ࡱ>  fbjbj )hh^\w*  U.$   8Cdd h LWme> gggggggilNg!@agg5%5%5%8g5%g5%5%^_cE]D4 _6gg0h5`*l{ ll_c_clsc05%gg5%hl :  PRIMARY CARE DEVELOPMENT 4.1.1 ENHANCED SERVICE SPECIFICATION FOR CHILDHOOD IMMUNISATIONS SERVICE OUTLINE 1.1 This specification defines the enhanced service (incorporating the required Directed Enhanced Service elements) for: immunising children aged two years and under pre-school boosters for children aged five years and under catch-up immunisation programmes (Pneumococcal/Men C/Hib (see Appendix 1) 2 SERVICE AIMS 2.1 The purpose of this enhanced service is to continue to ensure that a high percentage of children aged five years and under receive the appropriate immunisations, and that all those that have missed routine immunisations are included in catch-up programmes. 2.2 The scheme will provide a cost-effective means of ensuring that children are protected from these serious diseases and from the complications of those diseases. The scheme remains one of the most effective public health tools in that it not only protects children individually but collectively in the wider community also (especially those for whom immunisation is contra-indicated). 2.3 General Practitioner (GP) providers are required to work with Patient and Practitioner Services to: develop and maintain a register of all children under and up to five years of age liaise with and inform all parents or guardians of these children of the immunisation programme all children and their parents/carers need to be made aware of the benefits of being immunised against childhood infectious diseases written information should also be given when appropriate to support parents knowledge and understanding. Providers should consider providing leaflets in other formats or languages on request (refer to section 12.1) undertake to immunise children under five with the relevant immunisations: this specification is based on the existing lower (70%) and higher (90%) target payments as described in Appendix 2 ensure that all staff providing the enhanced service to patients will have the necessary skill and training to do so have appropriate resuscitation equipment on site in case of anaphylactic reaction, including appropriate doses of adrenalin and a telephone in case of an emergency to implement ad-hoc immunisation catch-up campaigns when necessary, these will be subject to additional fees where the work is additional to the current requirements 2.4 Exception reporting, including for informed dissent, does not apply. 3 TRAINING 3.1 The Provider must ensure that any health care professional who is involved in administering a vaccine has: any necessary experience, skills and training with regard to the administration of the vaccine training with regard to the recognition and initial treatment of anaphylaxis awareness of relevant consent (see Section 9) 4 STORAGE All vaccines must be stored in accordance with the manufacturers instructions and with regard to Chapter 3 of the 2006 Department of Health guidance, Immunisation against Infectious Diseases (also called the Green Book) available at HYPERLINK "http://www.dh.gov.uk/greenbook"www.dh.gov.uk/greenbook. All refrigerators in which vaccines are stored must have a maximum/minimum thermometer. Readings from the refrigerator thermometer(s) should be taken on all working days and temperature recordings should be recorded and documented. The Provider should refer to vaccine manufacturers instructions if the refrigerator is not performing consistently. 5 INFECTION CONTROL 5.1 Providers must have infection control policies that are compliant with national guidelines, which include: disposal of clinical waste needle stick incidents environmental cleanliness standard precautions, including hand washing 6 REVIEW/AUDIT 6.1 All providers involved in the scheme will be required to conduct an annual review which should include as a minimum an audit of: the rates of immunisation among children two years and under the rates of booster immunisation for children up to five years old any changes in these rates within the year and possible reasons for those changes a review of any patient feedback 7 SIGNIFICANT/ADVERSE EVENTS 7.1 The Department of Health emphasizes the importance of collected incidents nationally to ensure that lessons are learned across the NHS. A proactive approach to the prevention of recurrence is fundamental to making improvements in patient safety. 