF`aef$a$xjjj*+C}1[ & F G$dh^ $dh$a$+CGHM} J  ԾԨԞzԞl^jhZOJQJU^J *hl_hZOJQJ^JhZOJQJ\^J *hZOJQJ^J *h @[hZOJQJ^JhZOJQJ^J*jh @[hZ5OJQJU^J*jDh @[hZ5OJQJU^JhZ5OJQJ^J hZ5OJQJ^JmHnHujhZ5OJQJU^J$ J V  ' 8 L _ ~  $ $a$ $ $$dh^ & F GW$dh^ & F G$dh^ & F G$dh^      <=no $   o0]kz{Ƕۦ逛rbjhZ5OJQJU^J *hARUhZOJQJ^JhZCJOJQJ^JaJhZ6OJQJ]^JhZ5OJQJ^J *h @[hZ5OJQJ^J!j<h#hZOJQJU^J&jhZOJQJU^JmHnHujhZOJQJU^JhZOJQJ^J *hZ5OJQJ^J#Iv~-K]o./KLjk $ڿ}rr\QrQrrhZOJQJ\^J*jhARUhZ5OJQJU^JhZ5OJQJ^J!hD,hZB*OJQJ^JphhZOJQJ^JmHnHu'jJhARUhZOJQJU^JjhZOJQJU^JhZOJQJ^J hZ5OJQJ^JmHnHujhZ5OJQJU^J*jhARUhZ5OJQJU^J0OP #$+,V^V  $NP^_ijkuv#$+ھکھm\L *hl_hZ5OJQJ^J hZOJQJ\^JmHnHu*jNh(hZOJQJU\^JjhZOJQJU\^J*jhARUhZ5OJQJU^JhZ5OJQJ^JhZOJQJ^JhZOJQJ\^J hZ5OJQJ^JmHnHujhZ5OJQJU^J*jFhARUhZ5OJQJU^J oy[_`e6!^!_!f!!!""""##($M$N$U$$$d&&&&@'J'(((((V)`)*** , ,,hZhZ>*OJQJ^J *hAnhZOJQJ^J *hehZOJQJ^JhZ5>*OJQJ^J *hl_hZOJQJ^J *hZOJQJ^J *h=jahZOJQJ^JhZ5OJQJ^JhZOJQJ^J7 hiWX^ & FV^VgdZ f^^  5!6!^!_!f!g!!!!!"""V^V8^8 & F & F""##q#r###'$($M$N$U$V$$$$$%%%%E&F&d& & F ^}^} & F ^V^Vd&e&&&&&?'@'J'K'((((**** , ,,,M.N.O.P.Q.R.V^V  $,,L.M.S.g.P/Q/r/00011112&2c22h5i555555`7}78888::;;;;;g<h< ==="===??<@a@e@o@@@C3C4C*OJQJ^JhZ>*OJQJ^JhZB*OJQJ^JphhZOJQJ^JhZ5OJQJ^J=R.S.g.h.P/Q/R/S/T/r/s/000001111122&2'2c2h5  $V^VV^Vh5i555555555777777$8%8D8E8w8 } & F }^ }}^} & F }^V^V  $w8x8888888:::::C:D:::;;;;g<h<<^ & F^  $ & F }^ }gdZ<<<< ==="=#=====@>>>>>>>>>??(?)?^ & F e^^ & F^)?@W@X@_@`@@@@@#AwAABsBC3C4C & F eW_^W`_ & F e^4C;C*OJQJ\^JD[GGGHHHHHH*OJQJ\^JDA@D Default Paragraph FontViV  Table Normal :V 44 la (k(No List 4@4 Header  !4 @4 Footer  !.)@. Page NumberPC@"P Body Text Indent V^V OJQJ^Jdd z z z z z z z z z z z z z z z z z z z z z z z z z z z z z z~ 07)f S(+j/2 7?:=d?DI L7STTmZE]ad0+ ' $ 3  '.8"#F !)*EF`aef*+C}1[JV'8L_~ < = n o    # I v ~ -K]o./KLjk0OP #$+, hiWX 56^_fgqr'(MNUVE F d e ?!@!J!K!""""$$$$ & &&&M(N(O(P(Q(R(S(g(h(P)Q)R)S)T)r)s)*****+++++,,&,',c,h/i/////////111111$2%2D2E2w2x222222244444C4D4445555g6h66666 777"7#77777@88888888899(9)9<9=9P9Q9`9a999=:>:W:X:_:`:::::#;w;;<s<=3=4=;=<=====k>l>c??????@@@@ AAZA[AAABBBBBB@CDEFHIJKLMOPQRSTUWj8 &z^judFFFFFFFFFFFF!@   @333 (  ~  > % #  s"*?`  c $X99? > %  C 333C"?'UC  B S  ?H 0(  d$pt Text1Text2Text3Text4Text5Text6Text13Text14Text15Text16Text17Text18z^d 'vd'    " zKN^v9F""xdxdzdzd{d{d}d~ddddddddddd'z^vwdxddddddd)|r}ܠ|~x*P [Ƽ'LUf>:Pt Z:a&x^gYDB Ht |vt dV,0 d! ή=+*vA,j:s9T-@8ך5\i?@7I҂1Nb LQJBTR$v-=BW|^sOY,QNl_K_΅hAKa_cR$vk`d:QTE.f>[lsRXvo&bnt]s6v{b#>|,QN^`.^`.88^8`.^`. ^`OJQJo( ^`OJQJo( 88^8`OJQJo( ^`OJQJo(hh^h`. hh^h`OJQJo( ii^i`o(hH. ^`hH. q Lq ^q `LhH. A A ^A `hH. ^`hH. L^`LhH. ^`hH. ^`hH. QLQ^Q`LhH.- - ^- `5OJPJQJ^J.hh^h`o(. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH. 00^0`o(hH. ^`hH. L^`LhH.   ^ `hH. pp^p`hH. @L@^@`LhH. ^`hH. ^`hH. L^`LhH.^`o(. ^`hH.  L ^ `LhH.   ^ `hH. ff^f`hH. 6L6^6`LhH. ^`hH. ^`hH. L^`LhH.5ee^e`5OJPJQJ^J.5 hh^h`hH.5 8 L8 ^8 `LhH.5   ^ `hH.5 ^`hH.5 L^`LhH.5 xx^x`hH.5 HH^H`hH.5 L^`LhH. ^`o(hH. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH. 00^0`o(hH. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH.- - ^- `5OJPJQJ^J. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH.- - ^- `5OJPJQJ^J. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH.- - ^- `5OJPJQJ^J. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH. 00^0`o(hH. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH.5ee^e`OJPJQJ^J.5 hh^h`hH.5 8 L8 ^8 `LhH.5   ^ `hH.5 ^`hH.5 L^`LhH.5 xx^x`hH.5 HH^H`hH.5 L^`LhH. ii^i`o(hH. ^`hH. q Lq ^q `LhH. A A ^A `hH. ^`hH. L^`LhH. ^`hH. ^`hH. QLQ^Q`LhH.^`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.5ee^e`5OJPJQJ^J.5 hh^h`hH.5 8 L8 ^8 `LhH.5   ^ `hH.5 ^`hH.5 L^`LhH.5 xx^x`hH.5 HH^H`hH.5 L^`LhH.GG^G`o(. ^`hH.  L ^ `LhH.   ^ `hH. ^`hH. WLW^W`LhH. ''^'`hH. ^`hH. L^`LhH.- - ^- `5OJPJQJ^J. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH.00^0`o(. ^`hH. L^`LhH.   ^ `hH. pp^p`hH. @L@^@`LhH. ^`hH. ^`hH. L^`LhH.^`OJPJQJ^J. ^`hH.  L ^ `LhH.   ^ `hH. ff^f`hH. 6L6^6`LhH. ^`hH. ^`hH. L^`LhH. 00^0`o(hH. ^`hH. L^`LhH.   ^ `hH. pp^p`hH. @L@^@`LhH. ^`hH. ^`hH. L^`LhH. 00^0`o(hH. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH. ii^i`o(hH. ^`hH. q Lq ^q `LhH. A A ^A `hH. ^`hH. L^`LhH. ^`hH. ^`hH. QLQ^Q`LhH. ii^i`o(hH. ^`hH. q Lq ^q `LhH. A A ^A `hH. ^`hH. L^`LhH. ^`hH. ^`hH. QLQ^Q`LhH.00^0`o(. ^`hH. L^`LhH.   ^ `hH. pp^p`hH. @L@^@`LhH. ^`hH. ^`hH. L^`LhH.GG^G`o(. ^`hH. pLp^p`LhH. @ @ ^@ `hH. ^`hH. L^`LhH. ^`hH. ^`hH. PLP^P`LhH.^`o(. ^`hH.  L ^ `LhH.   ^ `hH. ff^f`hH. 6L6^6`LhH. ^`hH. ^`hH. L^`LhH. 00^0`o(hH. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH.- - ^- `5OJPJQJ^J. hh^h`hH. 8 L8 ^8 `LhH.   ^ `hH. ^`hH. L^`LhH. xx^x`hH. HH^H`hH. L^`LhH. ii^i`o(hH. ^`hH. q Lq ^q `LhH. A A ^A `hH. ^`hH. L^`LhH. ^`hH. ^`hH. QLQ^Q`LhH.GG^G`o(. ^`hH.  L ^ `LhH.   ^ `hH. ^`hH. WLW^W`LhH. ''^'`hH. ^`hH. L^`LhH. 00^0`o(hH. ^`hH. L^`LhH.   ^ `hH. pp^p`hH. @L@^@`LhH. ^`hH. ^`hH. L^`LhH.)6v{\i?1Nk`dTE.fYDB -=BWs9T-IHt d! LQxXvo=+0 _cBTl_K_AKantavA,8>[lV#>|sOYt ~}|))        2>0                2        ל                2        2        2                T<                         PW>>        2        T<                                ?@ABCDEFGHIJKLMNOPQRSTUVWXZ[\]^_`bcdefghijklmnopqrstuvwxyz{|}~Root Entry Fv`XData Y1Tablea6WordDocument"SummaryInformation(DocumentSummaryInformation8CompObjXObjectPoolv`Xv`X FMicrosoft Word DocumentNB6WWord.Document.8