ࡱ> m \bjbj bbKdddddxxx8x%!  $"% d" dd Rdd  P+nDBR  0%!,&m&&d ?%!&B *:   SHAPE \* MERGEFORMAT  College Health Services AUTHORIZATION FOR THE RELEASE OF HEALTH INFORMATION NAME: ________________________________ DATE OF BIRTH: ____________ PHONE #: _____________________________ I hereby authorize and request ý Health Services staff to disclose the information specified below: Send Medical Records ( office notes, labs, diagnostic tests) Request Records ___________________________________ Authorize Phone discussion / E-mail correspondence For: Dates of treatment: ______________ to _______________ Condition: _______________________________________ Please release the authorized information to: (initial those that apply) _____ MHC Counseling Service _____ Athletics _____ Office of the Academic Deans _____ Disability Services _____ Parent/Guardian: __________________________Phone:________________ E-mail:________________________________________________ _____ Other: _________________________________________________________ - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - These records may contain information about drug abuse, alcoholism, AIDS, alcohol abuse, sexually transmitted disease, abortion or sexual abuse. I Do DO NOT (circle one) consent to have this information disclosed. I understand that I may revoke this consent at any time, except where information has already been released. This authorization is valid for a six-month period from the date that it is signed. _____________________________________ Date: __________________ Signature Expires: ________________ Witness       !"