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0.996 g
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BT
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0.996 g
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0 g
BT
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0.04 Tc (No) Tj
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0.996 g
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558.48 551.76 l
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0.996 g
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0.996 g
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0.996 g
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0.996 g
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0 g
BT
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0.04 Tc (No) Tj
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0.996 g
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0.629 g
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0.813 g
f*
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4.8 523.44 0.72 -19.92 re
0.816 g
f*
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f*
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f*
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0.629 g
f*
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ET
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0.996 g
f*
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0 g
BT
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-0.02 Tc (Aspirin) Tj
ET
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0.996 g
f*
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11.52 488.64 9.36 -9.36 re
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0 g
BT
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-0.076 Tc (Penicillin) Tj
ET
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72.72 488.4 9.12 -9.12 re
0.996 g
f*
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0 g
BT
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-0.142 Tc (Codeine) Tj
ET
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0.996 g
f*
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141.36 488.64 9.36 -9.36 re
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0 g
BT
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-0.066 Tc (Acrylic) Tj
ET
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0.996 g
f*
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206.64 488.64 9.36 -9.36 re
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S
0 g
BT
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ET
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0.996 g
f*
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263.52 488.64 9.36 -9.36 re
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0 g
BT
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ET
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320.88 488.4 9.12 -9.12 re
0.996 g
f*
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h
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0 g
BT
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ET
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378.72 488.4 9.12 -9.12 re
0.996 g
f*
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378.48 488.64 9.36 -9.36 re
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1 g
f*
0 g
BT
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-0.147 Tc 0.106 Tw (If yes, please explain:) Tj
ET
0.72 w
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BT
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ET
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547.92 192.48 l
S
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547.92 175.92 l
S
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61.92 159.36 m
547.92 159.36 l
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547.92 126.48 l
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0.017 Tc -0.271 Tw (Excessive Thirst) Tj
1 0 0 1 151.2 347.52 Tm
0.022 Tc -0.037 Tw (Fainting Spells/Dizziness) Tj
1 0 0 1 151.2 337.68 Tm
-0.008 Tc -0.005 Tw (Frequent Cough) Tj
1 0 0 1 151.2 327.84 Tm
0.013 Tc -0.027 Tw (Frequent Diarrhea) Tj
1 0 0 1 151.2 317.52 Tm
-0.004 Tc -0.009 Tw (Frequent Headaches) Tj
1 0 0 1 151.2 307.68 Tm
0.022 Tc -0.036 Tw (Genital Herpes) Tj
1 0 0 1 151.2 297.84 Tm
0.067 Tc 0 Tw (Glaucoma) Tj
1 0 0 1 151.2 288.24 Tm
-0.104 Tc 0.09 Tw (Hay Fever) Tj
1 0 0 1 151.2 278.4 Tm
0.012 Tc -0.506 Tw (Heart Attack/Failure) Tj
1 0 0 1 151.2 268.8 Tm
-0.003 Tc -0.01 Tw (Heart Murmur) Tj
1 0 0 1 151.2 258.96 Tm
-0.035 Tc 0.021 Tw (Heart Pace Maker) Tj
1 0 0 1 151.2 249.12 Tm
0.026 Tc -0.28 Tw (Heart Trouble/Disease) Tj
1 0 0 1 9.36 425.52 Tm
-0.056 Tc 0.042 Tw (AIDS/HIV Positive) Tj
1 0 0 1 9.36 415.68 Tm
0.047 Tc -0.061 Tw (Alzheimer's Disease) Tj
1 0 0 1 9.36 405.84 Tm
-0.068 Tc 0 Tw (Anaphylaxis) Tj
1 0 0 1 9.36 376.8 Tm
0.033 Tc (Arthritis/Gout) Tj
1 0 0 1 9.36 366.96 Tm
0.041 Tc -0.055 Tw (Artificial Heart V) Tj
49.92 0 Td -0.085 Tc 0 Tw (alve) Tj
1 0 0 1 9.36 357.12 Tm
0.056 Tc -0.07 Tw (Artificial Joint) Tj
1 0 0 1 9.36 347.52 Tm
0.039 Tc 0 Tw (Asthma) Tj
1 0 0 1 9.36 337.68 Tm
0.025 Tc -0.04 Tw (Blood Disease) Tj
1 0 0 1 9.36 327.84 Tm
0.023 Tc -0.277 Tw (Blood Transfusion) Tj
1 0 0 1 9.36 317.52 Tm
0.000 Tc -0.014 Tw (Breathing Problem) Tj
1 0 0 1 9.36 307.68 Tm
0.042 Tc -0.056 Tw (Bruise Easily) Tj
1 0 0 1 9.36 297.84 Tm
0.008 Tc 0 Tw (Cancer) Tj
1 0 0 1 9.36 288.24 Tm
0.006 Tc (Chemotherapy) Tj
1 0 0 1 9.36 278.4 Tm
0.005 Tc -0.019 Tw (Chest Pains) Tj
1 0 0 1 9.36 268.8 Tm
0.009 Tc -0.023 Tw (Cold Sores/Fever Blisters) Tj
1 0 0 1 9.36 258.96 Tm
0.016 Tc -0.03 Tw (Congenital Heart Disorder) Tj
1 0 0 1 9.36 249.12 Tm
-0.011 Tc 0 Tw (Convulsions) Tj
1 0 0 1 291.36 425.52 Tm
0.055 Tc (Hemophilia) Tj
1 0 0 1 291.36 415.68 Tm
0.031 Tc -0.525 Tw (Hepatitis A) Tj
1 0 0 1 291.36 405.84 Tm
0.02 Tc -0.035 Tw (Hepatitis B or C) Tj
1 0 0 1 291.36 396.24 Tm
0.000 Tc 0 Tw (Herpes) Tj
1 0 0 1 291.36 386.4 Tm
0.019 Tc -0.033 Tw (High Blood Pressure) Tj
1 0 0 1 291.36 376.8 Tm
0.003 Tc -0.017 Tw (Hives or Rash) Tj
1 0 0 1 291.36 366.96 Tm
-0.021 Tc 0 Tw (Hypoglycemia) Tj
1 0 0 1 291.36 357.12 Tm
-0.004 Tc -0.01 Tw (Irregular Heartbeat) Tj
1 0 0 1 291.36 347.52 Tm
-0.012 Tc -0.001 Tw (Kidney Problems) Tj
1 0 0 1 291.36 337.68 Tm
0.013 Tc 0 Tw (Leukemia) Tj
1 0 0 1 291.36 327.84 Tm
0.01 Tc -0.025 Tw (Liver Disease) Tj
1 0 0 1 291.36 317.52 Tm
0.011 Tc -0.025 Tw (Low Blood Pressure) Tj
1 0 0 1 291.36 307.68 Tm
0.02 Tc -0.034 Tw (Lung Disease) Tj
1 0 0 1 291.36 297.84 Tm
0.004 Tc -0.018 Tw (Mitral V) Tj
23.04 0 Td -0.011 Tc -0.002 Tw (alve Prolapse) Tj
1 0 0 1 291.36 288.24 Tm
0.026 Tc -0.04 Tw (Pain in Jaw Joints) Tj
1 0 0 1 291.36 278.4 Tm
0.000 Tc -0.015 Tw (Parathyroid Disease) Tj
1 0 0 1 291.36 268.8 Tm
0.018 Tc -0.032 Tw (Psychiatric Care) Tj
1 0 0 1 291.36 258.96 Tm
0.017 Tc -0.271 Tw (Radiation Treatments) Tj
1 0 0 1 291.36 249.12 Tm
0.033 Tc -0.047 Tw (Recent Weight Loss) Tj
1 0 0 1 517.44 425.76 Tm
-0.802 Tc 0 Tw (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
0.24 w
n
513.84 428.4 m
513.84 430.56 511.92 432.24 509.76 432.24 c
507.6 432.24 505.92 430.56 505.92 428.4 c
505.92 426.24 507.6 424.32 509.76 424.32 c
511.92 424.32 513.84 426.24 513.84 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.12 425.76 Tm
0.014 Tc (No) Tj
ET
n
539.52 428.4 m
539.52 430.56 537.6 432.24 535.44 432.24 c
533.28 432.24 531.6 430.56 531.6 428.4 c
531.6 426.24 533.28 424.32 535.44 424.32 c
537.6 424.32 539.52 426.24 539.52 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 517.44 415.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
513.84 418.56 m
513.84 420.72 511.92 422.4 509.76 422.4 c
507.6 422.4 505.92 420.72 505.92 418.56 c
505.92 416.4 507.6 414.48 509.76 414.48 c
511.92 414.48 513.84 416.4 513.84 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.12 415.92 Tm
0.014 Tc (No) Tj
ET
n
539.52 418.56 m
539.52 420.72 537.6 422.4 535.44 422.4 c
533.28 422.4 531.6 420.72 531.6 418.56 c
531.6 416.4 533.28 414.48 535.44 414.48 c
537.6 414.48 539.52 416.4 539.52 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 517.44 406.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
513.84 408.72 m
513.84 410.88 511.92 412.56 509.76 412.56 c
507.6 412.56 505.92 410.88 505.92 408.72 c
505.92 406.56 507.6 404.64 509.76 404.64 c
511.92 404.64 513.84 406.56 513.84 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.12 406.08 Tm
0.014 Tc (No) Tj
ET
n
539.52 408.72 m
539.52 410.88 537.6 412.56 535.44 412.56 c
533.28 412.56 531.6 410.88 531.6 408.72 c
531.6 406.56 533.28 404.64 535.44 404.64 c
537.6 404.64 539.52 406.56 539.52 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 396.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 399.12 m
514.56 401.28 512.64 402.96 510.48 402.96 c
508.32 402.96 506.64 401.28 506.64 399.12 c
506.64 396.96 508.32 395.04 510.48 395.04 c
512.64 395.04 514.56 396.96 514.56 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 396.48 Tm
0.014 Tc (No) Tj
ET
n
540.24 399.12 m
540.24 401.28 538.32 402.96 536.16 402.96 c
534 402.96 532.32 401.28 532.32 399.12 c
532.32 396.96 534 395.04 536.16 395.04 c
538.32 395.04 540.24 396.96 540.24 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 386.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 389.28 m
514.56 391.44 512.64 393.12 510.48 393.12 c
508.32 393.12 506.64 391.44 506.64 389.28 c
506.64 387.12 508.32 385.2 510.48 385.2 c
512.64 385.2 514.56 387.12 514.56 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 386.64 Tm
0.014 Tc (No) Tj
ET
n
540.24 389.28 m
540.24 391.44 538.32 393.12 536.16 393.12 c
534 393.12 532.32 391.44 532.32 389.28 c
532.32 387.12 534 385.2 536.16 385.2 c
538.32 385.2 540.24 387.12 540.24 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 377.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 379.68 m
514.56 381.84 512.64 383.52 510.48 383.52 c
508.32 383.52 506.64 381.84 506.64 379.68 c
506.64 377.52 508.32 375.6 510.48 375.6 c
512.64 375.6 514.56 377.52 514.56 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 377.04 Tm
0.014 Tc (No) Tj
ET
n
540.24 379.68 m
540.24 381.84 538.32 383.52 536.16 383.52 c
534 383.52 532.32 381.84 532.32 379.68 c
532.32 377.52 534 375.6 536.16 375.6 c
538.32 375.6 540.24 377.52 540.24 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 367.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 369.84 m
514.56 372 512.64 373.68 510.48 373.68 c
508.32 373.68 506.64 372 506.64 369.84 c
506.64 367.68 508.32 365.76 510.48 365.76 c
512.64 365.76 514.56 367.68 514.56 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 367.2 Tm
0.014 Tc (No) Tj
