ࡱ>  bjbj]] 4??5J 8t$q:Qqeq $i*qqoNqqqqqResesesqq<esqqesesN|d@+j17erN0^EesEddE qqqqesqqqqqqqqqqesqqqqqqqqqqqqqqEqqqqqqqqqqqqqqqqqq  :   About you Recognition and Referral Does your Trust have a specified pathway from primary care to secondary care for inflammatory back pain in place? Please select one of the following response options Yes If you answered yes, please give details below of the pathway and, if applicable, arrangements in place to raise awareness in primary care If neither of the above response options apply to you, please provide more information on your local arrangements below  Diagnosis in specialist care settings What is the average current waiting time to diagnosis for a patient referred with inflammatory back pain? Please select one of the following response options OptionPlease tick here (one option only)Less than 1 month1  2 monthsP2  3 months3 4 months4 5 months5 6 months6 12 monthsMore than 12 months Are patients with suspected axial SpA (AS) routinely referred for a full spinal MRI? Please select one of the following response options OptionPlease tick here (one option only)YesPNo If neither of the above response options apply to you, please provide more information on your local arrangements below  Information and Support How do you ensure patients are given information and support following their diagnosis? Please select whichever response options apply OptionPlease tick here (tick all that apply)Written informationPVerbal informationPAccess to a helplinePNamed contact in the team PGroup educational sessionsOther (please provide details) We offer a weekly group exercise session which is open to all and used on a drop in basis. Newly diagnosed patients have the opportunity to have a buddy and further support from more experienced patients. We also have a weekly designated hydrotherapy session for our patients who have become independent with their exercises. This is as an addition to our normal hydrotherapy appointments. Pharmacological management of axial SpA (AS) What guidance are patients with axial SpA (AS) given when deciding whether to access biologic treatment? Please provide details of arrangements in your local area below  Bearing in mind the NICE anti TNF guidance for ankylosing spondylitis (TA383) states that, Treatment with another anti TNF is recommended for people who cannot tolerate, or whose disease has not responded to, treatment with the first TNF-alpha inhibitor, or whose disease has stopped responding after an initial response, after failure with one biologic, how many other