#%-:QRS  C O R S T _ n o p }  6 > S T _ a b q s u ȭȭȭȭh $Nhghhh0hi3hNsh + ho5\h; h8q8hoh;hoCJaJh8q8jhcUmHnHuhcjhcUho? &RSp  v  dhgd8q8 & Fdgd & Fdhgd dhgddgddgd $da$gddgd;dgd8q8 $da$gd;      H N n r > C Q     Ļįģ܏{h;h>*CJaJh;CJaJh~hCJaJh $N6CJaJhgh6CJaJh~hNs6CJaJhNs6CJaJh~ho6CJaJh9Qh^h $Nhhhghi36hohXh~hi3hNs0 ^ D  CKMNPQSTVWgd +gdvgddhgd0dhgd~dgd^)12>BJKLNOQRTUWYZ[\hih +hhjhhUh^hoCJaJh~hCJaJh;CJaJWXYZ[\21h:p;/ =!"#$ % `!P|Џs@ꅤVyD,X$(xncY Y=1g6Y/̪V^Y=BI%.8ܿ@nK ~3 7l0cy]")J"}muk{yޟ=7'|{?ןw!aM[޽ S ~c*>><{-?i~x獼H7\H1{|~Q?_{J2~!.Å$.yxGǻ;:gi:}3=??>'~י]xݭR8;8]9]"c-׫mݩ~2?Цu2erڮ >̏xJBcSRұ+ac]S 7~ T>؍:hW78ڹ&ډ3=fܹ9;j6uڌ-GڳYMY_?iݶ*ɰk9eھjE3_Ֆ6ٓ*1~] ]L_ajK-yK'ڗjt.Y?Ӂ#Z !uj]Vu_{usu73LTb.W-&M$\ɣ,ԟuϗGf,_}v[Mi_޸{ݲϵ78αʸHjko)6{2"?g5Dҙ.<u$onɧz|4EI q:_zb^XfuiE])cr$&I-Ͱ1а]~߆<֛$]u=۬ѱ~7:6틽gaqiwi ikXo2"oM]C\tvF~66$4_zsnOif7gE> V[xM;ު< V7~ؽo;~u${b$nQ2*@~5݃zxQ_֟w\zYYRouxSyzUxapܲcqVt\}cSVqe? :wx'wtt;ydSkfI;:^۬<^};yVy\!jwt>y61]?8]?kM_st_w׏|[(Wt7f.%:_=;1ʆ~@} ~ǹ<3 3]t ѱ^Tqyy'hzqryFyx{XE[~BE٫@Y܄<ҍܭNKu/Hιlz+qJ_mޕ8]e3 hq~3 ptlhefZ?W - 'tX:< ZbTe%7GzUqҫh}Yhx{Fe:׏t.5ysytxr75;6!7nqqZ}wt|;tΎn/juuWs~~|鸴 &[eб?3۫m^zɻ|šЫ;:yTѥgq yl~8mJ*hm7f_LJչ8]V}+Bu+Po2tWcc=D%0՟/б{tб8Z^mM+ēw):=[yl118=tW.V:vMrj.ѱvSYoצVW9X{z|Mql:lU4}N F>]MՍ(֕ny5z>g.vMDw}Mx~qq8gVtKǫJNobwNG_ 7&Waw5:zu:*gk`vkVW(+ұ֢cF 7H+:H-co k[s0Vռ?k+)~X_eZ:4k}:/6+ұ;a"k4qל9(/[TPJꜛ p޽M ܩ֛5}+V+XobzRmV5YOtݪ&^~wDUߪ1D}t7a-Nm=זEr6ݍHt-s`k\ۆF8*|zuFt/ָwBNo 73NפO%YϐqKLmc<6<|}私ųƼݽ6m޳.'<=NG/mwFL׿ٿ~?0!~TG@7G_|TR7㓽Ãp8 qAg_>GOF@G{#Oۣ ^ ch(("ݽ'_| jP.Qd;.mU(QYUPdtpptr| 9ٟ돟aowt_N/v?}r4.[h ?<;? )h?~Ym?4<:|r<8zRh`O`b9Z9w?' ަw *(o8kx?ڥO_=>'T#P"v=G_}i7> #.R(e420"hpL|ptԌqƃӀ |< ^:"ޥJ99_x>?5ן` 0H fjsգ7 r+%?à( GF?~|>c}||p@*Uogo[CSB~sG'SdSd}y6E櫣PeeZ# 0^uY +cUmk`BAO=8Gӏ>!!CU>'"u \p Z1וSm~z:p<}-& O4"DJQѶA>)ߨcmJô*eJ%)? 