ET
n
540.24 369.84 m
540.24 372 538.32 373.68 536.16 373.68 c
534 373.68 532.32 372 532.32 369.84 c
532.32 367.68 534 365.76 536.16 365.76 c
538.32 365.76 540.24 367.68 540.24 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 357.36 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 360 m
514.56 362.16 512.64 363.84 510.48 363.84 c
508.32 363.84 506.64 362.16 506.64 360 c
506.64 357.84 508.32 355.92 510.48 355.92 c
512.64 355.92 514.56 357.84 514.56 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 357.36 Tm
0.014 Tc (No) Tj
ET
n
540.24 360 m
540.24 362.16 538.32 363.84 536.16 363.84 c
534 363.84 532.32 362.16 532.32 360 c
532.32 357.84 534 355.92 536.16 355.92 c
538.32 355.92 540.24 357.84 540.24 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 347.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 350.4 m
514.56 352.56 512.64 354.24 510.48 354.24 c
508.32 354.24 506.64 352.56 506.64 350.4 c
506.64 348.24 508.32 346.32 510.48 346.32 c
512.64 346.32 514.56 348.24 514.56 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 347.76 Tm
0.014 Tc (No) Tj
ET
n
540.24 350.4 m
540.24 352.56 538.32 354.24 536.16 354.24 c
534 354.24 532.32 352.56 532.32 350.4 c
532.32 348.24 534 346.32 536.16 346.32 c
538.32 346.32 540.24 348.24 540.24 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 337.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 340.56 m
514.56 342.72 512.64 344.4 510.48 344.4 c
508.32 344.4 506.64 342.72 506.64 340.56 c
506.64 338.4 508.32 336.48 510.48 336.48 c
512.64 336.48 514.56 338.4 514.56 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 337.92 Tm
0.014 Tc (No) Tj
ET
n
540.24 340.56 m
540.24 342.72 538.32 344.4 536.16 344.4 c
534 344.4 532.32 342.72 532.32 340.56 c
532.32 338.4 534 336.48 536.16 336.48 c
538.32 336.48 540.24 338.4 540.24 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 328.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 330.72 m
514.56 332.88 512.64 334.56 510.48 334.56 c
508.32 334.56 506.64 332.88 506.64 330.72 c
506.64 328.56 508.32 326.64 510.48 326.64 c
512.64 326.64 514.56 328.56 514.56 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 328.08 Tm
0.014 Tc (No) Tj
ET
n
540.24 330.72 m
540.24 332.88 538.32 334.56 536.16 334.56 c
534 334.56 532.32 332.88 532.32 330.72 c
532.32 328.56 534 326.64 536.16 326.64 c
538.32 326.64 540.24 328.56 540.24 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 317.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 320.4 m
514.56 322.56 512.64 324.24 510.48 324.24 c
508.32 324.24 506.64 322.56 506.64 320.4 c
506.64 318.24 508.32 316.32 510.48 316.32 c
512.64 316.32 514.56 318.24 514.56 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 317.76 Tm
0.014 Tc (No) Tj
ET
n
540.24 320.4 m
540.24 322.56 538.32 324.24 536.16 324.24 c
534 324.24 532.32 322.56 532.32 320.4 c
532.32 318.24 534 316.32 536.16 316.32 c
538.32 316.32 540.24 318.24 540.24 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 307.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 310.56 m
514.56 312.72 512.64 314.4 510.48 314.4 c
508.32 314.4 506.64 312.72 506.64 310.56 c
506.64 308.4 508.32 306.48 510.48 306.48 c
512.64 306.48 514.56 308.4 514.56 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 307.92 Tm
0.014 Tc (No) Tj
ET
n
540.24 310.56 m
540.24 312.72 538.32 314.4 536.16 314.4 c
534 314.4 532.32 312.72 532.32 310.56 c
532.32 308.4 534 306.48 536.16 306.48 c
538.32 306.48 540.24 308.4 540.24 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 298.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 300.72 m
514.56 302.88 512.64 304.56 510.48 304.56 c
508.32 304.56 506.64 302.88 506.64 300.72 c
506.64 298.56 508.32 296.64 510.48 296.64 c
512.64 296.64 514.56 298.56 514.56 300.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 298.08 Tm
0.014 Tc (No) Tj
ET
n
540.24 300.72 m
540.24 302.88 538.32 304.56 536.16 304.56 c
534 304.56 532.32 302.88 532.32 300.72 c
532.32 298.56 534 296.64 536.16 296.64 c
538.32 296.64 540.24 298.56 540.24 300.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 288.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 291.12 m
514.56 293.28 512.64 294.96 510.48 294.96 c
508.32 294.96 506.64 293.28 506.64 291.12 c
506.64 288.96 508.32 287.04 510.48 287.04 c
512.64 287.04 514.56 288.96 514.56 291.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 288.48 Tm
0.014 Tc (No) Tj
ET
n
540.24 291.12 m
540.24 293.28 538.32 294.96 536.16 294.96 c
534 294.96 532.32 293.28 532.32 291.12 c
532.32 288.96 534 287.04 536.16 287.04 c
538.32 287.04 540.24 288.96 540.24 291.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 278.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 281.28 m
514.56 283.44 512.64 285.12 510.48 285.12 c
508.32 285.12 506.64 283.44 506.64 281.28 c
506.64 279.12 508.32 277.2 510.48 277.2 c
512.64 277.2 514.56 279.12 514.56 281.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 278.64 Tm
0.014 Tc (No) Tj
ET
n
540.24 281.28 m
540.24 283.44 538.32 285.12 536.16 285.12 c
534 285.12 532.32 283.44 532.32 281.28 c
532.32 279.12 534 277.2 536.16 277.2 c
538.32 277.2 540.24 279.12 540.24 281.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 269.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 271.68 m
514.56 273.84 512.64 275.52 510.48 275.52 c
508.32 275.52 506.64 273.84 506.64 271.68 c
506.64 269.52 508.32 267.6 510.48 267.6 c
512.64 267.6 514.56 269.52 514.56 271.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 269.04 Tm
0.014 Tc (No) Tj
ET
n
540.24 271.68 m
540.24 273.84 538.32 275.52 536.16 275.52 c
534 275.52 532.32 273.84 532.32 271.68 c
532.32 269.52 534 267.6 536.16 267.6 c
538.32 267.6 540.24 269.52 540.24 271.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 518.16 259.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
514.56 261.84 m
514.56 264 512.64 265.68 510.48 265.68 c
508.32 265.68 506.64 264 506.64 261.84 c
506.64 259.68 508.32 257.76 510.48 257.76 c
512.64 257.76 514.56 259.68 514.56 261.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 543.84 259.2 Tm
0.014 Tc (No) Tj
ET
n
540.24 261.84 m
540.24 264 538.32 265.68 536.16 265.68 c
534 265.68 532.32 264 532.32 261.84 c
532.32 259.68 534 257.76 536.16 257.76 c
538.32 257.76 540.24 259.68 540.24 261.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 9.36 396.24 Tm
0.038 Tc (Anemia) Tj
1 0 0 1 9.36 386.4 Tm
-0.008 Tc (Angina) Tj
ET
n
4.32 454.56 555.36 -0.72 re
1 g
f*
n
558.96 497.52 0.72 -43.2 re
f*
n
4.32 497.52 0.72 -43.2 re
0.629 g
f*
n
4.8 497.52 6.96 -0.72 re
f*
n
145.92 497.52 413.28 -0.72 re
f*
n
4.8 455.04 554.4 -0.72 re
0.813 g
f*
n
558.48 497.04 0.72 -42.24 re
f*
n
4.8 497.04 0.72 -42.24 re
0.816 g
f*
n
5.28 497.04 6.48 -0.72 re
f*
n
145.92 497.04 412.8 -0.72 re
f*
n
5.28 455.52 553.44 -0.72 re
0.629 g
f*
n
558 496.56 0.72 -41.28 re
f*
n
5.28 496.56 0.72 -41.28 re
1 g
f*
n
5.76 496.56 6 -0.72 re
f*
n
145.92 496.56 412.32 -0.72 re
f*
0 g
BT
/F9 7.92 Tf
1 0 0 1 12.48 493.92 Tm
-0.142 Tc 0.102 Tw (Are you allergic to any of the following?) Tj
ET
0.72 w
n
142.8 432.48 m
142.8 248.64 l
S
n
283.2 432.48 m
283.2 248.64 l
S
n
413.76 432.48 m
413.76 248.64 l
S
n
275.04 239.76 272.4 -10.56 re
1 g
f*
n
275.04 239.76 78.96 -9.84 re
f*
0 g
BT
1 0 0 1 275.04 232.08 Tm
-0.147 Tc 0.106 Tw (If yes, please explain:) Tj
ET
n
355.92 229.2 m
547.92 229.2 l
S
BT
1 0 0 1 229.68 231.84 Tm
-0.962 Tc 0 Tw (Ye) Tj
8.4 0 Td 0 Tc (s) Tj
ET
0.24 w
n
225.6 234.72 m
225.6 237.36 223.44 239.28 221.04 239.28 c
218.4 239.28 216.48 237.36 216.48 234.72 c
216.48 232.32 218.4 230.16 221.04 230.16 c
223.44 230.16 225.6 232.32 225.6 234.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 259.92 231.84 Tm
0.04 Tc (No) Tj
ET
n
255.84 234.72 m
255.84 237.36 253.68 239.28 251.28 239.28 c
248.64 239.28 246.72 237.36 246.72 234.72 c
246.72 232.32 248.64 230.16 251.28 230.16 c
253.68 230.16 255.84 232.32 255.84 234.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 26.4 231.84 Tm
-0.163 Tc 0.122 Tw (Have you ever had any serious illness not listed above?) Tj
/F9 6.96 Tf
1 0 0 1 419.76 425.52 Tm
0.016 Tc -0.03 Tw (Renal Dialysis) Tj
1 0 0 1 419.76 415.68 Tm
-0.001 Tc -0.012 Tw (Rheumatic Fever) Tj
1 0 0 1 419.76 405.84 Tm
0.036 Tc 0 Tw (Rheumatism) Tj
1 0 0 1 419.76 396.24 Tm
-0.015 Tc 0.001 Tw (Scarlet Fever) Tj
1 0 0 1 419.76 386.4 Tm
0.008 Tc 0 Tw (Shingles) Tj
1 0 0 1 419.76 376.8 Tm
0.045 Tc -0.06 Tw (Sickle Cell Disease) Tj
1 0 0 1 419.76 366.96 Tm
0.027 Tc -0.281 Tw (Sinus Trouble) Tj
1 0 0 1 419.76 357.12 Tm
0.009 Tc -0.024 Tw (Spina Bifida) Tj
1 0 0 1 419.76 347.52 Tm
0.017 Tc -0.031 Tw (Stomach/Intestinal Disease) Tj
1 0 0 1 419.76 337.68 Tm
-0.033 Tc 0 Tw (Stroke) Tj
1 0 0 1 419.76 327.84 Tm
0.033 Tc -0.047 Tw (Swelling of Limbs) Tj
1 0 0 1 419.76 317.52 Tm
0.138 Tc 0 Tw (Thy) Tj
11.52 0 Td 0.048 Tc -0.061 Tw (roid Disease) Tj
1 0 0 1 419.76 307.68 Tm
0.03 Tc 0 Tw (Tonsillitis) Tj
1 0 0 1 419.76 297.84 Tm
0.045 Tc (Tuberculosis) Tj
1 0 0 1 419.76 288.24 Tm
0.042 Tc -0.056 Tw (Tumors or Growths) Tj
1 0 0 1 419.76 278.4 Tm
0.063 Tc 0 Tw (Ulcers) Tj
1 0 0 1 419.76 268.8 Tm
-0.562 Tc (Ve) Tj
7.92 0 Td 0.034 Tc -0.048 Tw (nereal Disease) Tj
1 0 0 1 419.76 258.96 Tm
-0.802 Tc 0 Tw (Ye) Tj
7.68 0 Td 0.045 Tc -0.06 Tw (llow Jaundice) Tj
1 0 0 1 371.04 425.76 Tm
-0.802 Tc 0 Tw (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 428.4 m
367.44 430.56 365.52 432.24 363.36 432.24 c
361.2 432.24 359.52 430.56 359.52 428.4 c
359.52 426.24 361.2 424.32 363.36 424.32 c
365.52 424.32 367.44 426.24 367.44 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 425.76 Tm
0.014 Tc (No) Tj
ET
n
393.12 428.4 m
393.12 430.56 391.2 432.24 389.04 432.24 c
386.88 432.24 385.2 430.56 385.2 428.4 c
385.2 426.24 386.88 424.32 389.04 424.32 c
391.2 424.32 393.12 426.24 393.12 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 371.04 415.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 418.56 m
367.44 420.72 365.52 422.4 363.36 422.4 c
361.2 422.4 359.52 420.72 359.52 418.56 c
359.52 416.4 361.2 414.48 363.36 414.48 c
365.52 414.48 367.44 416.4 367.44 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 415.92 Tm
0.014 Tc (No) Tj
ET
n
393.12 418.56 m
393.12 420.72 391.2 422.4 389.04 422.4 c
386.88 422.4 385.2 420.72 385.2 418.56 c
385.2 416.4 386.88 414.48 389.04 414.48 c
391.2 414.48 393.12 416.4 393.12 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 371.04 406.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 408.72 m
367.44 410.88 365.52 412.56 363.36 412.56 c
361.2 412.56 359.52 410.88 359.52 408.72 c
359.52 406.56 361.2 404.64 363.36 404.64 c
365.52 404.64 367.44 406.56 367.44 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 406.08 Tm