biologics will your commissioners fund a patient with axial SpA (AS) to try, including IL 17As? Please select one of the following response options OptionPlease tick here (one option only)None123 or moreP If none of the above response options apply to you, please provide more information on your local arrangements below  Non-pharmacological management of axial SpA What proportion of adults with axial SpA (AS) are referred to a specialist physiotherapist for a structured exercise programme within your local area when first diagnosed? Please provide details below  Flare management What percentage of patients with axial SpA (AS) have a written care plan to support them with a flare? Please provide details below: Organisation of care Does the Trust have a dedicated axial SpA (AS) clinic? Please select one of the following response options OptionPlease tick here (one option only)YesPNo If neither of the above response options apply to you, please provide more information on your local arrangements below Mental health and well being Are axial SpA (AS) patients under the care of a rheumatologist offered access to psychological services? Please select one of the following response options OptionPlease tick here (one option only)YesNoP If you ticked  yes , please specify the services on offer     Freedom of Information Request May 2019 Assessing variation in Axial Spondyloarthritis Services Our pathway has been discussed with the CCG and implemented so that suspected inflammatory back pain(IBP) patients are identified and booked into a designated IBP clinic which is conducted with a Consultant Rheumatologist and a Clinical Specialist Physiotherapist Our IBP clinic is held on a monthly basis with Dr Gladston Chelliah &'16  ʻo`VoF9FhM*56B* ^Jph!h^h56B* ^Jph!h^B* ^Jph!h1YhN~5B* ^Jph!h^h^56B* ^Jph!h^56B* ^Jph!hOh%45B* ^Jph!h"6B* ^Jph!hOB* ^Jph!hN~5B* ^Jph!hYhY5B* ^Jph!h.#[hlN 5^Jh.#[h|5^Jh2WB* ^Jphh;B* ^Jphjhe[UmHnHu'` x^gd.0m$ ^gdJm$ d^gd^ dgd^  & Fdgdggd^ & FgdN~gdN~gdlN  ' _ c j 4 ^ x H һwj`V`jL?h^56B* ^Jph!hjyB* ^Jph!hOB* ^Jph!h4B* ^Jph!h9ZhjyB* ^Jph!h|h|5B* ^Jph!hjyhM*B* ^Jph!hM*B* ^Jph!jhe[UmHnHuh^hN~56B* ^Jph!hN~B* ^Jph!hu56B* ^Jph!h&b56B* ^Jph!h^h56B* ^Jph!h^hw56B* ^Jph! H V >kd$$Ifl0df'  t0644 lapyte[d$If^gde[l gd^  & Fgd9ZH v        , . / < > ? S T U V | ξΪξξξξξξۚyobh^56B* ^Jph!h^B* ^Jph!h%4B* ^Jph!hu B* ^Jph!h9ZhjyB* ^Jph!h^hM*56B* ^Jph!'he[h1Y56B* OJQJ^Jph!he[hM*56B* ^Jph!he[hM*B* ^Jph! he[hM*he[h8(5B* ^Jph!he[hM*5B* ^Jph!