0e(˓$=<>:@bx?c6:~>sz -VHɭVthwp|M;jB>'k3 f 􇠍MATFrQu~R:@[L_D8j`#2J.,0j! D,l+?% 0Eb qckढ ]_ڟ2bfp;0#O|ϟ <,א ;\Y(h0|rPv9 f96=?z<!? xu|LB+/gOl<9M_We>?Σap48fIJUROd9 RpVQ}8kދ@th2ۑbIǧmslМ$/O,`ddgگMzR2T⊲;lYq%YgEV5^$n#2an jbJ Uʦ}6i6iA3é]S}1s)2VU66zr*,G) o6hGcwvZ0S9:dsJKd/i~%3'2>ap0NN0v)ha'#2HZ.Ğ=y ~>#‡XSC ]C7Ky??s-'E62_é.Ӷْӧٲ}'42/ füaEު'4֒W`:m4Hң O`Ãxd8<~zH7Sav$2rĜ65\)wK@UgpLdvqlg͋Q{<~8wHΖ;Ҋ,c0Ȝ5O_$G^p,-\~V#fsydQ{-E=VN؈97_ ~};j!) koGnbC}u{CWc(neNn7}"B>Wl;/g6 Կ(Uy:˅q\KӝNfp|b}/(&z7ëeT)H3:gE4&v FHVGA9dSYj{t4K S@[ 'ޛƐ>]'{b 3ӽ'߻ӃFDk-)"+v%:og}[xdAqVl7KmEt_ t? B檓ӯQ|N5_k_O%]\b5{;fO+߂]h,=Wk[jUp n>"ꊳ贳-f1L3Ͱ&鳼ڙڧ=?5'PN"*G;𤖴ڃ┲$t#Uld }`-8\)(Y! ?@Dd ѐW{HwﵻtS/SV+^:Ϊ1xuw|tLc:j&ԤM3^@ekX9Wa-9|vxvyҭ_ja89H;)z*?N~AzHb^D?jan ylF5 bΥ ҹa ז@Fl(tOcK,(̊ ҍ8az k?)# 5~3@پ:&y|r*/W:[\," F;.]buPȃ#,&eĉ)8&Gӆ: K. ,gwyd!cV?aj`BDlo#6G/uk ʬTt'F btP[*4Ԙ=E-[5|>=8%#-9%xv&2$MY%*<k}]BlUHy.d-LXr8]q!EO:hW%CШV06Ts\;[6! _컎IeCKqy.E+#F+kS4C s7plZNN:l\0ZʜX͌.h1vsAJBnh-,󼾴p"][)%ah*W]7.N3y.7D7+X9 [ st$+L5Oۣ_jC4_sChZ* hM8ܓjy#;N0+<"'?0aUMu +B1w}zFNhU_hq ~]mVtϼ-  rWVgɜn?4bմr+0f. [ ޷WL>n!EeluB2?'gSVFBZ@ԭ6 S`.d o\rJ.ZЙP-`9Yc9]ǚ 7yѭOvk:['7Zk8%g ?i H la}h&?k~֯BDzztTbcR<3ح4)q:܆ѸO@9BJd03uZ EBӐ~h @d~ j=!߶~wQ.:l#ٵp.Xt5$z/~$64#s bgFͮU0]n &wǤݮvKNӅߌ0srܭ-ϓu8 zԚQ8><6ǰfmOՐ4!s}%3qmv}䵧 [|?6`9V#Χ+V&LJ,O#4#l> *49 xIUHIl^z6g>7:|5^;u^Ґo|!3% N*ˢL13K1vVqjDndm(crra OG/TvtNBsvEF!tYbAe)Gc4;daD0>~=z!{,7:z%,YLRN3DL+^i2zVO)jTu#աm=8&.R.fKZ4U3˽[cm*OtC\\v쵨ъW7~8+"7nDm6&UUh sqʨǣC:Ea5XGc{lщ𳼼D>%9Q1,ĹӲ.óA<"H3g/ΫuxSۋܧQOlB?xa?4о^=ޕÓދX'}k;r?tthN> &l\%fd}Wp>Y ӥ v\0>6/3ιl=&հ-e1A4r'-"Ŷ3K;$x!7ʥ<.B n0v8]cn6NsqmGI2:eJv8:nDXB5xps.a=.