0.014 Tc (No) Tj
ET
n
393.12 408.72 m
393.12 410.88 391.2 412.56 389.04 412.56 c
386.88 412.56 385.2 410.88 385.2 408.72 c
385.2 406.56 386.88 404.64 389.04 404.64 c
391.2 404.64 393.12 406.56 393.12 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 371.04 396.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 399.12 m
367.44 401.28 365.52 402.96 363.36 402.96 c
361.2 402.96 359.52 401.28 359.52 399.12 c
359.52 396.96 361.2 395.04 363.36 395.04 c
365.52 395.04 367.44 396.96 367.44 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 396.48 Tm
0.014 Tc (No) Tj
ET
n
393.12 399.12 m
393.12 401.28 391.2 402.96 389.04 402.96 c
386.88 402.96 385.2 401.28 385.2 399.12 c
385.2 396.96 386.88 395.04 389.04 395.04 c
391.2 395.04 393.12 396.96 393.12 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 371.04 386.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 389.28 m
367.44 391.44 365.52 393.12 363.36 393.12 c
361.2 393.12 359.52 391.44 359.52 389.28 c
359.52 387.12 361.2 385.2 363.36 385.2 c
365.52 385.2 367.44 387.12 367.44 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 386.64 Tm
0.014 Tc (No) Tj
ET
n
393.12 389.28 m
393.12 391.44 391.2 393.12 389.04 393.12 c
386.88 393.12 385.2 391.44 385.2 389.28 c
385.2 387.12 386.88 385.2 389.04 385.2 c
391.2 385.2 393.12 387.12 393.12 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 371.04 377.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 379.68 m
367.44 381.84 365.52 383.52 363.36 383.52 c
361.2 383.52 359.52 381.84 359.52 379.68 c
359.52 377.52 361.2 375.6 363.36 375.6 c
365.52 375.6 367.44 377.52 367.44 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 377.04 Tm
0.014 Tc (No) Tj
ET
n
393.12 379.68 m
393.12 381.84 391.2 383.52 389.04 383.52 c
386.88 383.52 385.2 381.84 385.2 379.68 c
385.2 377.52 386.88 375.6 389.04 375.6 c
391.2 375.6 393.12 377.52 393.12 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 371.04 367.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
367.44 369.84 m
367.44 372 365.52 373.68 363.36 373.68 c
361.2 373.68 359.52 372 359.52 369.84 c
359.52 367.68 361.2 365.76 363.36 365.76 c
365.52 365.76 367.44 367.68 367.44 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396.72 367.2 Tm
0.014 Tc (No) Tj
ET
n
393.12 369.84 m
393.12 372 391.2 373.68 389.04 373.68 c
386.88 373.68 385.2 372 385.2 369.84 c
385.2 367.68 386.88 365.76 389.04 365.76 c
391.2 365.76 393.12 367.68 393.12 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 357.36 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 360 m
366.72 362.16 364.8 363.84 362.64 363.84 c
360.48 363.84 358.8 362.16 358.8 360 c
358.8 357.84 360.48 355.92 362.64 355.92 c
364.8 355.92 366.72 357.84 366.72 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 357.36 Tm
0.014 Tc (No) Tj
ET
n
392.4 360 m
392.4 362.16 390.48 363.84 388.32 363.84 c
386.16 363.84 384.48 362.16 384.48 360 c
384.48 357.84 386.16 355.92 388.32 355.92 c
390.48 355.92 392.4 357.84 392.4 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 347.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 350.4 m
366.72 352.56 364.8 354.24 362.64 354.24 c
360.48 354.24 358.8 352.56 358.8 350.4 c
358.8 348.24 360.48 346.32 362.64 346.32 c
364.8 346.32 366.72 348.24 366.72 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 347.76 Tm
0.014 Tc (No) Tj
ET
n
392.4 350.4 m
392.4 352.56 390.48 354.24 388.32 354.24 c
386.16 354.24 384.48 352.56 384.48 350.4 c
384.48 348.24 386.16 346.32 388.32 346.32 c
390.48 346.32 392.4 348.24 392.4 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 337.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 340.56 m
366.72 342.72 364.8 344.4 362.64 344.4 c
360.48 344.4 358.8 342.72 358.8 340.56 c
358.8 338.4 360.48 336.48 362.64 336.48 c
364.8 336.48 366.72 338.4 366.72 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 337.92 Tm
0.014 Tc (No) Tj
ET
n
392.4 340.56 m
392.4 342.72 390.48 344.4 388.32 344.4 c
386.16 344.4 384.48 342.72 384.48 340.56 c
384.48 338.4 386.16 336.48 388.32 336.48 c
390.48 336.48 392.4 338.4 392.4 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 328.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 330.72 m
366.72 332.88 364.8 334.56 362.64 334.56 c
360.48 334.56 358.8 332.88 358.8 330.72 c
358.8 328.56 360.48 326.64 362.64 326.64 c
364.8 326.64 366.72 328.56 366.72 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 328.08 Tm
0.014 Tc (No) Tj
ET
n
392.4 330.72 m
392.4 332.88 390.48 334.56 388.32 334.56 c
386.16 334.56 384.48 332.88 384.48 330.72 c
384.48 328.56 386.16 326.64 388.32 326.64 c
390.48 326.64 392.4 328.56 392.4 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 317.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 320.4 m
366.72 322.56 364.8 324.24 362.64 324.24 c
360.48 324.24 358.8 322.56 358.8 320.4 c
358.8 318.24 360.48 316.32 362.64 316.32 c
364.8 316.32 366.72 318.24 366.72 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 317.76 Tm
0.014 Tc (No) Tj
ET
n
392.4 320.4 m
392.4 322.56 390.48 324.24 388.32 324.24 c
386.16 324.24 384.48 322.56 384.48 320.4 c
384.48 318.24 386.16 316.32 388.32 316.32 c
390.48 316.32 392.4 318.24 392.4 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 307.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 310.56 m
366.72 312.72 364.8 314.4 362.64 314.4 c
360.48 314.4 358.8 312.72 358.8 310.56 c
358.8 308.4 360.48 306.48 362.64 306.48 c
364.8 306.48 366.72 308.4 366.72 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 307.92 Tm
0.014 Tc (No) Tj
ET
n
392.4 310.56 m
392.4 312.72 390.48 314.4 388.32 314.4 c
386.16 314.4 384.48 312.72 384.48 310.56 c
384.48 308.4 386.16 306.48 388.32 306.48 c
390.48 306.48 392.4 308.4 392.4 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 298.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 300.72 m
366.72 302.88 364.8 304.56 362.64 304.56 c
360.48 304.56 358.8 302.88 358.8 300.72 c
358.8 298.56 360.48 296.64 362.64 296.64 c
364.8 296.64 366.72 298.56 366.72 300.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 298.08 Tm
0.014 Tc (No) Tj
ET
n
392.4 300.72 m
392.4 302.88 390.48 304.56 388.32 304.56 c
386.16 304.56 384.48 302.88 384.48 300.72 c
384.48 298.56 386.16 296.64 388.32 296.64 c
390.48 296.64 392.4 298.56 392.4 300.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 288.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 291.12 m
366.72 293.28 364.8 294.96 362.64 294.96 c
360.48 294.96 358.8 293.28 358.8 291.12 c
358.8 288.96 360.48 287.04 362.64 287.04 c
364.8 287.04 366.72 288.96 366.72 291.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 288.48 Tm
0.014 Tc (No) Tj
ET
n
392.4 291.12 m
392.4 293.28 390.48 294.96 388.32 294.96 c
386.16 294.96 384.48 293.28 384.48 291.12 c
384.48 288.96 386.16 287.04 388.32 287.04 c
390.48 287.04 392.4 288.96 392.4 291.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 278.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 281.28 m
366.72 283.44 364.8 285.12 362.64 285.12 c
360.48 285.12 358.8 283.44 358.8 281.28 c
358.8 279.12 360.48 277.2 362.64 277.2 c
364.8 277.2 366.72 279.12 366.72 281.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 278.64 Tm
0.014 Tc (No) Tj
ET
n
392.4 281.28 m
392.4 283.44 390.48 285.12 388.32 285.12 c
386.16 285.12 384.48 283.44 384.48 281.28 c
384.48 279.12 386.16 277.2 388.32 277.2 c
390.48 277.2 392.4 279.12 392.4 281.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 269.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 271.68 m
366.72 273.84 364.8 275.52 362.64 275.52 c
360.48 275.52 358.8 273.84 358.8 271.68 c
358.8 269.52 360.48 267.6 362.64 267.6 c
364.8 267.6 366.72 269.52 366.72 271.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 269.04 Tm
0.014 Tc (No) Tj
ET
n
392.4 271.68 m
392.4 273.84 390.48 275.52 388.32 275.52 c
386.16 275.52 384.48 273.84 384.48 271.68 c
384.48 269.52 386.16 267.6 388.32 267.6 c
390.48 267.6 392.4 269.52 392.4 271.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 259.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 261.84 m
366.72 264 364.8 265.68 362.64 265.68 c
360.48 265.68 358.8 264 358.8 261.84 c
358.8 259.68 360.48 257.76 362.64 257.76 c
364.8 257.76 366.72 259.68 366.72 261.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 259.2 Tm
0.014 Tc (No) Tj
ET
n
392.4 261.84 m
392.4 264 390.48 265.68 388.32 265.68 c
386.16 265.68 384.48 264 384.48 261.84 c
384.48 259.68 386.16 257.76 388.32 257.76 c
390.48 257.76 392.4 259.68 392.4 261.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 370.32 249.36 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
366.72 252 m
366.72 254.16 364.8 255.84 362.64 255.84 c
360.48 255.84 358.8 254.16 358.8 252 c
358.8 249.84 360.48 247.92 362.64 247.92 c
364.8 247.92 366.72 249.84 366.72 252 c
h
0.996 g
B*
0 g
BT
1 0 0 1 396 249.36 Tm
0.014 Tc (No) Tj
ET
n
392.4 252 m
392.4 254.16 390.48 255.84 388.32 255.84 c
386.16 255.84 384.48 254.16 384.48 252 c
384.48 249.84 386.16 247.92 388.32 247.92 c
390.48 247.92 392.4 249.84 392.4 252 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 425.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 428.4 m
237.84 430.56 235.92 432.24 233.76 432.24 c
231.6 432.24 229.92 430.56 229.92 428.4 c
229.92 426.24 231.6 424.32 233.76 424.32 c
235.92 424.32 237.84 426.24 237.84 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 425.76 Tm
0.014 Tc (No) Tj
ET
n
263.52 428.4 m
263.52 430.56 261.6 432.24 259.44 432.24 c
257.28 432.24 255.6 430.56 255.6 428.4 c
255.6 426.24 257.28 424.32 259.44 424.32 c
261.6 424.32 263.52 426.24 263.52 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 415.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 418.56 m
237.84 420.72 235.92 422.4 233.76 422.4 c
231.6 422.4 229.92 420.72 229.92 418.56 c
229.92 416.4 231.6 414.48 233.76 414.48 c
235.92 414.48 237.84 416.4 237.84 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 415.92 Tm
0.014 Tc (No) Tj
ET
n
263.52 418.56 m
263.52 420.72 261.6 422.4 259.44 422.4 c
257.28 422.4 255.6 420.72 255.6 418.56 c
255.6 416.4 257.28 414.48 259.44 414.48 c
261.6 414.48 263.52 416.4 263.52 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 406.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 408.72 m
237.84 410.88 235.92 412.56 233.76 412.56 c
231.6 412.56 229.92 410.88 229.92 408.72 c
229.92 406.56 231.6 404.64 233.76 404.64 c
235.92 404.64 237.84 406.56 237.84 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 406.08 Tm
0.014 Tc (No) Tj
ET
n
263.52 408.72 m
263.52 410.88 261.6 412.56 259.44 412.56 c
257.28 412.56 255.6 410.88 255.6 408.72 c
255.6 406.56 257.28 404.64 259.44 404.64 c