& Dkd$$Ifl0df' t0644 lapyte[d$If^gde[l d$Ifgde[l   x\\d$If^gde[l kd\$$Ifl0df' t0644 lapyte[    x\\d$If^gde[l kd$$Ifl0df' t0644 lapyte[    x\\d$If^gde[l kd$$Ifl0df' t0644 lapyte[ - . x\\d$If^gde[l kd9$$Ifl0df' t0644 lapyte[. / = > x\\d$If^gde[l kd$$Ifl0df' t0644 lapyte[> ? S T x\\d$If^gde[l kdw$$Ifl0df' t0644 lapyte[T U V xsisMMd$If^gde[l  & Fgd9Zgd^kd$$Ifl0df' t0644 lapyte[   &  FκΪ۠|rh|ZN?h.#[hN!Z5B* ^Jph!hN!Z5B* ^Jph!jhe[UmHnHuhM*B* ^Jph!h&bB* ^Jph!hN!ZB* ^Jph!hu56B* ^Jph!h&b56B* ^Jph!hN~B* ^Jph!he[hM*56B* ^Jph!'he[hJ8Q56B* OJQJ^Jph!he[hM*B* ^Jph! he[hM*he[hM*5B* ^Jph!he[h8(5B* ^Jph!  iQ5d$If^gde[l d$Ifgde[l kd$$Ifl0df'  t0644 lapyte[ x`Dd$If^gde[l d$Ifgde[l kdr$$Ifl0df' t0644 lapyte[ xq_QqqqJxgd.0 dgdN!Z d^gd&bgd)xkd$$Ifl0df' t0644 lapyte[FTVdd$If^gde[l gd^  & Fgd9Zxgd.0 F$FRTV  8:<>tvxz˼qaaaaahe[hM*56B* ^Jph!'he[hM*56B* OJQJ^Jph!'he[h-(56B* OJQJ^Jph!he[hM*B* ^Jph! he[hM*he[hD^85B* ^Jph!he[hM*5B* ^Jph!hM*56B* ^Jph!hS56B* ^Jph!h^56B* ^Jph!h9Zh.#[B* ^Jph! iQ5d$If^gde[l d$Ifgde[l kd$$Ifl0df'  t0644 lapyte[ x`Dd$If^gde[l d$Ifgde[l kdm$$Ifl0df' t0644 lapyte[ 8<x`Dd$If^gde[l d$Ifgde[l kd $$Ifl0df' t0644 lapyte[<>txx`Dd$If^gde[l d$Ifgde[l kd $$Ifl0df' t0644 lapyte[xzx`Dd$If^gde[l d$Ifgde[l kdJ $$Ifl0df' t0644 lapyte[x`DDDd$If^gde[l d$Ifgde[l kd $$Ifl0df' t0644 lapyte[]^_`οxk]kRJRBRh#fnH tH hsnH tH hwhnH tH jhe[UmHnHuh^56B* ^Jph!hE756B* ^Jph!h9ZhN~B* ^Jph!h<;B* ^Jph!h^B* ^Jph!h9Zh.#[B* ^Jph!h<;5B* ^Jph!h.#[h.#[5B* ^Jph!hmB* ^Jph! he[hM*he[hM*56B* ^Jph!he[h1Y56B* ^Jph!^`jvkdZUUMHgdg & FgdCgd^  & Fgd9Zxgd.0 e^egd)xkd $$IflY0df' t0644 lapyte[ 4@dfhj(*468<>@DFH\^`bd&迲rrr^rQhu56B* ^Jph!'he[h 56B* OJQJ^Jph!he[h8(56B* ^Jph!he[h8(B* ^Jph! he[h8(he[h8(5B* ^Jph!h8(56B* ^Jph!hg56B* ^Jph!h2!hL/]^JhsnH tH hSnH tH h%4nH tH h2!nH tH hwhnH tH h2!h6nH tH (*4H0d$Ifgde[l kd+ $$Ifl0df'  t0644 lapyte[d$If^gde[l gdg468<>\Dd$Ifgde[l kd $$Ifl0df' t0644 lapyte[d$If^gde[l >@DFx`Dd$If^gde[l d$Ifgde[l kd $$Ifl0df' t0644 lapyte[FH\`x`Dd$If^gde[l d$Ifgde[l kd&$$Ifl0df' t0644 lapyte[`bd')*+,Xxff_____U  & Fgd9Zxgd.0 d^gdukd$$Ifl0df' t0644 lapyte[ &'(,X}!"$%&'8̿wjZPD5h)xh)x5B* ^Jph!h-(5B* ^Jph!h2!B* ^Jph!h^hN!Z56B* ^Jph!hN!Z56B* ^Jph!h8(56B* ^Jph!hlN B* ^Jph!h9ZhgB* ^Jph!h9Zh B* ^Jph!h9Zhu B* ^Jph!hu B* ^Jph!h9ZhlN B* ^Jph!h.#[h.#[5B* ^Jph!h8(5B* ^Jph!jhe[UmHnHuhuB* ^Jph!!#$%&'8d$If^gde[l 5^5gdJm$gdg  & Fxgd9Zxgd  & Fdgd9Zxgd.0gd2!gd8(8Thö~q~~gZPA: he[h8(he[h8(5B* ^Jph!hJB* ^Jph!hg56B* ^Jph!hWB* ^Jph!h9Zh9ZB* ^Jph!h9ZhhB* ^Jph!hhhW5B* ^Jph!h8(5B* ^Jph!h^h8(56B* ^Jph!hN!Z56B* ^Jph!h8(56B* ^Jph!jhe[UmHnHuh"B* ^Jph!hu B* ^Jph!h9Zh)xB* ^Jph!iQ5d$If^gde[l d$Ifgde[l kdd$$Ifl0df'  t0644 lapyte[,2PdfhzmcmYmOBYh.056B* ^Jph!hhB* ^Jph!hOB* ^Jph!hu B* ^Jph!h*hhB* ^Jph!hhhh5B* ^Jph! hu^JhN!ZB* ^Jph!hN!Z56B* ^Jph!hu56B* ^Jph!jhe[UmHnHu h8(^J he[h8(he[h8(56B* ^Jph!'he[h-(56B* OJQJ^Jph!he[h8(B* ^Jph!x`Dd$If^gde[l d$Ifgde[l kd!