\Tro[R5Sﱈ[^DNWǔ,܄9ysCvj;ZaGc*h?hTG}w'd:*n /طSáoÁa/d=9?:x"Tm(3ڂO7 qėt,t}u_ьślkc<5x6Cl `Zϖo|z|4̝N ی\oiffq47Gق}@Y^u'W=Yf 1؇q8? ke~ؿo9 Kxn&ųW6n,sά:~} so۩m_ٲlA7mFC$3%g4wq1/~#o'_aG9w+>Eedl;ɽbM, mn5} `+ PR+5ăVhx{)nԌj7F4qK63|_ w6x>qK;|! CѺ{t4Ԏ2ymoӽ)tవ0hBAvvx 1ߏdsx;럛8sR`8{ нo^pgh!w[k0D{{.K_uD^Θ܍Cs>ңsС(̗൲qyۥSȴ:.ƳҰճՑܻ{)g!=䲇NC9㢲L'.8f,4PF=p9/}XM|;Q M12I)_.C1H38{i|<`$hIZ 씢&; ZXzǠ½]d'#$%óg}珙;>5~\+.Ӟ+. mEjL`x<0~G12qdO:W+]"#!x +͓Ԏdf6SROfJd8$B3%1ȸ͔fFkLf LN&0%l9%Xe9d#6SN6Bh9ds Мg[L>'%93<&N>d9 @6̬>$䀲9:ͱ-h6'ܟ-pE#-&>f93<&N^m3BtʶЙlh4[Hnl`>fBIN\Ij.-N$5Ɵ9\~-L@ .\m FKhږPm J H8 Z@NS H)}j>$ہ@$ր 2`Jhږ̘%,SBӶf H22.p3p"2\r-!p}eJ( ) LE!peeeE-<"l}ahE8[B\`v!Iyl=eh6#ov-})Zl&A[-"ç1 6!q8ԎIÿ;1蘴mwݙi־l<ƶlf+P' l;0fߘZcvev!:`L1- cIϾY]E /=@.Vx;&--98jPOr|D\6TLpLi|^B*1ZȤ7ĉcpB4Sz VtꣻZt/x>8=؇:)5ϳ-k֦Fڱ6;)2(͎<:=C#I?"({-EFVSi-n, '&Inb9=놼ZZprC h缼`rUkfA Mų\Na% ( ]IVmJjC4ܾ ɴaN 6ƻb pFTG8t*܉M2G] 9I@%\ɑ0*@ ("HҶ.40W'4r.Vq "b*rϓa(U(B("!3X).̰,1 3:d/*D4b;T, [ {+(&괉 Z8eU"PlvZ1qkG8%`/&7 q #H%qgE +a՗@8LHIgmSBRܾ\Q UKx;$߾ÔcdBHX+!* O#Ljs3*W$4?dd \Nuz/"Gs| |,sΦ,bRB*ϑ¢Ǭ\"<&‹2J`U"\$R%^u$s),a[PAT@h& $PaKW{$\S9b-`Ťfb`WL-CfK-Dh rG6$Iq\Y`5r^i$vSj<OIcؔg.hH†I;o!I@ _QtWui)RYP^zz4p9%2ƌgUNR R}@q<#QiY&EA+i%Jٴ( 45dh<9r7MRa- nY\#jBbRHS&@B(M2;Ұ1M9RLDJ+}YI;w%&/0\8Z0Ù}1#=$f,*9 )S)3L̜xrV.LϘ[oGS q)bRL"71ȋRQ&LB1S[# YZ\1aJ*PJ5*El*.HNFF&h2oo`XbҚ84Xa*+/0H%漐 _W%MU\i!sbLV|ʶ7F UQ gkMs2a3GH|""fǼ1ji;XyaL@.96.G(/v ̆_;Ѧ6Ku kq4A~`yļAd 3ӊ%cxږYsRggPlo09<ŝ[iKzJh^]Lm5@F̢Ain׾:;6cftX%9CʞLWHDMh0<[^N3*e IKD)GV8mC_9Q!T6AW3(at[)2q4a *=P*I%4>m-S2#K!/LNc83 -w|`fq}wZj2;ني "fkIpƘfO?OHkS /Ӱ-uȜr ?Y3CY xJg%˗igڀy{Qbp 0]2f\Zݼ3ٍkѾ6KR8.AC;79Ik}q KbtI2>QnWQ7;M r"N\klȤ.i6bCN~*u!lEvCHp`):MX1v7vt:q(a KC 1MnvD yQ$to l'1{=؄9,W/I}Iܑ~Fh6uBRrgah"^M!*i/MH"RXA01!ce7qEJ Tzs6db-LD'E\t)al8c$M!WE*V-S1L=vN6TSpF$@\W*LJIlQBN"W|`"c3ym㔎INInENR ߤM)o }`\d` }q+tٗ5; 1*1BoD:;ЕZvt1_2pPJ-[Igd3:x)s?3h/1rb2Avf1Fyp+UuFq0glo}*Yl9Ro`4 E8c Mj A8fI;28Gg`e*rF?