261.6 404.64 263.52 406.56 263.52 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 396.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 399.12 m
237.84 401.28 235.92 402.96 233.76 402.96 c
231.6 402.96 229.92 401.28 229.92 399.12 c
229.92 396.96 231.6 395.04 233.76 395.04 c
235.92 395.04 237.84 396.96 237.84 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 396.48 Tm
0.014 Tc (No) Tj
ET
n
263.52 399.12 m
263.52 401.28 261.6 402.96 259.44 402.96 c
257.28 402.96 255.6 401.28 255.6 399.12 c
255.6 396.96 257.28 395.04 259.44 395.04 c
261.6 395.04 263.52 396.96 263.52 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 386.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 389.28 m
237.84 391.44 235.92 393.12 233.76 393.12 c
231.6 393.12 229.92 391.44 229.92 389.28 c
229.92 387.12 231.6 385.2 233.76 385.2 c
235.92 385.2 237.84 387.12 237.84 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 386.64 Tm
0.014 Tc (No) Tj
ET
n
263.52 389.28 m
263.52 391.44 261.6 393.12 259.44 393.12 c
257.28 393.12 255.6 391.44 255.6 389.28 c
255.6 387.12 257.28 385.2 259.44 385.2 c
261.6 385.2 263.52 387.12 263.52 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 377.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 379.68 m
237.84 381.84 235.92 383.52 233.76 383.52 c
231.6 383.52 229.92 381.84 229.92 379.68 c
229.92 377.52 231.6 375.6 233.76 375.6 c
235.92 375.6 237.84 377.52 237.84 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 377.04 Tm
0.014 Tc (No) Tj
ET
n
263.52 379.68 m
263.52 381.84 261.6 383.52 259.44 383.52 c
257.28 383.52 255.6 381.84 255.6 379.68 c
255.6 377.52 257.28 375.6 259.44 375.6 c
261.6 375.6 263.52 377.52 263.52 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 367.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 369.84 m
237.84 372 235.92 373.68 233.76 373.68 c
231.6 373.68 229.92 372 229.92 369.84 c
229.92 367.68 231.6 365.76 233.76 365.76 c
235.92 365.76 237.84 367.68 237.84 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 367.2 Tm
0.014 Tc (No) Tj
ET
n
263.52 369.84 m
263.52 372 261.6 373.68 259.44 373.68 c
257.28 373.68 255.6 372 255.6 369.84 c
255.6 367.68 257.28 365.76 259.44 365.76 c
261.6 365.76 263.52 367.68 263.52 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 357.36 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 360 m
237.84 362.16 235.92 363.84 233.76 363.84 c
231.6 363.84 229.92 362.16 229.92 360 c
229.92 357.84 231.6 355.92 233.76 355.92 c
235.92 355.92 237.84 357.84 237.84 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 357.36 Tm
0.014 Tc (No) Tj
ET
n
263.52 360 m
263.52 362.16 261.6 363.84 259.44 363.84 c
257.28 363.84 255.6 362.16 255.6 360 c
255.6 357.84 257.28 355.92 259.44 355.92 c
261.6 355.92 263.52 357.84 263.52 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 347.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 350.4 m
237.84 352.56 235.92 354.24 233.76 354.24 c
231.6 354.24 229.92 352.56 229.92 350.4 c
229.92 348.24 231.6 346.32 233.76 346.32 c
235.92 346.32 237.84 348.24 237.84 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 347.76 Tm
0.014 Tc (No) Tj
ET
n
263.52 350.4 m
263.52 352.56 261.6 354.24 259.44 354.24 c
257.28 354.24 255.6 352.56 255.6 350.4 c
255.6 348.24 257.28 346.32 259.44 346.32 c
261.6 346.32 263.52 348.24 263.52 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 337.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 340.56 m
237.84 342.72 235.92 344.4 233.76 344.4 c
231.6 344.4 229.92 342.72 229.92 340.56 c
229.92 338.4 231.6 336.48 233.76 336.48 c
235.92 336.48 237.84 338.4 237.84 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 337.92 Tm
0.014 Tc (No) Tj
ET
n
263.52 340.56 m
263.52 342.72 261.6 344.4 259.44 344.4 c
257.28 344.4 255.6 342.72 255.6 340.56 c
255.6 338.4 257.28 336.48 259.44 336.48 c
261.6 336.48 263.52 338.4 263.52 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 328.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 330.72 m
237.84 332.88 235.92 334.56 233.76 334.56 c
231.6 334.56 229.92 332.88 229.92 330.72 c
229.92 328.56 231.6 326.64 233.76 326.64 c
235.92 326.64 237.84 328.56 237.84 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 328.08 Tm
0.014 Tc (No) Tj
ET
n
263.52 330.72 m
263.52 332.88 261.6 334.56 259.44 334.56 c
257.28 334.56 255.6 332.88 255.6 330.72 c
255.6 328.56 257.28 326.64 259.44 326.64 c
261.6 326.64 263.52 328.56 263.52 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 317.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 320.4 m
237.84 322.56 235.92 324.24 233.76 324.24 c
231.6 324.24 229.92 322.56 229.92 320.4 c
229.92 318.24 231.6 316.32 233.76 316.32 c
235.92 316.32 237.84 318.24 237.84 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 317.76 Tm
0.014 Tc (No) Tj
ET
n
263.52 320.4 m
263.52 322.56 261.6 324.24 259.44 324.24 c
257.28 324.24 255.6 322.56 255.6 320.4 c
255.6 318.24 257.28 316.32 259.44 316.32 c
261.6 316.32 263.52 318.24 263.52 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 307.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 310.56 m
237.84 312.72 235.92 314.4 233.76 314.4 c
231.6 314.4 229.92 312.72 229.92 310.56 c
229.92 308.4 231.6 306.48 233.76 306.48 c
235.92 306.48 237.84 308.4 237.84 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 307.92 Tm
0.014 Tc (No) Tj
ET
n
263.52 310.56 m
263.52 312.72 261.6 314.4 259.44 314.4 c
257.28 314.4 255.6 312.72 255.6 310.56 c
255.6 308.4 257.28 306.48 259.44 306.48 c
261.6 306.48 263.52 308.4 263.52 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 298.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 300.72 m
237.84 302.88 235.92 304.56 233.76 304.56 c
231.6 304.56 229.92 302.88 229.92 300.72 c
229.92 298.56 231.6 296.64 233.76 296.64 c
235.92 296.64 237.84 298.56 237.84 300.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 298.08 Tm
0.014 Tc (No) Tj
ET
n
263.52 300.72 m
263.52 302.88 261.6 304.56 259.44 304.56 c
257.28 304.56 255.6 302.88 255.6 300.72 c
255.6 298.56 257.28 296.64 259.44 296.64 c
261.6 296.64 263.52 298.56 263.52 300.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 288.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 291.12 m
237.84 293.28 235.92 294.96 233.76 294.96 c
231.6 294.96 229.92 293.28 229.92 291.12 c
229.92 288.96 231.6 287.04 233.76 287.04 c
235.92 287.04 237.84 288.96 237.84 291.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 288.48 Tm
0.014 Tc (No) Tj
ET
n
263.52 291.12 m
263.52 293.28 261.6 294.96 259.44 294.96 c
257.28 294.96 255.6 293.28 255.6 291.12 c
255.6 288.96 257.28 287.04 259.44 287.04 c
261.6 287.04 263.52 288.96 263.52 291.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 278.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 281.28 m
237.84 283.44 235.92 285.12 233.76 285.12 c
231.6 285.12 229.92 283.44 229.92 281.28 c
229.92 279.12 231.6 277.2 233.76 277.2 c
235.92 277.2 237.84 279.12 237.84 281.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 278.64 Tm
0.014 Tc (No) Tj
ET
n
263.52 281.28 m
263.52 283.44 261.6 285.12 259.44 285.12 c
257.28 285.12 255.6 283.44 255.6 281.28 c
255.6 279.12 257.28 277.2 259.44 277.2 c
261.6 277.2 263.52 279.12 263.52 281.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 269.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 271.68 m
237.84 273.84 235.92 275.52 233.76 275.52 c
231.6 275.52 229.92 273.84 229.92 271.68 c
229.92 269.52 231.6 267.6 233.76 267.6 c
235.92 267.6 237.84 269.52 237.84 271.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 269.04 Tm
0.014 Tc (No) Tj
ET
n
263.52 271.68 m
263.52 273.84 261.6 275.52 259.44 275.52 c
257.28 275.52 255.6 273.84 255.6 271.68 c
255.6 269.52 257.28 267.6 259.44 267.6 c
261.6 267.6 263.52 269.52 263.52 271.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 259.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 261.84 m
237.84 264 235.92 265.68 233.76 265.68 c
231.6 265.68 229.92 264 229.92 261.84 c
229.92 259.68 231.6 257.76 233.76 257.76 c
235.92 257.76 237.84 259.68 237.84 261.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 259.2 Tm
0.014 Tc (No) Tj
ET
n
263.52 261.84 m
263.52 264 261.6 265.68 259.44 265.68 c
257.28 265.68 255.6 264 255.6 261.84 c
255.6 259.68 257.28 257.76 259.44 257.76 c
261.6 257.76 263.52 259.68 263.52 261.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 241.44 249.36 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
237.84 252 m
237.84 254.16 235.92 255.84 233.76 255.84 c
231.6 255.84 229.92 254.16 229.92 252 c
229.92 249.84 231.6 247.92 233.76 247.92 c
235.92 247.92 237.84 249.84 237.84 252 c
h
0.996 g
B*
0 g
BT
1 0 0 1 267.12 249.36 Tm
0.014 Tc (No) Tj
ET
n
263.52 252 m
263.52 254.16 261.6 255.84 259.44 255.84 c
257.28 255.84 255.6 254.16 255.6 252 c
255.6 249.84 257.28 247.92 259.44 247.92 c
261.6 247.92 263.52 249.84 263.52 252 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 425.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 428.4 m
99.12 430.56 97.2 432.24 95.04 432.24 c
92.88 432.24 91.2 430.56 91.2 428.4 c
91.2 426.24 92.88 424.32 95.04 424.32 c
97.2 424.32 99.12 426.24 99.12 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 425.76 Tm
0.014 Tc (No) Tj
ET
n
124.56 428.4 m
124.56 430.56 122.64 432.24 120.48 432.24 c
118.32 432.24 116.64 430.56 116.64 428.4 c
116.64 426.24 118.32 424.32 120.48 424.32 c
122.64 424.32 124.56 426.24 124.56 428.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 415.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 418.56 m
99.12 420.72 97.2 422.4 95.04 422.4 c
92.88 422.4 91.2 420.72 91.2 418.56 c
91.2 416.4 92.88 414.48 95.04 414.48 c
97.2 414.48 99.12 416.4 99.12 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 415.92 Tm
0.014 Tc (No) Tj
ET
n
124.56 418.56 m
124.56 420.72 122.64 422.4 120.48 422.4 c
118.32 422.4 116.64 420.72 116.64 418.56 c
116.64 416.4 118.32 414.48 120.48 414.48 c
122.64 414.48 124.56 416.4 124.56 418.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 406.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 408.72 m
99.12 410.88 97.2 412.56 95.04 412.56 c
92.88 412.56 91.2 410.88 91.2 408.72 c
91.2 406.56 92.88 404.64 95.04 404.64 c
97.2 404.64 99.12 406.56 99.12 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 406.08 Tm
0.014 Tc (No) Tj
ET
n
124.56 408.72 m
124.56 410.88 122.64 412.56 120.48 412.56 c
118.32 412.56 116.64 410.88 116.64 408.72 c
116.64 406.56 118.32 404.64 120.48 404.64 c
122.64 404.64 124.56 406.56 124.56 408.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 396.48 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 399.12 m
99.12 401.28 97.2 402.96 95.04 402.96 c
92.88 402.96 91.2 401.28 91.2 399.12 c
91.2 396.96 92.88 395.04 95.04 395.04 c
97.2 395.04 99.12 396.96 99.12 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 396.48 Tm