$$Ifl0df' t0644 lapyte[xlZHHHHH d^gdu d^gdN!Z 5^5gdJm$kd$$Ifl0df' t0644 lapyte[,fhvd$If^gde[l gdggd.0  & Fxgd*xgd 5^5gdJm$ d^gduh$%&'(*+-.013456789ݹꯡwg_[_[_[_[W[W[W[h.0hCjhCUhN!ZhW56B* ^Jph!hN!Z56B* ^Jph!h.056B* ^Jph!h.0hO56B* ^Jph!jhe[UmHnHuh8(B* ^Jph!'he[h 56B* OJQJ^Jph!he[h8(56B* ^Jph!he[h8(B* ^Jph! he[h8(he[h8(5B* ^Jph!!iQ5d$If^gde[l d$Ifgde[l kd_$$Ifl0df'  t0644 lapyte[x`Dd$If^gde[l d$Ifgde[l kd$$Ifl0df' t0644 lapyte[')*,-/023xsndbdbdbdb dgd2WgdN!Zgdgkd$$Ifl0df' t0644 lapyte[ 3456789<=>?@ABajkgdM*$-DM a$gd2W tgdgV9<=>?@B`adijkƯ{\=<he[h.05B*CJ$OJQJ^JaJmH nH ph}1sH tH <he[h`+5B*CJ$OJQJ^JaJmH nH ph}1sH tH 3h.0h`+5CJOJQJ^JaJmH nH sH tH 3h.0h.05CJOJQJ^JaJmH nH sH tH -hQL5CJOJQJ^JaJmH nH sH tH -h2W5CJ OJQJ^JaJmH nH sH tH -h 55CJ OJQJ^JaJmH nH sH tH h.0hChgV́́΁Ёсa£„ea]Ya]W]YaYa]SOSaSaKSaKh-(h h8(UhM*h1YhC<he[h2W5B*CJ$OJQJ^JaJmH nH ph}1sH tH <he[h`+5B*CJ$OJQJ^JaJmH nH ph}1sH tH <he[hVG5B*CJ$OJQJ^JaJmH nH ph}1sH tH <he[h.05B*CJ$OJQJ^JaJmH nH ph}1sH tH <he[h)x5B*CJ$OJQJ^JaJmH nH ph}1sH tH  and Dr Jane Martindale Ongoing progression of the condition is closely monitored with physiotherapy review on a 6 12 monthly basis and additional Consultant reviews also occur. The response to NSAIDS and physical therapy are monitored and if there is a failure of conventional treatment the MDT are notified. Using the specialist Physiotherapy assessment and/or Nurse Specialist reviews biologic interventions are discussed and instigated as required. All (100%) of adults with a diagnosis of axial SpA are referred to a designated clinical specialist physiotherapist who provides all essential exercise advise and support at initial diagnosis. They are invited to join the weekly class and are made aware of all resources provided by NASS There is no written care plan is currently provided but the Clinical Specialist Physiotherapist uses the NASS flare leaflet if appropriate. All patients who attend the service are given named contact physiotherapy details and are encouraged to phone the department. A telephone triage call is made and verbal advice or urgent physiotherapy appointments are given. We are aware that there is a need for psychological support for our patients and monitor for this. Unfortunately, we currently do not have access to psychological support within our Trust. We currently have to ask out GP colleagues to refer for this service which is provided in a community