[ U0y0zU1F܋1- _|2eeVQi l3h|txe /arl9MA}x(DpU"N޲P3iRTd2 $.$1,ގK⼸F~# \'<*RQD yЁ42I]佨m h e󐐲#ᷡ4$Ze"dz:dŰD<0}4-e ]4/@94)xL0.R @ͪO5D?OiY;EܫG  ϋ8ܚYJSxN&* p-[3+F8x>$)Kp0W[7x6XmВI9ёSq(Ȱl1#KT9, 3bkgxܧRVƑZY1!G"nfh& sTyxINgx3kxҦP<ǝxE}%9M"1U:&y/$N<M;Чrkl)9`J֕Z2fxARPudt^dS 2HAjx8Q8NɎLXMwS3х EL_foE=GYjm"⡑^AlL lR vB\^23V;B%j#N(e{#[_?xpIpV]9iJzMPxK0@_z#2x Hhw_\/ָ?0ld,~6? x)MܰCs;ʚ,{ՅVhiBB\?)T8v.u)`8O2dI@Jp:BA7)ۮ"8qء Sflp ; Vqؑ^8[!/S%,fRj1)icd,p a?ͤű;/6X’`qm'_i,q*`H#JiAgp_\` E?ڗ#x+[JqјZ2H*1QN0֍  97p>|TJZSnTB?,ۙV?WYYm` 3@>\KkEbDb9QXLO䳌 q$: 3 ) ۘ?i0y.g\;pC0e5thK1Gy xO.עM2e)nqRZzܱ&'eaABw*{djp{8 Gh6^ݟ%"ЅhsCY#4X`,-W‰Ɲ WoY62c0, 2n`d9o\ Wt9#.V`U\C5{rr879*y C<˃c~m)䐂q.xO;/){CgUEOS.[0mJ_ʙnE %Dӊ%W/WKi*"X7>ёR> x6Ȓ1cζ m{Hx.cCB_DQ/<&AN`XWͱZ~(2b?yNG.4b?.{X-0E!2#e~C%sryh_Ӵ7˓BQTDzhرi Y!הv95[LΝe+&^zi<҆D>>78xoKr!z3-3 UB&JXpJnb%* rr<]B@B#b>.DZF,H➂7$=1PIǏZԳ36F-ܗa[ےɊ<m Y( ѹM,W8tm&n۴ID|]Ya;VE,J`$l-uOV `>W@/A"AO,)]QgoUK4lVƒDa`*ފQ%!y 5KYY=btJi1ɐ|DI5SUn7LfU,^\1Z\HKU9fxQvQ4=rڽa T}G۲%#uAn:G 넃 -"au|4%x: 2wt:)"4!vabh:S e-m7P4di<`kjJ۵鐿j&^vBp.;bKBI:eсx oNQB ӕ$t39 C0X$Y2^~a$QfҮ~\g# #-:;#r%!ׄVl{< UYH;>G )BA|0D'=- v4R:ysI4B[-(Z!cXٞwpc2 (VQ4ȥ0lʄV2"L汄l?+I*Xm?HW - 9KR͉lQLuF5vǠ`pp9ЪQ+ EBS) e!ox0Mm"Am<3Dl۠EVm*RT (^0+򒿚d/2EXga,k0\6dS"F%Y4J@S QD>0[+*T\;0/遂@#@pB{`'=K^EHC%R) #YhԎnJRⵗ]q%Oe`EdĄDTY6 Mu*쐯aNS|khVY=ԱF7'##S:u*:|vDĈ7*[piI xĂ3(EƬeg6[-*>"հٲx$ںٶ;GT3ʱ&:1̈́lɤ!6#yS,tHHāR9[¡QL$d}MG['ڋVWZ%{K20DL }؝"ʞ{:M[:gF).VR6օ86Og)r2DCMgFQ(4 Q_B#0#}qlEzzb^j`j}QTDZWu4j A5HZRGZL>3RRⵗ]q%ﻉRSXƆ*(*xX egN Ip[^JbJ_)1 hC^1'T bCuL_/Tݖr I@\K.JP$\KlfnQ j{k}Bⷞ=K ۺ5S2H%$t?Ǵx೴\ET_X#Mh?ݔl̶ESoM?F c@ʆ.