0.014 Tc (No) Tj
ET
n
124.56 399.12 m
124.56 401.28 122.64 402.96 120.48 402.96 c
118.32 402.96 116.64 401.28 116.64 399.12 c
116.64 396.96 118.32 395.04 120.48 395.04 c
122.64 395.04 124.56 396.96 124.56 399.12 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 386.64 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 389.28 m
99.12 391.44 97.2 393.12 95.04 393.12 c
92.88 393.12 91.2 391.44 91.2 389.28 c
91.2 387.12 92.88 385.2 95.04 385.2 c
97.2 385.2 99.12 387.12 99.12 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 386.64 Tm
0.014 Tc (No) Tj
ET
n
124.56 389.28 m
124.56 391.44 122.64 393.12 120.48 393.12 c
118.32 393.12 116.64 391.44 116.64 389.28 c
116.64 387.12 118.32 385.2 120.48 385.2 c
122.64 385.2 124.56 387.12 124.56 389.28 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 377.04 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 379.68 m
99.12 381.84 97.2 383.52 95.04 383.52 c
92.88 383.52 91.2 381.84 91.2 379.68 c
91.2 377.52 92.88 375.6 95.04 375.6 c
97.2 375.6 99.12 377.52 99.12 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 377.04 Tm
0.014 Tc (No) Tj
ET
n
124.56 379.68 m
124.56 381.84 122.64 383.52 120.48 383.52 c
118.32 383.52 116.64 381.84 116.64 379.68 c
116.64 377.52 118.32 375.6 120.48 375.6 c
122.64 375.6 124.56 377.52 124.56 379.68 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 367.2 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 369.84 m
99.12 372 97.2 373.68 95.04 373.68 c
92.88 373.68 91.2 372 91.2 369.84 c
91.2 367.68 92.88 365.76 95.04 365.76 c
97.2 365.76 99.12 367.68 99.12 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 367.2 Tm
0.014 Tc (No) Tj
ET
n
124.56 369.84 m
124.56 372 122.64 373.68 120.48 373.68 c
118.32 373.68 116.64 372 116.64 369.84 c
116.64 367.68 118.32 365.76 120.48 365.76 c
122.64 365.76 124.56 367.68 124.56 369.84 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 357.36 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 360 m
99.12 362.16 97.2 363.84 95.04 363.84 c
92.88 363.84 91.2 362.16 91.2 360 c
91.2 357.84 92.88 355.92 95.04 355.92 c
97.2 355.92 99.12 357.84 99.12 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 357.36 Tm
0.014 Tc (No) Tj
ET
n
124.56 360 m
124.56 362.16 122.64 363.84 120.48 363.84 c
118.32 363.84 116.64 362.16 116.64 360 c
116.64 357.84 118.32 355.92 120.48 355.92 c
122.64 355.92 124.56 357.84 124.56 360 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 347.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 350.4 m
99.12 352.56 97.2 354.24 95.04 354.24 c
92.88 354.24 91.2 352.56 91.2 350.4 c
91.2 348.24 92.88 346.32 95.04 346.32 c
97.2 346.32 99.12 348.24 99.12 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 347.76 Tm
0.014 Tc (No) Tj
ET
n
124.56 350.4 m
124.56 352.56 122.64 354.24 120.48 354.24 c
118.32 354.24 116.64 352.56 116.64 350.4 c
116.64 348.24 118.32 346.32 120.48 346.32 c
122.64 346.32 124.56 348.24 124.56 350.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 337.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 340.56 m
99.12 342.72 97.2 344.4 95.04 344.4 c
92.88 344.4 91.2 342.72 91.2 340.56 c
91.2 338.4 92.88 336.48 95.04 336.48 c
97.2 336.48 99.12 338.4 99.12 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 337.92 Tm
0.014 Tc (No) Tj
ET
n
124.56 340.56 m
124.56 342.72 122.64 344.4 120.48 344.4 c
118.32 344.4 116.64 342.72 116.64 340.56 c
116.64 338.4 118.32 336.48 120.48 336.48 c
122.64 336.48 124.56 338.4 124.56 340.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 328.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 330.72 m
99.12 332.88 97.2 334.56 95.04 334.56 c
92.88 334.56 91.2 332.88 91.2 330.72 c
91.2 328.56 92.88 326.64 95.04 326.64 c
97.2 326.64 99.12 328.56 99.12 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 328.08 Tm
0.014 Tc (No) Tj
ET
n
124.56 330.72 m
124.56 332.88 122.64 334.56 120.48 334.56 c
118.32 334.56 116.64 332.88 116.64 330.72 c
116.64 328.56 118.32 326.64 120.48 326.64 c
122.64 326.64 124.56 328.56 124.56 330.72 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 317.76 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 320.4 m
99.12 322.56 97.2 324.24 95.04 324.24 c
92.88 324.24 91.2 322.56 91.2 320.4 c
91.2 318.24 92.88 316.32 95.04 316.32 c
97.2 316.32 99.12 318.24 99.12 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 317.76 Tm
0.014 Tc (No) Tj
ET
n
124.56 320.4 m
124.56 322.56 122.64 324.24 120.48 324.24 c
118.32 324.24 116.64 322.56 116.64 320.4 c
116.64 318.24 118.32 316.32 120.48 316.32 c
122.64 316.32 124.56 318.24 124.56 320.4 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 307.92 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 310.56 m
99.12 312.72 97.2 314.4 95.04 314.4 c
92.88 314.4 91.2 312.72 91.2 310.56 c
91.2 308.4 92.88 306.48 95.04 306.48 c
97.2 306.48 99.12 308.4 99.12 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 128.16 307.92 Tm
0.014 Tc (No) Tj
ET
n
124.56 310.56 m
124.56 312.72 122.64 314.4 120.48 314.4 c
118.32 314.4 116.64 312.72 116.64 310.56 c
116.64 308.4 118.32 306.48 120.48 306.48 c
122.64 306.48 124.56 308.4 124.56 310.56 c
h
0.996 g
B*
0 g
BT
1 0 0 1 102.72 298.08 Tm
-0.802 Tc (Ye) Tj
7.68 0 Td 0 Tc (s) Tj
ET
n
99.12 300.72 m
99.12 302.88 97.2 304.56 95.04 304.56 c
92.88 304.56 91.2 302.88 91.2 300.72 c
91.2 298.56 92.88 296.64 95.04 296.64 c
97.2 296.64 99.12 298.56 99.12 300.72 c
h
0.996 g
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q 1 0 0 1 225.6 602.16 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 276.72 599.28 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 255.84 602.16 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
278.64 607.2 78.96 -10.56 re
f*
Q
BT
/TT1 7.92 Tf
-0.147 Tc 0.106 Tw 295.44 599.28 Td
(If yes, please explain:)Tj
-0.962 Tc 0 Tw -48.96 -11.28 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 225.6 590.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 276.72 588 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 255.84 590.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
278.64 595.92 78.96 -10.56 re
f*
Q
BT
/TT1 7.92 Tf
-0.147 Tc 0.106 Tw 295.44 588 Td
(If yes, please explain:)Tj
-0.962 Tc 0 Tw -48.96 -56.4 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 225.6 534.48 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 276.72 531.6 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 255.84 534.48 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.962 Tc 246.48 576.72 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 225.6 579.6 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 276.72 576.72 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 255.84 579.6 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
278.64 583.92 78.96 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.147 Tc 0.106 Tw 295.44 576.24 Td
(If yes, please explain:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 280.08 551.76 cm
0 0 m
278.4 0 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 280.08 562.8 cm
0 0 m
278.4 0 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
11.52 517.92 118.56 -10.56 re
f*
Q
BT
/TT1 7.92 Tf
-0.123 Tc 0.083 Tw 28.32 510 Td
(Pregnant/Trying to get pregnant?)Tj
-0.962 Tc 0 Tw 133.44 0 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 140.88 512.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 191.28 510 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 170.4 512.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.158 Tc 0.118 Tw 222 510 Td
(Taking oral contraceptives?)Tj
-0.962 Tc 0 Tw 113.52 0 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 314.64 512.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 365.04 510 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 344.16 512.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.024 Tc 398.16 510 Td
(Nursing?)Tj
-0.962 Tc 50.64 0 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 427.92 512.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 478.32 510 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 457.44 512.88 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
4.32 503.28 555.36 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
558.96 523.92 0.72 -20.88 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
4.32 523.92 0.72 -20.88 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
4.8 523.92 6.96 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
72.96 523.92 486.24 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.813 g
4.8 503.76 554.4 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.813 g
558.48 523.44 0.72 -19.92 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.816 g
4.8 523.44 0.72 -19.92 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.816 g
5.28 523.44 6.48 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.816 g
72.96 523.44 485.76 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
5.28 504.24 553.44 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
558 522.96 0.72 -18.96 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
5.28 522.96 0.72 -18.96 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
5.76 522.96 6 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
72.96 522.96 485.28 -0.72 re
f*
Q
BT
/TT1 7.92 Tf
0.444 Tc 29.28 520.32 Td
(Wo)Tj
-0.175 Tc -0.025 Tw 12 0 Td
(men: Are you)Tj
-0.092 Tc 0 Tw 0.96 -54.96 Td
(Other)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
11.76 472.56 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
11.52 472.8 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.02 Tc 42.24 481.2 Td
(Aspirin)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
11.76 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
11.52 488.64 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.076 Tc 103.2 481.2 Td
(Penicillin)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
72.72 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
72.48 488.64 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.142 Tc 172.08 481.2 Td
(Codeine)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
141.6 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
141.36 488.64 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.066 Tc 237.36 481.2 Td
(Acrylic)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
206.88 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
206.64 488.64 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.201 Tc 294.24 481.2 Td
(Metal)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
263.76 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
263.52 488.64 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.193 Tc 351.36 481.2 Td
