%PDF-1.4 % 4 0 obj <> endobj xref 4 40 0000000016 00000 n 0000001193 00000 n 0000001455 00000 n 0000001541 00000 n 0000001725 00000 n 0000001771 00000 n 0000001878 00000 n 0000003070 00000 n 0000003160 00000 n 0000003237 00000 n 0000003422 00000 n 0000003452 00000 n 0000003570 00000 n 0000003629 00000 n 0000003775 00000 n 0000003805 00000 n 0000003920 00000 n 0000003945 00000 n 0000004113 00000 n 0000004143 00000 n 0000004258 00000 n 0000004308 00000 n 0000004473 00000 n 0000004503 00000 n 0000004618 00000 n 0000004660 00000 n 0000010949 00000 n 0000011136 00000 n 0000059347 00000 n 0000059610 00000 n 0000059798 00000 n 0000059845 00000 n 0000059898 00000 n 0000060004 00000 n 0000060563 00000 n 0000061120 00000 n 0000061386 00000 n 0000109180 00000 n 0000109452 00000 n 0000001268 00000 n trailer<<832ed0844fb9af20d82062d9d37e6398>]>> startxref 0 %%EOF 5 0 obj <> endobj 43 0 obj <
>stream xc``Pa``b```2wf@l@1LDXL022(1T(|?dӂX1cX $$qL #[ endstream endobj 6 0 obj <> endobj 7 0 obj <> endobj 8 0 obj [ 13 0 R 17 0 R 21 0 R 25 0 R] endobj 9 0 obj <>/Font<>/ProcSet[/PDF/Text]>> endobj 10 0 obj <> endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <> endobj 14 0 obj <> endobj 15 0 obj <>stream endstream endobj 16 0 obj (Signature of Patient or Representative-3) endobj 17 0 obj <> endobj 18 0 obj <> endobj 19 0 obj <>stream endstream endobj 20 0 obj (Date-4) endobj 21 0 obj <> endobj 22 0 obj <> endobj 23 0 obj <>stream endstream endobj 24 0 obj (Name of Personal Representative) endobj 25 0 obj <> endobj 26 0 obj <> endobj 27 0 obj <>stream endstream endobj 28 0 obj (Relationship to Patient) endobj 29 0 obj <>stream h[ےq}߯uLB"l +C,0bWD}Ꞟ٥2KVdVgnx7MCi~-^?rx2Nz=G0Ɯܸ3Y8%zDgq ^itU?58o~&;2_~{~gwqE+coVVvi0`뭏gټܺilg1l_<|xvƲm|x\@ϗ6ݷuog8ɧ/]ο\V؟ۊyWϿxq&-_6rko=s>K=_g]/;{)E;%ϓ!Nm2~ͣ|^ /_}{__=|~뭟sU