뀄B͍ SF۩LǍ7χD}T8J ߈}JߜFHc$T> UXdFZ9cϝVrxjUZ"W3-vnq;W9tvbͤDdFȶ+emA'\FJo졯/P2G) Hb6HUg鬤Ndmu #RY DizgMRhyI 'dItppv;E{%ÌbNh60\EVES?C#Igz eG5$|rcfkdVIk4{G)^О$cF87d܋$Itܭ-fnoRt[@_=hK2! I+jn ݼ+q([(Wc ,3phby^ ĝƔgJt M,:kϹWRDC4l-4QqgN ύ(|"« A=& fHk>vڂa^/$L뒢-O N+7}s2O~xܜ]$W;8x z i[Ge|U7@|Baeeh g 42/z3@0W`M:tRXϐjmp"J7 ^RU>/,FbRzWd@*aGh[hǎbFg NT`+ $oʌ QVVpm% F-6SQE;4}cpȎL%H(_+ >bT^gIRE;2%SBAxw䳒7":MZ:hJOH[r7ni9~vhJ?}c)7k %l3 pmM hJ@cQ*}):ڲӭ+]5HN>D5Hd&f6Ӥ F!M]Q7fjpLZBUh&dʂ hǦ,onm9Дh&{8SPfLXPДM [h&vu5x_YESq멼ZTR4`Jb+cȶOyQ^V9e>Cw(/ NոOa O۲tAo.  k 0sȘl#_ `K+18w1>ɓ抳;5ձ豹e*·0-)6+ܞJ$:|0Ã"7?3<6-./x0߂)O 4E\lUϦpS/Co9o5J8`/@J7阢k3 d4a~xII͚~߇XqdgLnх>|AA'I  )>4)`+  ~E ~}v99N5 s0+Ҧ6Ȯij(K2%5AsE aL_MGwk[My9'#(0$#%+zM[zl8ulka_q{qi{$mFTP-ʄ (>b0oe_!_|eTS_aD=n7n#Enj?e 93gLoߘ=/Ǿ]uy*7ۜ:/ǤK|#`.R UhlT[HĪCdnbLNɦ Jz>ʳّ͘{Ҽ""Pc5#>۲5໲<鲃A,Mj6 MMMj60tyY3r ?bǼI+la ~Sd) TfVi%QD4lOOI >e]zFܑT Tfd\;PKRq;{Uu(Oᔜx)Lx. h!`(FtP*=f~ PRCQmڐa:Nԩ:jnht*}Tqm_1+}r J󉗚㯱4QckqqS2N4BUXUڏDTm?$`F*ފt$_yuDE8&ڢXMt@1rf>0|^ qҁIə 5Fc9ͅV0Nж`1JxG r`FqSy E>㤮몹89>ٹɤ8'"41#.Ulyœa \IHqPp#isJR l|4e8Α_ 2Q@G0 grbMy"mD|7..1JmG50C#@#*#B[#u0.C@8`Yϋ^^Q/q`E݌e 0^H(c@B18e 0+cf 0GS"ě<I4pe|[dMT r {d "-,IbdRàr843zVy)G 3b و( *0&Q|!7rsnS*DSI;eˣSHY ۆ=7%[5ZՎG32vLh8YqM) vcF;!ABqt>w&a( vpA8AS:Nx"wF8Zf #1#'\T:N鸳}$]GpU瘼̖{NzS~ ]?\^^^c&Tlzuo6/׷-LDG΄T;u %]] -4 RTfO) S^jz5Q-J+h:׃R@H xM0,Lo3Y=UTen 6څ`G+9 T;`x$kGpn;Z |'>үB@ :55C2be 1.b8e\E Ţ_ q\uozۻeAjЃ/0a10rX(G5ьvt؏8qrziv~qXa9.˕X`^Vf> WJ7%0FHcaYrvs 1̆bNEQt\2ʐJ/,TB*KŦOEE a(jEeʘ@OeJRT\*.]zI"W, TTDKR8*6<ܻ4ɟK݊ʒʘʐJOeJL%P8*6#Pv'b{C-pМKG`m,n5̈@FD"A|8 `ܺa24, Sd˃Y6 (g+ Ԃj\wb)A{A-HY0+P#@#PTT07]XAVJ 1tT0i_A"'ʂBulփb ρ3 vZq؃-=hM - 5Az>C&I$N=IO$.