7.2 The Provider should be aware of the various reporting systems such as: the National Patient Safety Agency National Reporting and Learning System the Medicines and Healthcare Products Regulatory Agency reporting systems for adverse reactions to medication (yellow card system), and accidents involving medical devices the legal obligation to report certain incidents to the Health and Safety Executive under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations (RIDDOR) 7.3 In addition to any regulatory requirements the Primary Care Trust wishes the Provider to use a Significant Event Audit system (agreed with the Primary Care Trust) to facilitate the dissemination of learning, minimising risk and improving patient care and safety. 7.4 In addition to their statutory obligations, the Provider will give notification, within 72 hours of the information becoming known to him/her, of all emergency admissions or deaths of any patient treated by the Provider under this enhanced service, where such admission or death is or may be due to the Providers treatment of the relevant underlying medical condition covered by this specification. Notifications are to be sent to the Director of Nursing and Patient Safety with a copy to the Senior Primary Care Commissioning Manager for the specific locality. 8 HEALTH RECORD 8.1 Providers need to ensure that the current immunisation status of each child is recorded in the GP held lifelong record and in the Personal Child Health Record (PCHD, red book) in line with local Patient Group Directions (PGDs). 8.2 This should include a record of: any parent or guardian refusing to give permission for immunisation (where parents refuse to have their refusal documented in the PCHD, the information should be recorded in the GP held lifelong record all information and advice given to the parent or guardian involved any adverse reactions to immunisations must also be recorded the batch number of the vaccine where two vaccines are administered at the same time or in close succession, the route of administration and the injection site of each vaccine 9 CONSENT 9.1 Appropriate consent should be sought this may be in the form of implicit consent (where the parent/legal guardian brings the child for the immunisation) but consent should always be from someone with parental responsibility. If they do not bring the child themselves it is likely that written consent is necessary. 9.2 Where the parent does not wish their child to be immunised this should be recorded within the childs medical records, where possible including the reason for refusal. 10 SAFEGUARDING CHILDREN 10.1 Anyone undertaking childhood immunisation must be aware of their responsibility for safeguarding children and have the knowledge and skills, supported by appropriate training, to identify where there are concerns about the welfare of a child, or indicators of abuse or neglect. If concerns about possible abuse or neglect are identified when the child presents for immunisation the practitioner must follow the relevant provider child protection procedures and ultimately the Somerset Local Safeguarding Childrens Board procedures. Concerns may also be raised because a child has repeatedly failed to attend for appointments. The local Health Visitor may be able to advise on the appropriate course of action, especially in relation to non-attendance and welfare concerns. 11 PRICING 11.1 Monthly payment will be made to providers for the achievement of childhood vaccination and immunisation targets based on outturn achievement of the previous year. This payment will be on the basis of information recorded on the Exeter system by Patient and Practitioner Services. It is the Providers responsibility to check the information to ensure it is correct. 11.2 Adjustments to budgets will occur in September of the following year due to the timing of the information available, this will include reconciliations for targets missed/increases in population and a new budget being set and backdated payments for the first six months of the financial year. 11.3 The prices are based on a provider with a list of 5,000, which has 59.25 patients aged two and 61.45 patients aged five. To calculate the actual payment a provider will receive, the prices above are multiplied by the ratio of actual patients in these age bands to the number of patients provided above. Please refer to the Statement of Financial Entitlements for complete details. 11.4 For childhood immunisation the price in 2008/09 will be 2,829 for providers meeting the lower target and 8,537.94 for those meeting the higher target. 11.5 For pre-school boosters the price in 2008/09 will be 881.13 for providers meeting the lower target and 2,642.32 for those meeting the higher rate. 11.6 Providers will be responsible for reporting all immunisations given as soon as possible to the Child Health team, situated within Patient and Practitioner Services, Somerset Primary Care Trust, East Reach House, Taunton. 