ࡱ>  bjbj 2{=, , ooooo8gD6++++ 6< X @6B6B6B6B6B6B6#9;hB6oh   h h B6oo++W6"""h jo+o+@6"h @6""Rl45+pFj `5,6m606~5f-<x!r-<<5-<o5Hh h "h h h h h B6B6"h h h 6h h h h -<h h h h h h h h h , 5: Screening/Baseline Visit *Note: Screening/Baseline Tests must be conducted within a 21-day period before initial study drug administration or tests will have to be repeated.* Has patient signed Informed Consent prior to any study related procedures? YES NO Date of Consent: ____/____/_____ Copy of signed Informed Consent given to subject. YES NO (dd/mmm/yyyy) Height & Weight Assessment/Vital Signs (Shoes off ) Time: ____:____ (24 hour clock) Height (cm) _____ Weight (kg) _________ Temp (0C) _______ (oral (axillary Respiration Rate _______  Blood Pressure and Heart Rate (sitting and supine) SittingBlood Pressure (mmHg) ______/_______ Systolic/DiastolicHeart Rate ----------- SupineBlood Pressure (mmHg) ______/_______ Systolic/DiastolicHeart Rate ------------  Laboratory Tests* Time: ____:____ (24 hour clock) Complete Local Lab Requisition. *Serum Chemistry- ALT, AST, Creatinine, Alk Phos, Creatinine, Hemoglobin (For females of child bearing potential only) Serum B-HCG or  FORMCHECKBOX  N/A (Indicate below) >2 yrs post menopause (Year of menopause _______________) Surgically sterilized Other (Specify):______________________________________ Results of Pregnancy Test (For females of child bearing potential only): Positive * (Not Eligible to be enrolled) Negative Laboratory Tests for Central Labs Time _____:_____ (24 hour clock) Complete Central Lab Requisition. Hematology Chemistry Coagulation Trough serum digoxin for pt on digoxin only Urinalysis  List labs not done/reason:  *Any abnormal laboratory results must be assessed by the Investigator for possible clinical significance. Any clinically significant laboratory abnormalities and their subsequent follow up are to be documented in the source documents. Clinically significant laboratory abnormalities must be included on the Adverse Events CRF page. 12 Lead ECG (Investigator to review for clinical abnormalities and sign/date). Completed ECG. Print out 2 ECG reports and have Investigator review and sign both copies. Were all screening procedures completed ? YES NO If no explain: __________________________________________________________________________________ _____________________________________________________________________________________________ PI / Physicians Checklist Review/ Sign Informed Consent and answer any questions with Patient Review and sign off Medical History Review Screening Inclusion/ Exclusion Criteria for enrollment considerations to date Complete physical exam Review and sign off ECG Review methods of birth control for females of child bearing