setting. =́́΁ρЁсbcdefggdN!Zgd8( & F$gd1YgdM*acdfghN!ZhW56B* ^Jph!h hCh8(21h:pM*. A!S"S#$%7w $$If!vh#v#v:V l  t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l  t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l  t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V lY t0655apyte[$$If!vh#v#v:V l  t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l  t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l  t0655apyte[$$If!vh#v#v:V l t0655apyte[$$If!vh#v#v:V l t0655apyte[j$ 666666666vvvvvvvvv666666>6666666666666666666666666666666666666666666666666hH66666666666666666666666666666666666666666666666666666666666666666p62 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ OJPJQJ_HmH nH sH tH J`J xNormal dCJ_HaJmH sH tH DA D Default Paragraph FontRi@R 0 Table Normal4 l4a (k ( 0No List @@@ \ List Paragraph ^m$LOL 2Wdefault dCJOJQJ^JaJtH >@> 2W0HeaderdB#.!. 2W0 Header Char> @2> 2W0FooterdB#.A. 2W0 Footer Char6U`Q6 0 Hyperlink >*B*phcToaT 0Unresolved Mention1B*phq `or`  NICE normal dh$CJOJPJQJ_HaJmH sH tH PoP NICE normal CharCJOJPJQJ^JaJR@R ) :0 Balloon Text dCJOJQJ^JaJNoN ) :0Balloon Text CharCJOJQJ^JaJFV`F C0FollowedHyperlink >*B*phOrZoZ eDefault 7$8$H$%B*CJ^J_HaJmH phsH tH t`t K|p Table Grid7:V0 dd^@d {0 Normal (Web)ddd[$\$CJOJPJQJ^JaJtH B'`B e0Comment ReferenceCJaJB@B !e0 Comment Text dCJaJBoB  e0Comment Text CharCJaJ@j@@ #e0Comment Subject"5\No1N "e0Comment Subject Char5CJ\aJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭VGRU1a$N% ʣꂣKЛjVkUDRKQj/dR*SxMPsʧJ5$4vq^WCʽ D{>̳`3REB=꽻Ut Qy@֐\.X7<:+& 0h @>nƭBVqu ѡ{5kP?O&Cנ Aw0kPo۵(h[5($=CVs]mY2zw`nKDC]j%KXK 'P@$I=Y%C%gx'$!V(ekڤք'Qt!x7xbJ7 o߼W_y|nʒ;Fido/_1z/L?>o_;9:33`=—S,FĔ觑@)R8elmEv|!ո/,Ә%qh|'1:`ij.̳u'k CZ^WcK0'E8S߱sˮdΙ`K}A"NșM1I/AeހQתGF@A~eh-QR9C 5 ~d"9 0exp<^!͸~J7䒜t L䈝c\)Ic8E&]Sf~@Aw?'r3Ȱ&2@7k}̬naWJ}N1XGVh`L%Z`=`VKb*X=z%"sI<&n| .qc:?7/N<Z*`]u-]e|aѸ¾|mH{m3CԚ .ÕnAr)[;-ݑ$$`:Ʊ>NVl%kv:Ns _OuCX=mO4m's߸d|0n;pt2e}:zOrgI( 'B='8\L`"Ǚ 4F+8JI$rՑVLvVxNN";fVYx-,JfV<+k>hP!aLfh:HHX WQXt,:JU{,Z BpB)sֻڙӇiE4(=U\.O. +x"aMB[F7x"ytѫиK-zz>F>75eo5C9Z%c7ܼ%6M2ˊ 9B" N "1(IzZ~>Yr]H+9pd\4n(Kg\V$=]B,lוDA=eX)Ly5ot e㈮bW3gp : j$/g*QjZTa!e9#i5*j5ö fE`514g{7vnO(^ ,j~V9;kvv"adV݊oTAn7jah+y^@ARhW.GMuO "/e5[s󿬅`Z'WfPt~f}kA'0z|>ܙ|UwF~w{#}l5&fwЪtI% :5Zh2]hpoָSiՇJЪutvhv3~L(`gMPK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!g theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] )bnI    )bnIL   H F&8h9a")+1359>?D    . > T  <x4>F`3 !#$%&'(*,-./024678:;<=CT   # @H 0(  eQ Q(     F?"Text Box 1C"PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!w{Odrs/e2oDoc.xmlTێ }@gmGv[Ti@Ǩ(jN塪 ps˫Z8H1j&ԮƟ7FňԊ;|~7VK-ԸTIh;. 