11.7 For details regarding the calculation for the immunisation target payments and catch-up programmes please refer to Appendix 1 and 2, alongside the Directions and Statement of Financial Entitlements (consolidated December 2007). 12 PATIENT AND PUBLIC INVOLVEMENT 12.1 The service will conform to professional and legal requirements especially clinical guidelines and standards of good practice issued by the National Institute for Health and Clinical Excellence (NICE) and professional regulatory bodies, and legislation prohibiting discrimination. It is anticipated that for the majority of enhanced services translated information will be available via the Department of Health. If a patient wishes to communicate via a language that is not covered via these leaflets please let the Primary Care Trust Equality and Diversity Lead know and use the commissioned interpretation and translation service (Applied Language Solutions) to facilitate the consultation and provision of information to the patient. Use of the interpretation/translation service should be recorded in the patients lifelong medical record including confirmation of the first language of the patient. 12.2 Providers should encourage, consider and record any patient feedback (positive and negative) on the service that they provide and use it to improve the care provided to patients, particularly if there are plans to alter the way a service is delivered or accessed. 13 REFERENCES 13.1 The Health Act 2006: Code of Practice for the Prevention and Control of Healthcare Associated Infections. The Stationary Office, 2006. These procedures are available at  HYPERLINK "http://www.swcpp.org.uk" www.swcpp.org.uk. 13.3 Department of Health. 2008. Last updated 23 April 2008.  HYPERLINK "http://www.dh.gov.uk/en/Healthcare/Primarycare/Primarycarecontracting/GMS/DH_4133079" http://www.dh.gov.uk/en/Healthcare/Primarycare/Primarycarecontracting/GMS/DH_4133079 13.4 Chief Medical Officer Letter 23 July 2007. 13.5 Immunisation against Infectious Disease HMSO (as updated) provides the immunisation schedule necessary for full childhood immunisation. Department of Health. 2008. Published 1 September 1996. HYPERLINK "http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4072977&chk=87uz6M"http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/PublicationsPolicyAndGuidanceArticle/fs/en?CONTENT_ID=4072977&chk=87uz6M APPENDIX 1 HIB BOOSTER 2003 2009 TIMELINE  APPENDIX 2 TARGET PAYMENTS CALCULATION TARGET PAYMENT SPECIFICATIONS 1.1 Providers will be eligible for target payments if on the first day of a quarter an average of 70 or 90 per cent of children on the provider list on that day: aged two (i.e. children who have celebrated their second birthday but not yet their third) have received the necessary completed courses (as recommended by the Green Book) needed for protection against: (Group 1) Diphtheria, tetanus, poliomyelitis, pertussis, haemophilius influenza Type B (50%) (Group 2) Measles/mumps/rubella (MMR) (25%) (Group 3) Meningitis C (25%) aged five (i.e. children who have celebrated their fifth birthday but not yet their sixth) have had the necessary reinforcing doses of diptheria, tetanus and polio For calculation purposes immunisation should only be counted if there are no outstanding courses or reinforcing doses required under each programme. 1.3 The maximum sums payable to a provider under each programme will depend on the number of children on the provider list at the first day of each quarter compared with the average UK number of children per 5000 population. These averages are based on ONS 2001 mid-year estimates, and are 59.25 for age 2 and 61.45 for age 5. The maximum sum payable is therefore: Number of children aged [2] [5] on the practice list X Appropriate target price [59.25] [61.45] 1.4 For the purposes of this enhanced service, only those immunisations completed in NHS general practice (i.e. under GMS, PMS or where agreed with other Medical Services contractors) will apply. This includes: patients who may have transferred to the provider having already received the necessary immunisations patients who may have transferred to the provider needing, and being given, the final immunisation or booster needed to complete the course, in NHS general practice 1.5 Work done by employed or attached staff at the direction of a provider as part of NHS general practice will be treated as being performed by the provider. 