#ٖ#f=č ⫑hA|S 1LPX-VJSLESVq[% (Uej*[~ Ւ-˭2na$,J)a"m[lS+}jm0x/6UW:{cG'ej<)yz[|/d8>Fc*g(|S ],p 鳿K}ǃF+LAS @_|vHz$IXW\EoܩVa%1-2:$"eI"S 7:66Q$-K#q66r@<\GH WKQ"IJ@ҀeER%dH:43q$,(.D6* [_SjfOMTԍC-G}?q$Eb˓VOυ&8 zv|bw^qS8O9βFY|dE ,.ktiWYo:v7Y'cd@ߓG?독FLX <Z,!'-`a^P40OH-R+X.^`gS54 Ö,*>bkF`!FbUM4(@ OP[f r ~B2h3-5 cõ>bT?+,v0 CHA!I5 )#`OhPAQdXd\M2,zɛȀ%C)" 3: b' G2D lwtg؝w |Wxgx 8 gTqRhygA gzB&xZhjEbGnnhG٣gfBj} k?vď#@|o.?#h >ī[(W caXk Vlf*lF8 dF~qaBꘛ <%b"Ȅ1sT1Fe×]2 Xpù^Me[ PaL*/el4 gE[X$gO" 1$Փ:[kH|5"1"P ÑLV#}ʽwY<,V_FϷt=z^kiFFbu>/T}^[X[oR"2XT+0dUJ6 f `MV&bZ(jthIG$dh*)a !ɴΓK=!^EQP@*?ٮwoZ_oّPE<ֿNj]ە֢. E$V@hf'V{,/6%Wľ][{@wCH׳x=. u&׃ZP^ඌنbAhLC-#L; F-zɇ^b|ĞHtvCmQ sWׄ7QO-SXg׺:ս誇|lov[W[Iνxw|'7./'xq;od㌙ni򲉬oeg YF6Ĵufhl#XǺQ&o ikLI55cM16fsp&MKYo5>h>Q^qՋۆh -| #3Qt=wWfg4lbnc)RV' f@5`D:fA^iu<fWAY@E{5Uݯ^?yQz6!f'k#= y> fBޤ0ԭ "VX= e;kv/ uC` PDz\?B[D\NA,t?F]" wc$X%`q?F]"7 s26=lbD.&e#ZI#1-Aj*Vveɺ8-3.ݱw ewe2d!E׮@>^L]N]P( XWo-.(}#=]ByTw ŝ~Ɗb ,.w;xbDTh]em]*]zrO9`<Kӕ[JFLuL?]T͈8U.%N_%8=h$4抇|;w\?L19\<Շ[3bkL\< ,ΡG&:؋,p O{aJܭP\V[m丮Bm@[:RE(|fjRS;lgKh]A:NmjԥZZ((ѶB ZmK )O)21n^S#t>`L_Ls+oh:Dw O5'[ve L6jN*(RJ t>%)9[&_U_"rMު*%QV2Piz#R ۤrMb+ls#g}j@&92|]5 j,لM:˖hg1 )G,)jD37(؉5dҲ;8XM#:<|N%/5b0e{#<㗊'Qă\̱&ǔӸ@nLQ}@sP`[ F4(f IAE*Bq).wPMҴk*kY6h ړ5Jܕ6@Ψ;3FC)QG{Fgړ+JdQ)Uԣ3E0b(Coyvs|Wwݼ^՗/.Ώ_ܞo{Gn._?Eg~^:YsyDӳ>]Τsg; e/mLnrٳE>|uT|-q&U)kgOAKf򗳧…: o?~;߻s|t`\H5aWBu@0hϞ ܟJSDQP R.ګ4"Ta B*͔&h37ʅ)Z^ Oe$k0?j3u]e'vZ PMPr63&n: k3\@RpKT@晀}ПgVy8xK.4=XA=P-J u<x UI=_5AGV$_〥+-5 CdtC]Ljm4 JǷyoy:Naɦp+ 9 -U8x57"9p$4#ӷ4`^m5|MhlhfF hd ?)M<$ rr}~y M}}yﱞ ҘFl桡X C̪Fv 7HCi[|,rJ#$"GvI/'4!Dŀo6wB$ /E@ N*έ82 (eSv1P)QgmtH+<ͺJ:SV4.2 xکttdkYj.2 5U{߉v v0 xԘFfc qd3%9h6T}@): 4&9Pz(4TDMh>y;7>O!学]pA[߁Ҡv@ΣaBqAADv!E9):\ ;L 6dF/4QrECK{Zm⹩Nsφ<{*b0@p J萃5dǁ¶0B| I=jU!