񰴻Yz'y.^[f9ؽxSiHbqq܆1Y_jgi=A!'hooPV; D7<d/< Ǚs, H(zG7z@YNo\N3d̽_R%jǯ} drtqdۿ !{#.B1KOgfB(6U\fFlEZH]Bicu¤p<'mqaw[iсJ6 7u*8+q;-Y^f drs/downrev.xmlLAn0Ezk*uSC! 8Ԫ[(CؐptJk-+X#ĕ- ?55vILJ3mGkJeϤtUC!;PK=M'_([ Pu>\o*y6-Mm aP^X;)-ˀ*X+Di dG \޿PPK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!w{O.drs/e2oDoc.xmlPK-!BR> drs/downrev.xmlPK    F?"Text Box 2C"PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!(Udrs/e2oDoc.xmlTێ }@g}V&Ti@ Q1P UN^0 gngX\@f,WU\*a3cd%Y˗/.YZ%(3@-{]9]F[{4l"jH蝈8F2TU3kvTeoVMcC ֯rAʝ!1 QtKpz%@u6ʪ]ժT $)hrX}.G8p$ ԀR_^5!ST"-;vc[F(DzmNQpCN1/:tJ G8fu}VRwD%ѡbڝbP%xAp cv$IJ_PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!(U.drs/e2oDoc.xmlPK-!7 drs/downrev.xmlPK B   R?"Text Box 2C"ÔPK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!u$Mdrs/e2oDoc.xmlT0#4intt)BZ]>qmRӖj "?ϼ79%N'9%phU͒i#*zޮ_Zt_]2;-8n5UV۬X\x~ >bn!.u\;l') Yh& >zgAixhÄΠm%fcVZo/4_ME4,@@Oo}aOÀǨs<1ى;k0i]]q|O3l  ӑ< :thSx8_Ŝy1ϓx+ϷM⦢OC̆%T*nWo#}M_*E2_ +D?Ah]^Xi{oԎI51eeNØ4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!N$Kdrs/e2oDoc.xmlTێ }@7NI7⬶٦Hq ;7M/CU? 33x}kEy ɔa8KqjIL%= Oo6/_;[ZPpA/:[6[dO 8nՎuUO\mp= tFiDs iuim֬;f[4?d4 u#'Ғ;Є AH.R XlK5-"Ղx{?XY4J(@@ONg}NBǨr{_=1mً[k1Y|]<p|PcvHAU:p<\,%V*_x~mh7%u|Bg{b6xv<(YRpj92]Fܔ!F_`CL'-˳+"moM10=cn 1U? 6SA}Bb ݍӈwJ:o%AqV?TɽM-K%Ki(9MVŹБwDghD,ܪчN a=Z 77/8"]-ǧ t,OPH˂ `E'A9?PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!N$K.drs/e2oDoc.xmlPK-!]<, ~drs/downrev.xmlPK A  R?"Text Box 2C"ÓPK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!6$Kdrs/e2oDoc.xmlTێ }@7NܤI8m*m/n?cCNE}pfonzI8/t6R" ZCI??_(񁙚)0gMg C  EgKچ`, XaY@ڱѵUց.ӻn~>6bn!.U\l+,4^X`oPZr03hEMeVZo/4?>9")1LD5$t`-x*JuVŗG{5a o!QE j\-p[/"`k|x+@)C:;aœK Az/J;T;ȉa7 0cb?Ahݕ%]]Xi{cԌI51eeF#uQQ 3`nFܴQag=2'(Q q1_,s4Mu} GJ. Ej)c&#qm'wPK!-1uGdrs/downrev.xmlLN0HH\Pkҟ8Bn&:nޞ n;7zt &ΣT3X{a#}4YIV֣c"ˋRڟ 0*X( mJ}y[T yJ$CuP'*w NuHZ՛_ۣ^ϸ{%30 *b#ȬeQR :Br`{xU_PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!6$K.drs/e2oDoc.xmlPK-!-1uG~drs/downrev.xmlPK E  R?"Text Box 2C"×PK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!@?(Ldrs/e2oDoc.xmlTn0?ג\vAE$,$W%iKgI):|,3Z_ZN)i6K)C-;voV8LQғpzպ 1T-,A㊾+i}W$͠y\}R[#V³+BkwRj,92,]b/”!}Iy>*WdL𷗴XJ꒮A}0uFϤHYIȠݨarlZ'-_X%u? J'\eE腸X9.Iuy GzJ A vL&XQBO\cO`PK!W drs/downrev.xmlLN0DHH\uiB ! oxl7 rΌfTbBzG  ƙZo+!j2zp 1>=tiܑ^pVp R+bK)CӡaF$[4^2M';l>`=Mas,C/+u~6݂8ǿ03:̴s2A 4㤂4~Qd +PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!@?