(Latex)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
320.88 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
320.64 488.64 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.095 Tc -0.424 Tw 409.2 481.2 Td
(Local Anesthetics)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
378.72 488.4 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
378.48 488.64 9.36 -9.36 re
h
S
Q
q
1 0 0 1 16.8000031 0 cm
1 g
53.76 472.8 78.96 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.147 Tc 0.106 Tw 70.56 465.12 Td
(If yes, please explain:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 134.64 463.2 cm
0 0 m
414.72 0 l
S
Q
Q
BT
/TT1 7.92 Tf
-0.105 Tc 0 Tw 30.72 196.56 Td
(Comments:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 61.92 192.48 cm
0 0 m
486 0 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 61.92 175.92 cm
0 0 m
486 0 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 61.92 159.36 cm
0 0 m
486 0 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 61.2 142.8 cm
0 0 m
486 0 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 61.92 126.48 cm
0 0 m
486 0 l
S
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc -0.028 Tw 168 425.52 Td
(Cortisone Medicine)Tj
0.001 Tc 0 Tw 0 -9.84 TD
(Diabetes)Tj
0.019 Tc -0.513 Tw T*
(Drug Addiction)Tj
-0.014 Tc 0 Tw 0 -9.6 TD
(Easily W)Tj
0.01 Tc 27.6 0 Td
(inded)Tj
-0.001 Tc -27.6 -9.84 Td
(Emphysema)Tj
-0.01 Tc -0.003 Tw T*
(Epilepsy or Seizures)Tj
-0.019 Tc 0.005 Tw 0 -9.84 TD
(Excessive Bleeding)Tj
0.017 Tc -0.271 Tw T*
(Excessive Thirst)Tj
0.022 Tc -0.037 Tw 0 -9.6 TD
(Fainting Spells/Dizziness)Tj
-0.008 Tc -0.005 Tw 0 -9.84 TD
(Frequent Cough)Tj
0.013 Tc -0.027 Tw T*
(Frequent Diarrhea)Tj
-0.004 Tc -0.009 Tw 0 -10.32 TD
(Frequent Headaches)Tj
0.022 Tc -0.036 Tw 0 -9.84 TD
(Genital Herpes)Tj
0.067 Tc 0 Tw T*
(Glaucoma)Tj
-0.104 Tc 0.09 Tw 0 -9.6 TD
(Hay Fever)Tj
0.012 Tc -0.506 Tw 0 -9.84 TD
(Heart Attack/Failure)Tj
-0.003 Tc -0.01 Tw 0 -9.6 TD
(Heart Murmur)Tj
-0.035 Tc 0.021 Tw 0 -9.84 TD
(Heart Pace Maker)Tj
0.026 Tc -0.28 Tw T*
(Heart Trouble/Disease)Tj
-0.056 Tc 0.042 Tw -141.84 176.4 Td
(AIDS/HIV Positive)Tj
0.047 Tc -0.061 Tw T*
(Alzheimer's Disease)Tj
-0.068 Tc 0 Tw T*
(Anaphylaxis)Tj
0.033 Tc 0 -29.04 TD
(Arthritis/Gout)Tj
0.041 Tc -0.055 Tw 0 -9.84 TD
(Artificial Heart V)Tj
-0.085 Tc 0 Tw 49.92 0 Td
(alve)Tj
0.056 Tc -0.07 Tw -49.92 -9.84 Td
(Artificial Joint)Tj
0.039 Tc 0 Tw 0 -9.6 TD
(Asthma)Tj
0.025 Tc -0.04 Tw 0 -9.84 TD
(Blood Disease)Tj
0.023 Tc -0.277 Tw T*
(Blood Transfusion)Tj
0 Tc -0.014 Tw 0 -10.32 TD
(Breathing Problem)Tj
0.042 Tc -0.056 Tw 0 -9.84 TD
(Bruise Easily)Tj
0.008 Tc 0 Tw T*
(Cancer)Tj
0.006 Tc 0 -9.6 TD
(Chemotherapy)Tj
0.005 Tc -0.019 Tw 0 -9.84 TD
(Chest Pains)Tj
0.009 Tc -0.023 Tw 0 -9.6 TD
(Cold Sores/Fever Blisters)Tj
0.016 Tc -0.03 Tw 0 -9.84 TD
(Congenital Heart Disorder)Tj
-0.011 Tc 0 Tw T*
(Convulsions)Tj
0.055 Tc 282 176.4 Td
(Hemophilia)Tj
0.031 Tc -0.525 Tw T*
(Hepatitis A)Tj
0.02 Tc -0.035 Tw T*
(Hepatitis B or C)Tj
0 Tc 0 Tw 0 -9.6 TD
(Herpes)Tj
0.019 Tc -0.033 Tw 0 -9.84 TD
(High Blood Pressure)Tj
0.003 Tc -0.017 Tw 0 -9.6 TD
(Hives or Rash)Tj
-0.021 Tc 0 Tw 0 -9.84 TD
(Hypoglycemia)Tj
-0.004 Tc -0.01 Tw T*
(Irregular Heartbeat)Tj
-0.012 Tc -0.001 Tw 0 -9.6 TD
(Kidney Problems)Tj
0.013 Tc 0 Tw 0 -9.84 TD
(Leukemia)Tj
0.01 Tc -0.025 Tw T*
(Liver Disease)Tj
0.011 Tc 0 -10.32 TD
(Low Blood Pressure)Tj
0.02 Tc -0.034 Tw 0 -9.84 TD
(Lung Disease)Tj
0.004 Tc -0.018 Tw T*
(Mitral V)Tj
-0.011 Tc -0.002 Tw 23.04 0 Td
(alve Prolapse)Tj
0.026 Tc -0.04 Tw -23.04 -9.6 Td
(Pain in Jaw Joints)Tj
0 Tc -0.015 Tw T*
(Parathyroid Disease)Tj
0.018 Tc -0.032 Tw 0 -9.6 TD
(Psychiatric Care)Tj
0.017 Tc -0.271 Tw 0 -9.84 TD
(Radiation Treatments)Tj
0.033 Tc -0.047 Tw T*
(Recent Weight Loss)Tj
-0.802 Tc 0 Tw 226.08 176.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 513.84 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 559.92 425.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 539.52 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.24 415.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 513.84 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 559.92 415.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 539.52 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.24 406.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 513.84 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 559.92 406.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 539.52 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 396.48 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 399.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 396.48 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 399.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 386.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 389.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 386.64 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 389.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 377.04 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 379.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 377.04 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 379.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 367.2 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 369.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 367.2 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 369.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 357.36 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 360 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 357.36 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 360 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 347.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 350.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 347.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 350.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 337.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 340.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 337.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 340.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 328.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 330.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 328.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 330.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 317.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 320.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 317.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 320.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 307.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 310.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 307.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 310.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 298.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 300.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 298.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 300.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 288.48 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 291.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 288.48 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 291.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 278.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 281.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 278.64 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 281.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 269.04 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 271.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 269.04 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 271.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 534.96 259.2 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 514.56 261.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 560.64 259.2 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 540.24 261.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.038 Tc 26.16 396.24 Td
(Anemia)Tj
-0.008 Tc T*
(Angina)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
4.32 454.56 555.36 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
558.96 497.52 0.72 -43.2 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
4.32 497.52 0.72 -43.2 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
4.8 497.52 6.96 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
145.92 497.52 413.28 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.813 g
4.8 455.04 554.4 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.813 g
558.48 497.04 0.72 -42.24 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.816 g
4.8 497.04 0.72 -42.24 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.816 g
5.28 497.04 6.48 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.816 g
145.92 497.04 412.8 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
5.28 455.52 553.44 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 g
558 496.56 0.72 -41.28 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
5.28 496.56 0.72 -41.28 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
5.76 496.56 6 -0.72 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
145.92 496.56 412.32 -0.72 re
f*
Q
BT
/TT1 7.92 Tf
-0.142 Tc 0.102 Tw 29.28 493.92 Td
(Are you allergic to any of the following?)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 142.8 432.48 cm
0 0 m
0 -183.84 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 283.2 432.48 cm
0 0 m
0 -183.84 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 413.76 432.48 cm
0 0 m
0 -183.84 l
S
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
275.04 239.76 272.4 -10.56 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
275.04 239.76 78.96 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.147 Tc 0.106 Tw 291.84 232.08 Td
(If yes, please explain:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.72 w 1 j 1 J
q 1 0 0 1 355.92 229.2 cm
0 0 m
192 0 l
S
Q
Q
BT
/TT1 7.92 Tf
-0.962 Tc 0 Tw 246.48 231.84 Td
(Ye)Tj
0 Tc 8.4 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 225.6 234.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.04 Tc 276.72 231.84 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 255.84 234.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.163 Tc 0.122 Tw 43.2 231.84 Td
(Have you ever had any serious illness not listed above?)Tj
/TT1 6.96 Tf
0.016 Tc -0.03 Tw 393.36 193.68 Td
(Renal Dialysis)Tj
-0.001 Tc -0.012 Tw T*
(Rheumatic Fever)Tj
0.036 Tc 0 Tw T*
(Rheumatism)Tj
-0.015 Tc 0.001 Tw 0 -9.6 TD
(Scarlet Fever)Tj