1.6 Completed immunisation will not count where any other remuneration is received for the work outside of this enhanced service (e.g. children immunised privately). The Trust must therefore be notified of any appointments held within the provider which include the carrying out of childhood immunisation and pre-school boosters for any other body (NHS or otherwise). 1.7 The actual amount payable to a provider will be calculated as follows: the first step will be to determine whether the 90% or 70% target has been achieved by comparing the total number of completing immunisations necessary to achieve the target with the number of completing immunisations actually given where the calculation of completed courses of immunisations needed to reach the target levels would result in a fraction, the target will be rounded to the nearest integer (0.5 being rounded down) under the age 2 programme, because there are four groups the number necessary to achieve the target will be the appropriate percentage of four times the number of children concerned if a target has been achieved and the number of completing immunisations done by the provider as part of NHS general practice is greater than the number of children needed to reach target level, the latter figure will be counted the actual amount payable to the provider will be calculated by multiplying the maximum sum payable by the number of completing courses/boosters done by the provider as part of NHS general practice, divided by the number needed to achieve the appropriate percentage coverage APPENDIX 3 PNEUMOCOCCAL, HIB/MENINGITIS C CATCH UP PROGRAMME 1 PCV VACCINATIONS AND HIB/MENC VACCINATIONS AS PART OF THE ROUTINE CHILD IMMUNISATION SCHEDULE For full and complete details please refer to the Statement of Financial Entitlements, reference in Section 7. 1.2 The table below sets out the schedule for the administration of PCV and Hib/MenC vaccinations as part of the routine childhood immunisation schedule. When to immuniseWhat is givenHow vaccine is givenTwo months oldPneumococcal (PCV)One injectionFour months oldPneumococcal (PCV)One injectionAround 12 monthsHaemophilus influenzae type b, Meningitis C (Hib/MenC)One injectionAround 13 monthsPneumococcal (PCV)One injection Note: the final completing vaccination means the third in the series of three PCV vaccinations which is scheduled, in the table at paragraph administered at around 13 months and received all four vaccinations set out in the table. 1.3 The Primary Care Trust will pay a payment of 15.02 in respect of each registered child as part of their routine immunisation schedule. 2 AT RISK GROUPS AS DETAILED IN THE CHIEF MEDICAL OFFICERS LETTER 12 JULY 2006, IMPORTANT CHANGES TO THE CHILDHOOD IMMUNISATION PROGRAMME 2.1 A child who is in any of the pneumococcal clinical risks groups and consequently cannot receive, has not received, the four vaccinations in accordance with the routine scheduled in the table who still presents in time to received all four doses as scheduled in the table the Primary Care Trust will pay the final completing vaccination payment of 15.02 2.2 A child aged over 12 months and under 5 years and is in any of the Chief Medical Officers (CMO) letter clinical risk groups and presents late for schedule routine vaccinations and does not, has not received any the four doses as part of the routine schedule but does receive either a single dose of PCV, or has asplenia, splenic dysfunction or is immunocompromised, two doses of PCV, the second dose two months after the first dose. 3 CHILDREN OVER 13 MONTHS AND UNDER 5 YEARS WHO HAVE PREVIOUSLY HAD INVASIVE PNEUMOCOCCAL DISEASE 3.1 All children under 5 years of age who have had invasive pneumococcal disease (IPD), for example pneumococcal meningitis or pneumococcal bacteraemia, should be offered a dose of PCV irrespective of previous vaccination history. Children under 13 months who are unvaccinated or partially vaccinated should complete the recommended PCV immunisation schedule. 3.2 A single dose of PCV is considered the final completing vaccination for this purpose and the Primary Care Trust will pay 15.02. These children should be investigated for immunological risk factors to seek a possible treatable condition predisposing them to pneumococcal infection. See Paragraph 6 Annex 1 of the Statement of Final Entitlements (consolidated Dec 2007). 3.3 Children with unknown or incomplete vaccination status and are too old to receive 2 doses of PCV before the age of 12 months, complete schedule of doses before aged 13 months but does receive an single dose of PCV before 24 months, the Primary Care Trust will pay 15.02 for the final completing vaccination as the single dose of PCV is considered the final completing vaccination for this purpose. 