potential Review and sign Pregnancy/Lab results Comments: ___________________________________________________________________________________________ __________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ Physician/ Investigator Physical Exam SYSTEMNORMALABNORMAL If yes: CS NCSCOMMENTS (Comment if Abnormal: Clinically Significant or Not Clinically Significant)SKIN FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX HENT FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX EYES FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX HEART FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX CHEST/LUNGS FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX ABDOMEN FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX REFLEXES FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX LYMPH NODES FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX SPINE FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX NERVOUS SYSTEM FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX EXTREMITIES FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX OTHER (specify) ________________ FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX OTHER (specify) ________________ FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX   FORMCHECKBOX  Investigators Signature: ___________________________________Date: ___________ @ Time:___:___ dd/mmm/yyyy (24 hour clock)     University of Rochester Study Protocol Name / #: Observing the Effect of Sunshine on Mood in Adults / #97531 Visit Date: ___/______/_____ Subject Initials __ __ __ ID: ___________ (dd-mmm-yyyy) Page ___ of ___ Study Staff Initials: ___ 15-Apr-13 Xx 5 h q r ~ ٵlZlE4E hMhMCJOJQJ^JaJ)hMhMB*CJOJQJ^JaJph#hMB*CJOJQJ^JaJph)hMh2}B*CJOJQJ^JaJph hMh2}CJOJQJ^JaJ hMhejCJOJQJ^JaJ#hMhej5CJOJQJ^JaJ#hMh2}5CJOJQJ^JaJ#hMhej6CJOJQJ^JaJ#hMh2}6CJOJQJ^JaJ(hMhej5B*CJOJQJaJph r       $$Ifa$h^h gdM$1$ &#$/ &#$/gdej$a$gdej & ' 3 4 : ; C E c d e Ϻẫ}iiWᏫ#hMh2}5CJOJQJ^JaJ& jhMh2}CJOJQJ^JaJ#hMh2}CJH*OJQJ^JaJhMh2}5CJOJQJaJhMCJOJQJaJhMh2}CJOJQJaJ)hMh2}B*CJOJQJ^JaJph#hMB*CJOJQJ^JaJph hMh2}CJOJQJ^JaJhMCJOJQJ^JaJ  % * + 3 F S X Y a b $$Ifa$$If b c d e jhhhh_____ $$Ifa$kd$$Ifl!\| ~, T04 laH   fkd$$Ifl!F<X 0    4 laytcC$If $$Ifa$ 8 A G I ^ b c g x  > j z ޺xcNcc)hMhejB*CJOJQJ^JaJph)hMh2}B*CJOJQJ^JaJph#hMh2}>*CJOJQJ^JaJhMh2}5CJOJQJaJhMB*CJOJQJaJphh2}B*CJOJQJaJph%hMh2}B*CJOJQJaJph hMhMCJOJQJ^JaJ hMh2}CJOJQJ^JaJ hMhejCJOJQJ^JaJ   / B M N O \ ] ^ lkdT$$Ifl!F<X 0    4 laytcC $$Ifa$ ^ _ ` a b c d e f g < = k $ & F !$1$If`a$gd2} & F $1$Ifgd2} & F $1$Ifgd2}$1$If & F$1$Ifgd2}$1$z {  +: ѴѣsasP>Pѣ#hMhM>*CJOJQJ^JaJ hMhMCJOJQJ^JaJ#hMh2}>*CJOJQJ^JaJ/hMh2};>*B*CJOJQJ^JaJph/hMh2}5>*B*CJOJQJ^JaJph hMh2}CJOJQJ^JaJ8jhMh2}B*CJOJQJU^JaJph)hMh2}B*CJOJQJ^JaJph2jhMh2}B*CJOJQJU^JaJph * + u B`kde$$IfTl4%@&04 laf4T & F $1$If`gd2} & F $1$Ifgd2}  !