0.008 Tc 0 Tw 0 -9.84 TD
(Shingles)Tj
0.045 Tc -0.06 Tw 0 -9.6 TD
(Sickle Cell Disease)Tj
0.027 Tc -0.281 Tw 0 -9.84 TD
(Sinus Trouble)Tj
0.009 Tc -0.024 Tw T*
(Spina Bifida)Tj
0.017 Tc -0.031 Tw 0 -9.6 TD
(Stomach/Intestinal Disease)Tj
-0.033 Tc 0 Tw 0 -9.84 TD
(Stroke)Tj
0.033 Tc -0.047 Tw T*
(Swelling of Limbs)Tj
0.138 Tc 0 Tw 0 -10.32 TD
(Thy)Tj
0.048 Tc -0.061 Tw 11.52 0 Td
(roid Disease)Tj
0.03 Tc 0 Tw -11.52 -9.84 Td
(Tonsillitis)Tj
0.045 Tc 0 -9.84 TD
(Tuberculosis)Tj
0.042 Tc -0.056 Tw 0 -9.6 TD
(Tumors or Growths)Tj
0.063 Tc 0 Tw 0 -9.84 TD
(Ulcers)Tj
-0.562 Tc 0 -9.6 TD
(Ve)Tj
0.034 Tc -0.048 Tw 7.92 0 Td
(nereal Disease)Tj
-0.802 Tc 0 Tw -7.92 -9.84 Td
(Ye)Tj
0.045 Tc -0.06 Tw 7.68 0 Td
(llow Jaundice)Tj
-0.802 Tc 0 Tw -56.4 166.8 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 425.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.84 415.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 415.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.84 406.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 406.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.84 396.48 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 399.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 396.48 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 399.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.84 386.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 389.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 386.64 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 389.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.84 377.04 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 379.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 377.04 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 379.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.84 367.2 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 367.44 369.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 413.52 367.2 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 393.12 369.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 357.36 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 360 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 357.36 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 360 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 347.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 350.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 347.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 350.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 337.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 340.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 337.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 340.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 328.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 330.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 328.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 330.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 317.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 320.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 317.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 320.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 307.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 310.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 307.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 310.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 298.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 300.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 298.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 300.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 288.48 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 291.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 288.48 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 291.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 278.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 281.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 278.64 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 281.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 269.04 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 271.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 269.04 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 271.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 259.2 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 261.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 259.2 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 261.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 387.12 249.36 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 366.72 252 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 412.8 249.36 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 392.4 252 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 425.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 425.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 415.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 415.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 406.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 406.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 396.48 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 399.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 396.48 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 399.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 386.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 389.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 386.64 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 389.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 377.04 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 379.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 377.04 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 379.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 367.2 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 369.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 367.2 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 369.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 357.36 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 360 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 357.36 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 360 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 347.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 350.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 347.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 350.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 337.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 340.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 337.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 340.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 328.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 330.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 328.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 330.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 317.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 320.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 317.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 320.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 307.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 310.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 307.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 310.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 298.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 300.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 298.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 300.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 288.48 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 291.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 288.48 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 291.12 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 278.64 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 281.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 278.64 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 281.28 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 269.04 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 271.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 269.04 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 271.68 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 259.2 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 261.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 259.2 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 261.84 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 258.24 249.36 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 237.84 252 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 283.92 249.36 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 263.52 252 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 119.52 425.76 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 99.12 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 144.96 425.76 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 124.56 428.4 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 119.52 415.92 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 99.12 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 144.96 415.92 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 124.56 418.56 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
-0.802 Tc 119.52 406.08 Td
(Ye)Tj
0 Tc 7.68 0 Td
(s)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 99.12 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 6.96 Tf
0.014 Tc 144.96 406.08 Td
(No)Tj
ET
q
1 0 0 1 16.8000031 0 cm
0.996 g
0.24 w 1 j 1 J
q 1 0 0 1 124.56 408.72 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
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BT
/TT1 7.92 Tf
-0.114 Tc 0.074 Tw 413.04 409.92 Td
(Emergency Contact:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
467.52 407.76 86.88 -0.48 re
W n
467.52 407.76 108.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
358.08 403.2 108.24 -11.52 re
f*
Q
BT
/TT1 7.92 Tf
-0.105 Tc 0.065 Tw 416.16 395.76 Td
(Relationship to Pt. :)Tj
ET
q
1 0 0 1 16.8000031 0 cm
467.52 393.6 86.88 -0.48 re
W n
467.52 393.6 108.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
358.08 389.04 108.24 -11.52 re
f*
Q
BT
/TT1 7.92 Tf
-0.125 Tc 0.085 Tw 435.36 381.6 Td
(Emergency #:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
467.52 379.44 86.88 -0.48 re