4 ADMINISTRATION OF THE PNEUMOCOCCAL VACCINATION AS PART OF A CATCH UP CAMPAIGN 4.1 Guidelines are set out in the CMO letter dated 12 July 2006 and Statement of Final Entitlements (consolidated Dec 2007). 4.2 Table demonstrating the schedule of PCV vaccinations for the catch-up campaign Age groupVaccination required and when requiredFinal completing vaccinationHow the vaccine is givenChildren born between 5September 2004 and 3August 2005 One dose of PCV to be administered between 4September 2006 and 31March2007 The final completing vaccination is the dose of PCV administered between 4September 2006 and 31March2007One injection  Children born between 4August2005 and 3February 2006  One dose of PCV to be administered to the child around the age of 13 months  The final completing vaccination is the dose of PCV administered around the age of 13 months  One injection Children born between 4February 2006 and 3 July 2006 Two doses of PCV, separated by a period of two months, before the age of 12 months and followed by a further dose of PCV around the age of 13 months The final completing vaccination is the third of the three required doses of PCV which is administered to the child around the age of 13 months On each occasion one injection  4.3 The Primary Care Trust will pay the payment of 7.51 in respect of each child registered who has received, as part of the pneumococcal catch-up campaign, the vaccinations set out in the table below appropriate to their age group the Provider has administered the final completing vaccination as set out in the table column How vaccination given, as part of the pneumococcal catch-up campaign 5 ELIGIBILITY FOR PAYMENT OF THE PNEUMOCOCCAL VACCINATION AS PART OF A CATCH UP CAMPAIGN 5.1 To be eligible for a payment the following conditions need to be met: the Provider is contracted to provide the childhood immunisation and pre-school booster Additional Service the child in respect of whom the payment is claimed was on the Providers list of registered patients at the time the final completing vaccination was administered the Provider administers the final completing vaccination to the child in respect of whom the payment is claimed the child in respect of whom the payment is claimed was, on 4 September 2006, aged over two months and under 2 years the Provider does not receive any payment from any other source in respect of any of the PCV vaccinations (if the Provider does receive any such payment in respect of any child from any other source, the Primary Care Trust must give serious consideration to recovering any payment made under this Section in respect of that child) the Provider submits the claim within 6 months of administering the final completing vaccination 5.2 The Primary Care Trust may set aside the requirement that the Provider submit the claim within 6 months of administering the final completing vaccination if it considers it reasonable to do so. 6 CONDITIONS ATTACHED TO PAYMENT PNEUMOCOCCAL VACCINATION AS PART OF A CATCH UP CAMPAIGN 6.1 The Provider must work with Patient and Practitioner Services to ensure the following information in respect of each child for which a payment is claimed is available: the date of birth of the child the NHS number of the child, where known confirmation that the child has received the required dose or doses of PCV in accordance with the Table schedule for the PCV vaccinations as part of the pneumococcal catch-up campaign where a parent or carer objects to details of the childs name or date of birth being supplied to the Primary Care Trust, the Provider need not supply such information to the Primary Care Trust but must supply the childs NHS number the childs records, kept in accordance with Paragraph 73 of Schedule 6 to the 2004 Regulations, any refusal of an offer of a pneumococcal vaccination the healthcare professional who performs any clinical service in connection with the administration of the vaccine has such clinical experience and training as are necessary to enable him to properly perform such services and that such health care professionals are trained in the recognition and initial treatment of anaphylaxis any returns required of it (whether computerised or otherwise) to the Exeter Registration System, and do so promptly and fully; and all information provided must be accurate. 6.2 If there are any breaches of any of these conditions, the Primary Care Trust may, in appropriate circumstances, withhold payment of any, or any part of, the payment due.  See reference 13.1.  See reference 13.2.  See reference 13.3.  