$1$If$ & Fx$1$If`xa$gd2}$ & F !$1$If`a$gd2} :FGRS`a !h$1$If^h 0$1$If`0$1$If2$1$If^2` & F 2$1$If^2`gd2} & F I$1$If^I`gd2} !$1$ !1$  ^dXVV $L^La$gdejxkd$$IfTl0bx$04 laytejT h$1$If^h & F$1$Ifgd2}$1$If 7Qfglv&'νwkwZHw#hMh2}6CJOJQJ^JaJ hMhejCJOJQJ^JaJhMCJOJQJaJhMh2}CJOJQJaJhM5CJOJQJ^JaJ&hMhej5CJOJQJ\^JaJ&hMh2}5CJOJQJ\^JaJ h,Jh2}CJOJQJ^JaJ hMh2}CJOJQJ^JaJhMCJOJQJ^JaJ#hMh2}5CJOJQJ^JaJ^nR6'()4 & F !d^`gd2} & Fd^`gd2} & F !0d`0gd2}$a$ & Fgd,J & F h^gd,J45JK $$1$Ifa$$If ) p@ P !$1$$$ ) p@ P !$1$a$$a$L^L  *+STUVZ[\j̷̓~~~~oZZB.jhMh2}B*CJOJQJUaJph(hMh2}>*B*CJOJQJaJphhcCh2}CJOJQJaJ(hcChcC5B*CJOJQJaJph(hcCh2}5B*CJOJQJaJphhMh2}CJOJQJaJ(hMh2}5B*CJOJQJaJph%hMh2}B*CJOJQJaJphhMhej5CJOJQJaJhMh2}5CJOJQJaJ UV[I= xx$1$Ifkd$$IfTl    \ $$px0    4 laT $$Ifa$gdcC $$1$If$1$Ifjklmn|}~͸ͥ͸ͥoͥͥT͸ͥ94jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph4jNhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jfhMh2}B*CJOJQJUaJph[mxx$1$If^ xx$1$If$xx$1$Ifa$# xx$Ifkd6$$IfTl    @r $$px (0    4 lap(To\A4j hMh2}B*CJOJQJUaJph%hMhejB*CJOJQJaJph4jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJphxx$If^ xx$If $xx$Ifa$# xx$Ifkdm $$IfTl    @r $$px (0    4 lap(T#JKxx$If^ xx$If $xx$Ifa$ !"#$23489GHILQRSabcdesѹ쉹n줹S4j hMh2}B*CJOJQJUaJph4j0 hMh2}B*CJOJQJUaJph4j hMh2}B*CJOJQJUaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jH hMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJphKLR# xx$Ifkd $$IfTl    @r $$px (0    4 lap(TRdvxx$If^ xx$If $xx$Ifa$stuvw͸ͥͥͥo͸ͥT͸ͥ4j&hMh2}B*CJOJQJUaJph4jYhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jqhMh2}B*CJOJQJUaJph# xx$Ifkd$$IfTl    @r $$px (0    4 lap(Txx$If^ xx$If $xx$Ifa$!͸ͥͥͥo͸ͥT͸ͥ4jOhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph# xx$Ifkd$$IfTl    @r $$px (0    4 lap(T$KLxx$If^ xx$If $xx$Ifa$!"#$%3459:HIJMUVWefghiw͸ͥͥͥo͸ͥT͸ͥ4jzhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph4j9hMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJphLMV# xx$Ifkd!$$IfTl    @r $$px (0    4 lap(TVhzxx$If^ xx$If $xx$Ifa$wxyz{͸ͥͥͥo͸ͥT͸ͥ4jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph4jdhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph# xx$IfkdL$$IfTl    @r $$px (0    4 lap(Txx$If^ xx$If $xx$Ifa$#͸ͥͥͥo͸ͥT͸ͥ4jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph# xx$Ifkdw$$IfTl    @r $$px (0    4 lap(T&MNxx$If^ xx$If $xx$Ifa$#$%&'567;<JKLO]^_mnopq͸ͥͥͥo͸ͥT͸ͥ4j hMh2}B*CJOJQJUaJph4j.hMh2}B*CJOJQJUaJph4jhMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jFhMh2}B*CJOJQJUaJphNO^# xx$Ifkd$$IfTl    @r $$px (0    4 lap(T^pxx$If^ xx$If $xx$Ifa$͸ͥͥͥo͸ͥT͸ͥ4j&$hMh2}B*CJOJQJUaJph4jY"hMh2}B*CJOJQJUaJph4j!hMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4jq!hMh2}B*CJOJQJUaJph# xx$Ifkd"$$IfTl    @r $$px (0    