(L.drs/e2oDoc.xmlPK-!W drs/downrev.xmlPK @  R?"Text Box 2C"ÒPK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!6-$Kdrs/e2oDoc.xmlTێ }@7Nd7⬶٦Hq ;7M/CU? 33x}kEy ɔa8KqjIL%= Oo6/_;[ZPpA/:[6[dO 8nՎuUOWYOKIM#x4^JVq6kVcL zcAixh„Πi$f6YjAr=,x숬KzEa%z} o'yd@ncT9U=ضŭsе՘,.8>T1 ;H@}t *T8.w*_x~mh7%u|Bg{b6xv<(YRpj92]Fܔ!F_`CL'-˳+"moM10=cn 1U? 6SA}Bb ݍӈwJ:o%AqVØ4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!8+^&Kdrs/e2oDoc.xmlTn0 } :5]  dYI&)%Ym/ "uDCvЊLE糜a84+ifM4L= Oo7_ @51mElewB3?+ :[p4>k]lWYOG'$<|n[/QBZ]ZfVSL| u#'Ғ;ІAJ.R X<QcǬH 9ޞi:~qD6-(1LDOb- d/1bXUNz'3{q` f77# u|$u:RdDGNgeb*WU.Vp]-"Oe|mh7u|Bgb6|yPIV9rd%^)C^B]I]9wITSVf1R7z䩡9!iM%=vvEs82B2bԗf8BU4P2n!OoT{dJ;6>MWK;El~PK!l* drs/downrev.xmlLN0DHH\PҐ8Bn&:nǝ;׳5l> ֩;oE,DJZnjY)wW=mcǨC%1aF2;Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!iS %Kdrs/e2oDoc.xmlTێ0}G,Ӵmtt)BZ..8Nca{6)_ɖjD,g| 1Mߟ JjĊH;Sf La)+3H }ՏTPXCw4;9A`PlE=յP% ]Hy3p"622SƎMGNQ۟PK!|; drs/downrev.xmlLN0EH5HluJ8B O?Vݣ{46cw֫ ^/K`1)%|cM{zҨZ{yzF%.JTs+?lUsԑʭWYVpFG ns{J8ħ+JWlpI0:#3uE(J!,EmPK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!iS %K.drs/e2oDoc.xmlPK-!|; drs/downrev.xmlPK  B  R ?"Text Box 2C"ÔPK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!`$Kdrs/e2oDoc.xmlTێ }@7NܤI8m*m/n?cCNE}pfonzI8/t6R" ZCI??_(񁙚)0gMg C  EgKچ`, XaY@ڱѵUց.ӻn~>6bn!.U\l+,4^X`oPZr03hEMeVZo/4?>9"뒮)1LD5$t`-x*JuVŗG{5a o!QE j\-p[/"`k|x+@)C:;aœK Az/J;T;ȉa7 0cb?Ahݕ%]]Xi{cԌI51eeF#uQQ 3`nFܴQag=2'(Q q1_,s4Mu} GJ. Ej)c&#qm'wPK!>{ drs/downrev.xmlLN0DHH\uT! q*[)nM"u4= NьfVbBzG RLOׇDo *]wv\B RthuXVGA$V sw {"^L_^ˋD9ѡf; bPLky+X-d]?PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!`$K.drs/e2oDoc.xmlPK-!>{ ~drs/downrev.xmlPK   A  R ?"Text Box 2C"ÓPK!8[Content_Types].xmlAN0EH%N@%邴K@`dOdlyLhoDX3'AL:*/@X*eRp208J妾)G,R}Q)=HiҺ0BL):T뢸WQDY;d]6O&8* VCLj"󃒝 yJ.;[wIC_ :{IOA !>Ø4 p;fɑ3׶Vc.ӵn(&poPK!8! _rels/.relsj0 }qN/k؊c[F232zQLZ%R6zPT]( LJ[ۑ̱j,Z˫fLV:*f"N.]m@= 7LuP[i?T;GI4Ew=}3b9`5YCƵkρؖ9#ۄo~e?zrPK!㻗$Mdrs/e2oDoc.xmlTێ }@7NܸXqVlSU^~8F~}E}p̙nA8/Tt6R" F]E??m_,(񁙆)0GUoKC eo+څ`, XaY@ƱѵUփk.~ >"V:zʝcD ͤ{;܁6L8 Vrrlf_y)ۋLOkFOb5 $֗h/ x)Uocf'Az2z:R0l  Q;T :8^Jp<,⦠2̋V&qSQOCdʳK Af+JȁalwBMccb?Ahߕ]\Xe{cԍI52'tasN9yM%=vE=s`u<C2MoU@ɸ݄4@QwXV&cG&'سI|š׏;PK! drs/downrev.xmlLN0DHH\P8BnM"u4=<ͼ-דو>t,0ڙoǙ&{GRƝmlX*PhmCy[:݀VtO:Z?G@.Ǐ_kqWv|J]^Lw"N_Urڻ#zbH&>2PK-!8[Content_Types].xmlPK-!8! /_rels/.relsPK-!㻗$M.drs/e2oDoc.xmlPK-! ~drs/downrev.xmlPK   B S  ?l5 /  =&j {Vt#rH &rT &KT#'T&T$x-''Tkt&Tkt&3T~&[Ta&T _Hlk513649189 _Hlk5189485n lm5 6 / 0 578:;=>@AOP@Elm5 6 / 0 578:;=>@AOP3333$y1/*Dq6: v/"$1?Hbo1VM'2Hnd20 418@L9^ s:9F?dHDjA \=jBznUCV"jkglF,MK{!1"N&QO^ L (a\Rr1b_1?7hjZ9{k~b (Crr^{7tVX7oO~PF 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( x ^x `OJQJo(H^H`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.^`5.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.^`5.