Orange book with regard to these services is available at  HYPERLINK "http://www.somersetpct.nhs.uk/how%20we%20do%20things" www.somersetpct.nhs.uk/how we do things PINs for accessing this service have been given to each provider.  See reference 13.4.  See reference 13.5.  See Section 11 - Pricing      PAGE \* MERGEFORMAT 4 $5GHR^_`abqrsw|¶|pi]QpiI>hh]RCJaJh@CJaJh'CJOJQJaJh@CJOJQJaJ h@h@h]RCJOJQJaJhMhxCJOJQJaJh )CJOJQJaJhxCJOJQJaJh?%CCJOJQJaJ hxhxh;CJOJQJaJh )h )CJOJQJaJh )hJ|CJOJQJaJh@ hhJ|h ) jh7h7UmHnHuH`ars}$d7$8$H$a$gd@$ nnd7$8$H$^n`a$gd@ & Fn^n`gdRJgd@ n&gdM Sn&gdMgdY Sn&gdY |    8 W X Y Z c p z Ҭuf^h'OJQJh'h'CJOJQJaJh@CJOJQJaJhoeh@CJaJh|UCJaJhqZCJaJh #CJaJh <CJaJhoeh|UCJaJhRCJaJhh)sCJaJhMCJaJh@CJaJhh@CJaJh]RCJaJhh]RCJaJhxCJaJ  X Y ff$nd7$8$H$^n`a$gdM ^gdM  ngdM$d7$8$H$^`a$gd@$d7$8$H$a$gd)s$d7$8$H$^a$gd)s$ & Fd7$8$H$^`a$gdRJ # $ : [ s x ! 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com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMOrientation 1 com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2006-07-20T15:29:32Z com.apple.print.ticket.stateFlag 0 com.apple.print.PageFormat.PMScaling com.apple.print.ticket.creator com.apple.printingmanager com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMScaling 1 com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2006-07-20T15:29:32Z com.apple.print.ticket.stateFlag 0 com.apple.print.PageFormat.PMVerticalRes com.apple.print.ticket.creator com.apple.printingmanager com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMVerticalRes 72 com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2006-07-20T15:29:32Z com.apple.print.ticket.stateFlag 0 com.apple.print.PageFormat.PMVerticalScaling com.apple.print.ticket.creator com.apple.printingmanager com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMVerticalScaling 1 com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2006-07-20T15:29:32Z com.apple.print.ticket.stateFlag 0 com.apple.print.subTicket.paper_info_ticket com.apple.print.PageFormat.PMAdjustedPageRect com.apple.print.ticket.creator com.apple.printingmanager com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMAdjustedPageRect 0.0 0.0 823.79999999999995 577 com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2006-10-20T14:23:03Z com.apple.print.ticket.stateFlag 0 com.apple.print.PageFormat.PMAdjustedPaperRect com.apple.print.ticket.creator com.apple.printingmanager com.apple.print.ticket.itemArray com.apple.print.PageFormat.PMAdjustedPaperRect -9 -9 832.79999999999995 586.20000000000005 com.apple.print.ticket.client com.apple.printingmanager com.apple.print.ticket.modDate 2006-10-20T14:23:03Z com.apple.print.ticket.stateFlag 0 com.apple.print.PaperInfo.PMPaperName com.apple.print.ticket.creator com.epson.printer.SPR300Series com.apple.print.ticket.itemArray com.apple.print.PaperInfo.PMPaperName iso-a4 com.apple.print.ticket.client com.epson.printer.SPR300Series com.apple.print.ticket.modDate 2004-10-26T09:51:13Z com.apple.print.ticket.stateFlag 1 com.apple.print.PaperInfo.PMUnadjustedPageRect com.apple.print.ticket.creator com.epson.printer.SPR300Series com.apple.print.ticket.itemArray com.apple.print.PaperInfo.PMUnadjustedPageRect 0.0 0.0 823.79999999999995 577 com.apple.print.ticket.client com.epson.printer.SPR300Series com.apple.print.ticket.modDate 2004-10-26T09:51:13Z com.apple.print.ticket.stateFlag 1 com.apple.print.PaperInfo.PMUnadjustedPaperRect com.apple.print.ticket.creator com.epson.printer.SPR300Series com.apple.print.ticket.itemArray com.apple.print.PaperInfo.PMUnadjustedPaperRect -9 -9 832.79999999999995 586.20000000000005 com.apple.print.ticket.client com.epson.printer.SPR300Series com.apple.print.ticket.modDate 2004-10-26T09:51:13Z com.apple.print.ticket.stateFlag 1 com.apple.print.ticket.APIVersion 00.20 com.apple.print.ticket.privateLock com.apple.print.ticket.type com.apple.print.PaperInfoTicket com.apple.print.ticket.APIVersion 00.20 com.apple.print.ticket.privateLock com.apple.print.ticket.type com.apple.print.PageFormatTicket 8BIMxHH8AAKg{HH(dh 8BIMXX8BIM&?8BIM 8BIM8BIM 8BIM 8BIM' 8BIMH/fflff/ff2Z5-8BIMp8BIM@@8BIM8BIMWdSomerset PCT ColAdnullboundsObjcRct1Top longLeftlongBtomlongdRghtlongslicesVlLsObjcslicesliceIDlonggroupIDlongoriginenum ESliceOrigin autoGeneratedTypeenum ESliceTypeImg boundsObjcRct1Top longLeftlongBtomlongdRghtlongurlTEXTnullTEXTMsgeTEXTaltTagTEXTcellTextIsHTMLboolcellTextTEXT horzAlignenumESliceHorzAligndefault vertAlignenumESliceVertAligndefault bgColorTypeenumESliceBGColorTypeNone topOutsetlong leftOutsetlong bottomOutsetlong rightOutsetlong8BIM( ?8BIM8BIM (K JFIFHH Adobe_CMAdobed            (" ?   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