4 lap(Txx$If^ xx$If $xx$Ifa$$%&45678F͸ͥͥͥo͸\ͥA͸ͥ4j_'hMh2}B*CJOJQJUaJph%hMhejB*CJOJQJaJph4j%hMh2}B*CJOJQJUaJph4j%hMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4j$hMh2}B*CJOJQJUaJph# xx$Ifgdejkd%$$IfTl    @r $$px (0    4 lap(T%7Ipqxx$If^ xx$If $xx$Ifa$ xx$IfgdejFGHIJXYZ^_mnor͸ͥͥͥo͸ͥT͸ͥ94j+hMh2}B*CJOJQJUaJph4j*hMh2}B*CJOJQJUaJph4j(hMh2}B*CJOJQJUaJph4jI(hMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph4j'hMh2}B*CJOJQJUaJphqr# xx$Ifkd1)$$IfTl    @r $$px (0    4 lap(Txx$If^ $xx$Ifa$ xx$IfABFz{|~teUB:6h+ jh+ U%h,Jh2}B*CJOJQJaJphh,JB*CJOJQJaJphhMh2}CJOJQJaJ+hMh2}5>*B*CJOJQJaJph4j+hMh2}B*CJOJQJUaJph4j+hMh2}B*CJOJQJUaJph%hMh2}B*CJOJQJaJph(hMh2}>*B*CJOJQJaJph.jhMh2}B*CJOJQJUaJph#kdj,$$IfTl    @r $$px (0    4 lap(TB{}~Y|$a$gdCi$a$gdCigd2} & p@ P gd,J0]0$ ,p@ P !$a$~"*Yadintz{|}˼ӱ~sod\TLoh(OJQJhjOJQJh2}OJQJhejhejOJQJh2}hejh2}OJQJ h2}CJh,Jh2}CJOJQJh,JhMCJOJQJh,JOJQJh,Jh,JOJQJh,Jh2}OJQJh,Jh2}OJQJmH sH hCiOJQJh,JhejOJQJhCi5OJQJhejhej5OJQJh+ jh+ U|} & p@ P gd,J$a$gd( $ !a$gdj !$a$%h,Jh2}B*CJOJQJaJph0&P1h/ =!"#$% $$IfH!vh55T55#v#vT#v:V l!055T54aH$$If!vh555#v:V l!054aytcC$$If!vh555#v:V l!054aytcCvDeCheck17$$If!vh5@&#v@&:V l405@&4f4T$$If!vh55#v#v:V l0554aytejT$$If!vh5p555x#vp#v#v#vx:V l0    ,5p555x/ 4TtDeCheck1tDeCheck2tDeCheck3tDeCheck3e$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / / 4p(TtDeCheck1tDeCheck2tDeCheck3tDeCheck3e$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / / 4p(TtDeCheck1tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TtDeCheck5tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TtDeCheck9tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TvDeCheck13tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TvDeCheck17tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TvDeCheck21tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TvDeCheck25tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TvDeCheck29tDeCheck2tDeCheck3tDeCheck3W$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / 4p(TvDeCheck33tDeCheck2tDeCheck3tDeCheck3e$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / / 4p(TvDeCheck33tDeCheck2tDeCheck3tDeCheck3e$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / / 4p(TvDeCheck33tDeCheck2tDeCheck3tDeCheck3e$$If!vh5p5555x#vp#v#v#v#vx:V l@ (0    5p5555x/ / / 4p(T^! 666666666vvvvvvvvv66666686666666666666666666666666666666666666666666666666hH6666666666666666666666666666666666666666666666666666666666666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH `@`  Heading 1$$-D@&M a$5CJOJQJaJ@@@  Heading 2$@& OJQJaJH@H  Heading 3 $x@&>*OJQJaJNN  Heading 4$$@&a$5B*CJ\phV@V  Heading 5$$1$@&a$5B*CJOJQJphJJ  Heading 6$@&5;>*B*\phF@F  Heading 7$@&5OJQJ\^JFF  Heading 8$$@&a$ 5B*phD D  Heading 9 $@&5B*CJphDA D Default Paragraph FontVi@V 0 Table Normal :V 44 la (k ( 0No List 4@4 Header  !4 @4 Footer  !ZB@Z  Body Textxe &#$/1$B*OJQJphLP"L  Body Text 25>*CJOJQJ\^JDQ@2D  Body Text 35OJQJ\^JH/BH Para *$CJOJQJ_HmH sH tH XRX Bullet List 1 & Fx*$CJOJQJ^JaJ<b< Row single OJQJaJ>q> Box@CJEHH*KHOJQJkHRR Box label 12!B*CJH*OJQJkHmH sH uDD X_field end56CJOJQJkHLL Label 12$5B*CJH*OJQJkHmH sH uFF Row 6 BAdxx OJQJaJ:": Captionx OJQJaJRC@R Body Text Indent h1$^h 5CJ\HRH Body Text Indent 2 h^h*W* Strong5\PSP Body Text Indent 3 1$^B*PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3ڗP 1Pm \\9Mؓ2aD];Yt\[x]}Wr|]g- eW )6-rCSj id DЇAΜIqbJ#x꺃 6k#ASh&ʌt(Q%p%m&]caSl=X\P1Mh9MVdDAaVB[݈fJíP|8 քAV^f Hn- "d>znNJ ة>b&2vKyϼD:,AGm\nziÙ.uχYC6OMf3or$5NHT[XF64T,ќM0E)`#5XY`פ;%1U٥m;R>QD DcpU'&LE/pm%]8firS4d 7y\`JnίI R3U~7+׸#m qBiDi*L69mY&iHE=(K&N!V.KeLDĕ{D vEꦚdeNƟe(MN9ߜR6&3(a/DUz<{ˊYȳV)9Z[4^n5!J?Q3eBoCM m<.vpIYfZY_p[=al-Y}Nc͙ŋ4vfavl'SA8|*u{-ߟ0%M07%<ҍPK! 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 +_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!Ptheme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK]  <<<? z js!w#F~ #'*-0369<?BEHJ b ^ ^4[KRLVN^q|!"$%&()+,./124578:;=>@ACDFGIz[ k m }  !#38HRbdtv"$49IVfhxz$&6;K^np%57GIY^nG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$8@0(  B S  ?Check17Check21Check33Wgov {}~ 04Xc{}~*5ny3333333ccwx:~~fgnn R R l v     * + S FFz{"*adiiqt{{} ,4 )jT5  (6 /9=2sVCQıuD lz%^'6c Us̑L.-t^`CJOJQJo(qh^`CJOJQJo(qh^`CJOJQJo(qh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(hh^h`CJOJQJo(qhh^h`CJOJQJo(qhh^h`CJOJQJo(qh^`CJOJQJo(qh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHhHH^H`CJOJQJo(q^`OJPJQJ^Jo(~^`OJPJQJ^Jo(  ^ `OJPJQJ^Jo($h ^`OJQJo(oh XX^X`OJQJo(h ((^(`OJQJo(h ^`OJQJo(oh ^`OJQJo(hh^h`CJOJQJo(q hh^h`OJQJo( ^`OJQJo(o pp^p`OJQJo( @ @ ^@ `OJQJo( ^`OJQJo(o ^`OJQJo( ^`OJQJo( ^`OJQJo(o PP^P`OJQJo(hh^h`CJOJQJo(qh^`CJOJQJo(qh ^`OJQJo(oh pp^p`OJQJo(h @ @ ^@ `OJQJo(h ^`OJQJo(oh ^`OJQJo(h ^`OJQJo(h ^`OJQJo(oh PP^P`OJQJo(h^`CJOJQJo(q^`OJPJQJ^Jo(~^`OJPJQJ^Jo(  ^ `OJPJQJ^Jo($ 0^`0OJPJQJ^Jo(h XX^X`OJQJo(h ((^(`OJQJo(h ^`OJQJo(oh ^`OJQJo( lz%^UssVC)j-t6c,4uD5(6/9=           + MXz0cC,JCiejj(H2}{}@@Unknown G*Ax Times New Roman5Symbol3. *Cx Arial7.@CalibriA.Arial NarrowO& BookMaker 2.1Arial;Wingdings?= *Cx Courier NewG WP MathASymbolA$BCambria Math"qhZJ'J'  ! !!20drr3QHX $Pej2 ! xx VISIT DATE:lhscKathleen Wessman<         Oh+'0   @ L X dpx VISIT DATE:lhscNormalKathleen Wessman6Microsoft Office Word@vA@Xi@6@T.j՜.+,0 hp   London Health Sciences Centre! r  VISIT DATE: Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKMNOPQRSTUVWXYZ[\]^_`abdefghijklmnopqrstuvwxyz{|}~Root Entry FFjData L-1Tableci<WordDocument2SummaryInformation(DocumentSummaryInformation8CompObjy  F'Microsoft Office Word 97-2003 Document MSWordDocWord.Document.89q