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.h^h`.8^8`.L^`L. ^ `. ^ `.xL^x`L.H^H`.^`.L^`L.^`5.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L. ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo( ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo(8^8`.^`. L^ `L. ^ `.x^x`.HL^H`L.^`.^`.L^`L. 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L. ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`o(.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.8^8`.^`. L^ `L. ^ `.x^x`.HL^H`L.^`.^`.L^`L.^`5.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.  8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L. 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L. 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo(^`.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L.8^8`.^`. L^ `L. ^ `.x^x`.HL^H`L.^`.^`.L^`L.^`.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L. 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( 8^8`OJQJo(^`OJQJ^Jo(o  ^ `OJQJo(  ^ `OJQJo(x^x`OJQJ^Jo(o H^H`OJQJo( ^`OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo(^`5.^`.pL^p`L.@ ^@ `.^`.L^`L.^`.^`.PL^P`L. ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo( ^`OJQJo(^`OJQJ^Jo(o p^p`OJQJo( @ ^@ `OJQJo(^`OJQJ^Jo(o ^`OJQJo( ^`OJQJo(^`OJQJ^Jo(o P^P`OJQJo($9{k6@CA3C#|C*qDTFZFDGVG6H I LQLnsMtMBNuwNW9OiOvPlQJ8Q[RIR5>R]R)SZOST2WwXY1Y ZN!Z[.#[8\L/]-a]dNae%g/Vg4k[=mLo;pq}r1s9sb0u]umuqw)xjyH`zTszQ"{|K|`|~!3#eE!SPc +EwgiKN~-?st^ e3 .?5xPh*;rE7J9Z0-Hb\<;gXiB>wxK?vLQVQy{ 0JOLtsG^&bWw"Dz$ms>.`^ gJvOZh!mNInKX?t9uw[`+=7W Dq$VY~okog9T-(#fG|.0X8O szSSW^eM*I3ER.ePJ\i Wof ;'auH5Cj}X5857@   @ @$@0@<@@Unknown G* Times New Roman5Symbol3. * Arial7.*{$ Calibri]ACaslonPro-RegularCambria?Wingdings 29. . Segoe UI?= .Cx Courier New;WingdingsA$BCambria Math"1hTwgTwgz )e=!S0 AJX  $PE6! xxj, $                           ! " # Oh+'0 px  Normal1Microsoft Office Word@@|07@|07z ՜.+,D՜.+, `hpx  e)   Titlex :BContentTypeId,0x010100CC85347C8BDAAA4D9A24E43D5D16D7E7  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEGHIJKLMNOQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~Root Entry F@l17 Data FZ1TablePWordDocument4SummaryInformation(DocumentSummaryInformation8MsoDataStorepW17@+j17XWEKGCX2JQ==2 pW17`&c17Item  &Properties@52UUSP4==2 pW17Pg17Item  PropertiesO2R1JLCK==2pW17@+j17Item 2Properties U This value indicates the number of saves or revisions. The application is responsible for updating this value after each revision.  !"#$%' DocumentLibraryFormDocumentLibraryFormDocumentLibraryForm   F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qCompObj&r