>w JV0 r,u\; 6yaal]03覴2 ƚ`нGE-G>FWIYt8PU0;4Ppg `Ip 4@>o.dPp\"$D j:@Ҵ<?j5SmU?ZIL%WiPQٖbIBp_j'xyRy༙L5yBZx2#zt>N3w*Lwz [Qh,Om F8yre%XV|[YFUIq Ń7]jygFpf3 Uh@h(Fǹ .S]5 GXՁ#ÁZ- F$$r a4Ћzz]DO2OC sI(<.ev&c $2hKե\q= @BGp!hfh#BҊlP'D'c ##%V _9p݈<Fɾkq ڈ_}xfss~_~?@r?o9P-T~| u}¬?c_?/_`v6Эvv9jEξEϮ  ~3hc$~w;tz6{ny%~cn_/g}xܢf |r&>O(-`Xm/52{Y٬go)pK|vuݛ9\5>z*X^_+ͿJBwDž?y9xKE|l%=/OO '?'O3~' ~?=2X_Dd D  3 @@"?s02 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@ 0@_HmH nH sH tH H`H Normal CJOJQJ_HaJmH sH tH :@:  Heading 1$@&5\DA D Default Paragraph FontViV  Table Normal :V 44 la (k (No List 44  +Header  H$>/>  + Header CharCJOJQJaJ4 @4  +0Footer  H$>/!>  +0 Footer CharCJOJQJaJH2H  + Balloon TextCJOJQJ^JaJN/AN  +Balloon Text CharCJOJQJ^JaJPK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭Vc:E3v@P~Ds |w< \  \  W\ !$\_l,2$P|Џs@ꅤV4@,(    s <L@@A mhlogo03S"??B S  ?"\ tKMNPQSTVWZ]KMNPQSTVWZ]3-: RSoopp}}STabHNnr  >CQ)12>B]-: RSoopp}}STabHNnr  >CQ)12>B]QW'h^`OJQJ^Jo(hHoh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHQW          Ns Ma)#-0i38q8;R?A-|A $N9QX5ao0~ +;g"c^~ivnhxUJKM@\@UnknownG.[x Times New Roman5Symbol3. .[x Arial5. .[`)Tahoma?= .Cx Courier New;WingdingsA$BCambria Math"qh·'·'z5 5 !24HH3QHP?c2!xx %MOUNT HOLYOKE COLLEGE HEALTH SERVICESmhcusermhcadmin Oh+'0 ,8 X d p |(MOUNT HOLYOKE COLLEGE HEALTH SERVICESmhcuser Normal.dotm mhcadmin2Microsoft Office Word@@88 2@J,B@J,B5 ՜.+,0  hp  MOUNT HOLYOKE COLLEGE H &MOUNT HOLYOKE COLLEGE HEALTH SERVICES Title  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWYZ[\]^_abcdefghijklmnopqrsuvwxyz{}~Root Entry FP+nDBData X1Table`'&WordDocumentSummaryInformation(tDocumentSummaryInformation8|CompObjr  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89q