W n
467.52 379.44 108.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
358.08 374.88 108.24 -11.52 re
f*
Q
BT
/TT1 7.92 Tf
-0.132 Tc 0.092 Tw 414.24 367.44 Td
(Cell Phone/Pager #:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
467.52 365.28 86.88 -0.48 re
W n
467.52 365.28 108.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
358.08 360.72 108.24 -11.52 re
f*
Q
BT
/TT1 7.92 Tf
-0.088 Tc 0.048 Tw 423.36 353.28 Td
(call list for patien:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
467.52 351.12 86.88 -0.48 re
W n
467.52 351.12 108.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
7.68 303.36 0.48 -135.36 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
7.68 303.6 6.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
118.56 303.6 447.84 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
565.92 303.6 0.48 -135.6 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
7.92 168.48 558.48 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
7.92 303.36 558.24 -135.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
13.92 307.92 104.88 -9.36 re
f*
Q
BT
/TT1 7.92 Tf
-0.104 Tc 0.063 Tw 31.44 300.48 Td
(Primary Insurance Information)Tj
ET
q
1 0 0 1 16.8000031 0 cm
7.68 654.24 0.48 -107.52 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
7.68 654.48 6.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
196.8 654.48 369.6 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
565.92 654.48 0.48 -107.76 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
7.92 547.2 558.48 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
7.92 654.24 558.24 -107.28 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
13.92 658.8 183.12 -9.36 re
f*
Q
BT
/TT1 7.92 Tf
-0.129 Tc 0.088 Tw 31.44 651.36 Td
(Responsible Party \(if someone other than the patient\))Tj
0 Tc 0 Tw 22.8 53.76 Td
(ID:)Tj
-0.084 Tc 0.044 Tw -29.52 -14.88 Td
(First Name:)Tj
-0.136 Tc 0.095 Tw 58.8 -14.16 Td
(Policy Holder)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
53.04 683.28 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w
52.8 683.52 9.36 -9.36 re
h
S
Q
BT
/TT1 7.92 Tf
-0.098 Tc 0.058 Tw 83.52 663.36 Td
(Responsible Party)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
53.04 670.56 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w
52.8 670.8 9.36 -9.36 re
h
S
Q
q
1 0 0 1 16.8000031 0 cm
1 g
0.72 w 1 j 1 J
q 1 0 0 1 29.28 556.08 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.118 Tc 0.077 Tw 49.44 552.24 Td
(Responsible Party is also a Policy Holder for Patient)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.72 w 1 j 1 J
q 1 0 0 1 239.28 556.08 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.113 Tc 0.073 Tw 259.44 552.24 Td
(Primary Insurance Policy Holder)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.72 w 1 j 1 J
q 1 0 0 1 389.28 556.08 cm
0 0 m
0 2.16 -1.92 3.84 -4.08 3.84 c
-6.24 3.84 -7.92 2.16 -7.92 0 c
-7.92 -2.16 -6.24 -4.08 -4.08 -4.08 c
-1.92 -4.08 0 -2.16 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
392.64 559.92 140.4 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.123 Tc 0.083 Tw 409.44 552.24 Td
(Secondary Insurance Policy Holder)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
57.36 426.48 37.68 -9.12 re
f*
Q
BT
/TT1 7.92 Tf
-0.105 Tc 0.064 Tw 74.16 419.04 Td
(Section 2)Tj
-0.073 Tc -0.206 Tw 53.76 -15.36 Td
(Full Time)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 107.04 406.56 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.085 Tc -0.195 Tw 192.96 403.68 Td
(Part Time)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 172.08 406.56 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.12 Tc 0 Tw 258 403.68 Td
(Retired)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 237.12 406.56 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
399.36 428.64 37.68 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.105 Tc 0.064 Tw 416.16 420.96 Td
(Section 3)Tj
-0.042 Tc 0.001 Tw -114.72 102.96 Td
(Address 2:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
327.36 522.48 223.68 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
327.36 531.36 223.68 -9.12 re
f*
Q
BT
/TT1 7.92 Tf
-0.108 Tc 0.067 Tw 237.84 508.8 Td
(State / Zip:)Tj
-0.229 Tc 0 Tw -207.12 -36.96 Td
(Sex:)Tj
-0.102 Tc 0.062 Tw 202.8 0 Td
(Marital Status:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
271.44 479.28 280.8 -9.36 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 G
0.24 w 1 j 1 J
271.2 479.52 281.04 -9.6 re
h
S
Q
BT
/TT1 7.92 Tf
-0.14 Tc 0 Tw 301.92 471.84 Td
(Married)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 281.04 474.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.066 Tc 358.08 471.84 Td
(Single)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 337.2 474.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.132 Tc 414.24 471.84 Td
(Divorced)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 393.36 474.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.177 Tc 470.4 471.84 Td
(Separated)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 449.52 474.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
0.684 Tc 526.56 471.84 Td
(Wi)Tj
-0.233 Tc 9.84 0 Td
(dowed)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 505.68 474.72 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.1 Tc 30.72 435.84 Td
(E-mail:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
42.24 433.92 219.84 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
42.24 443.52 219.84 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.144 Tc 0.104 Tw 300.96 436.08 Td
(I would like to receive correspondences via e-mail.)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
270.48 443.28 9.12 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
270.24 443.52 9.36 -9.36 re
h
S
Q
q
1 0 0 1 16.8000031 0 cm
1 g
15.36 427.92 33.12 -4.56 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
15.36 423.6 33.12 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
103.2 427.92 287.28 -4.56 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
103.2 423.6 287.28 -0.48 re
f*
Q
BT
/TT1 7.92 Tf
-0.036 Tc 0 Tw 30.72 523.92 Td
(Address:)Tj
-0.109 Tc 0 -15.12 TD
(City:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
33.36 506.88 181.68 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
33.36 516.48 181.68 -9.84 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
49.2 522.48 225.84 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
49.2 531.36 225.84 -9.12 re
f*
Q
BT
/TT1 7.92 Tf
-0.173 Tc 82.08 469.92 Td
(Male)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 61.2 472.8 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.092 Tc 82.08 460.56 Td
(Other)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 61.2 463.44 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
0.24 w 1 j 1 J
q 1 0 0 1 60.48 463.44 cm
0 0 m
0 2.16 -1.92 3.84 -3.84 3.84 c
-6 3.84 -7.68 2.16 -7.68 0 c
-7.68 -1.92 -6 -3.84 -3.84 -3.84 c
-1.92 -3.84 0 -1.92 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.176 Tc 150.24 469.92 Td
(Female)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 129.36 472.8 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
46.08 468.48 45.84 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.094 Tc 0.054 Tw 30.72 454.8 Td
(Birth Date:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
57.36 462.48 99.12 -9.84 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
57.36 452.88 99.12 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
13.92 348.48 93.12 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.073 Tc -0.206 Tw 110.64 384.24 Td
(Full Time)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 89.76 387.12 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.085 Tc -0.195 Tw 190.32 384.24 Td
(Part Time)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 169.44 387.12 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.119 Tc 0.078 Tw 30.72 405.12 Td
(Employment Status:)Tj
-0.079 Tc 0.039 Tw 0 -19.44 TD
(Student Status:)Tj
-0.097 Tc 0.057 Tw T*
(Medicaid ID:)Tj
-0.047 Tc 0.007 Tw 164.16 0 Td
(Pref. Dentist:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
228.24 364.32 124.56 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
228.24 373.92 124.56 -9.84 re
f*
Q
BT
/TT1 7.92 Tf
-0.129 Tc 0.089 Tw 30.72 343.92 Td
(Employer ID:)Tj
-0.096 Tc 0.056 Tw 163.44 0 Td
(Pref. Pharmacy:)Tj
-0.075 Tc 0.035 Tw -163.44 -20.88 Td
(Carrier ID:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
54.24 321.6 119.28 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
54.24 330.48 119.28 -9.12 re
f*
Q
BT
/TT1 7.92 Tf
-0.067 Tc 0.027 Tw 194.16 323.04 Td
(Pref. Hyg.:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
217.2 321.6 137.28 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
217.2 330.48 137.28 -9.12 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
448.8 427.92 106.56 -4.56 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
448.8 423.6 106.56 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
0.629 0.629 0.645 RG
0.72 w 1 j 1 J
q 1 0 0 1 356.64 413.52 cm
0 0 m
0 -93.6 l
S
Q
Q
BT
/TT1 7.92 Tf
-0.103 Tc 0.063 Tw 30.72 285.12 Td
(Name of Insured:)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
385.44 292.56 174.48 -9.36 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 G
0.24 w 1 j 1 J
385.2 292.8 174.72 -9.6 re
h
S
Q
BT
/TT1 7.92 Tf
-0.135 Tc 0 Tw 415.92 285.12 Td
(Self)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 395.04 288 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.075 Tc 459.6 285.12 Td
(Spouse)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 438.72 288 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.05 Tc 503.28 285.12 Td
(Child)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 482.4 288 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
BT
/TT1 7.92 Tf
-0.092 Tc 546.96 285.12 Td
(Other)Tj
ET
q
1 0 0 1 16.8000031 0 cm
1 g
0.24 w 1 j 1 J
q 1 0 0 1 526.08 288 cm
0 0 m
0 2.64 -2.16 4.56 -4.56 4.56 c
-7.2 4.56 -9.12 2.64 -9.12 0 c
-9.12 -2.4 -7.2 -4.56 -4.56 -4.56 c
-2.16 -4.56 0 -2.4 0 0 c
h
B*
Q
Q
q
1 0 0 1 16.8000031 0 cm
1 g
84.24 291.36 213.12 -9.84 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
84.24 281.76 213.12 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
431.52 612.24 123.12 -9.84 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
431.52 602.64 123.12 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
428.64 596.4 126.24 -9.84 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
428.64 586.8 126.24 -0.48 re
f*
Q
q
1 0 0 1 16.8000031 0 cm
1 g
14.64 643.68 41.28 -9.84 re
f*
Q
BT
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