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H.B. 160

             1     

EMERGENCY HEALTH RESPONSE

             2     
AMENDMENTS

             3     
2003 GENERAL SESSION

             4     
STATE OF UTAH

             5     
Sponsor: Marda Dillree

             6      This act amends professional licensing provisions, the powers and duties of local health
             7      departments, and provisions related to immunity from liability for governmental entities
             8      and certain professionals. The act establishes exceptions to certain licensing standards
             9      when a national, state, or local emergency is declared. The act amends certain
             10      prescription drug dispensing rules when emergencies are declared. The act authorizes
             11      local departments of health to investigate suspected bioterrorism and diseases and to
             12      provide public health assistance in a declared emergency. The act provides limited
             13      immunity from civil damages for governmental entities and certain health professionals
             14      responding to a declared emergency. This act has an immediate effective date.
             15      This act affects sections of Utah Code Annotated 1953 as follows:
             16      AMENDS:
             17          26A-1-114, as last amended by Chapter 249, Laws of Utah 2002
             18          58-1-307, as last amended by Chapter 63, Laws of Utah 2001
             19          58-13-2, as last amended by Chapter 160, Laws of Utah 2000
             20          58-17a-620, as enacted by Chapter 247, Laws of Utah 1996
             21          63-30-3, as last amended by Chapters 15 and 248, Laws of Utah 1991
             22          78-11-22, as last amended by Chapter 211, Laws of Utah 1987
             23      Be it enacted by the Legislature of the state of Utah:
             24          Section 1. Section 26A-1-114 is amended to read:
             25           26A-1-114. Powers and duties of departments.
             26          (1) A local health department may:
             27          (a) subject to the provisions in Section 26A-1-108 , enforce state laws, local ordinances,



             28      department rules, and local health department standards and regulations relating to public
             29      health and sanitation, including the plumbing code adopted by the Division of Occupational
             30      and Professional Licensing under Section 58-56-4 and under Title 26, Chapter 15a, Food
             31      Safety Manager Certification Act, in all incorporated and unincorporated areas served by the
             32      local health department;
             33          (b) establish, maintain, and enforce isolation and quarantine, and exercise physical
             34      control over property and over individuals as the local health department finds necessary for
             35      the protection of the public health;
             36          (c) establish and maintain medical, environmental, occupational, and other laboratory
             37      services considered necessary or proper for the protection of the public health;
             38          (d) establish and operate reasonable health programs or measures not in conflict with
             39      state law that:
             40          (i) are necessary or desirable for the promotion or protection of the public health and
             41      the control of disease; or
             42          (ii) may be necessary to ameliorate the major risk factors associated with the major
             43      causes of injury, sickness, death, and disability in the state;
             44          (e) close theaters, schools, and other public places and prohibit gatherings of people
             45      when necessary to protect the public health;
             46          (f) abate nuisances or eliminate sources of filth and infectious and communicable
             47      diseases affecting the public health and bill the owner or other person in charge of the premises
             48      upon which this nuisance occurs for the cost of abatement;
             49          (g) make necessary sanitary and health investigations and inspections on its own
             50      initiative or in cooperation with the Department of Health or Environmental Quality, or both,
             51      as to any matters affecting the public health;
             52          (h) pursuant to county ordinance or interlocal agreement:
             53          (i) establish and collect appropriate fees for the performance of services and operation
             54      of authorized or required programs and duties;
             55          (ii) accept, use, and administer all federal, state, or private donations or grants of funds,
             56      property, services, or materials for public health purposes; and
             57          (iii) make agreements not in conflict with state law that are conditional to receiving a
             58      donation or grant;



             59          (i) prepare, publish, and disseminate information necessary to inform and advise the
             60      public concerning:
             61          (i) the health and wellness of the population, specific hazards, and risk factors that may
             62      adversely affect the health and wellness of the population; and
             63          (ii) specific activities individuals and institutions can engage in to promote and protect
             64      the health and wellness of the population;
             65          (j) investigate the causes of morbidity and mortality;
             66          (k) issue notices and orders necessary to carry out this part;
             67          (l) conduct studies to identify injury problems, establish injury control systems,
             68      develop standards for the correction and prevention of future occurrences, and provide public
             69      information and instruction to special high risk groups;
             70          (m) cooperate with boards created under Section 19-1-106 to enforce laws and rules
             71      within the jurisdiction of the boards; [and]
             72          (n) cooperate with the state health department, the Department of Corrections, the
             73      Administrative Office of the Courts, the Division of Youth Corrections, and the Crime Victims
             74      Reparations Board to conduct testing for HIV infection of convicted sexual offenders and any
             75      victims of a sexual offense[.];
             76          (o) investigate suspected bioterrorism and disease pursuant to Section 26-23b-108 ; and
             77          (p) provide public health assistance in response to a national, state, or local emergency,
             78      a public health emergency as defined in Section 26-23b-102 , or a declaration by the President
             79      of the United States or other federal official requesting public health-related activities.
             80          (2) The local health department shall:
             81          (a) establish programs or measures to promote and protect the health and general
             82      wellness of the people within the boundaries of the local health department;
             83          (b) investigate infectious and other diseases of public health importance and implement
             84      measures to control the causes of epidemic and communicable diseases and other conditions
             85      significantly affecting the public health which may include involuntary testing of convicted
             86      sexual offenders for the HIV infection pursuant to Section 76-5-502 and voluntary testing of
             87      victims of sexual offenses for HIV infection pursuant to Section 76-5-503 ;
             88          (c) cooperate with the department in matters pertaining to the public health and in the
             89      administration of state health laws; and


             90          (d) coordinate implementation of environmental programs to maximize efficient use of
             91      resources by developing with the Department of Environmental Quality a Comprehensive
             92      Environmental Service Delivery Plan that:
             93          (i) recognizes that the Department of Environmental Quality and local health
             94      departments are the foundation for providing environmental health programs in the state;
             95          (ii) delineates the responsibilities of the department and each local health department
             96      for the efficient delivery of environmental programs using federal, state, and local authorities,
             97      responsibilities, and resources;
             98          (iii) provides for the delegation of authority and pass through of funding to local health
             99      departments for environmental programs, to the extent allowed by applicable law, identified in
             100      the plan, and requested by the local health department; and
             101          (iv) is reviewed and updated annually.
             102          (3) The local health department has the following duties regarding public and private
             103      schools within its boundaries:
             104          (a) enforce all ordinances, standards, and regulations pertaining to the public health of
             105      persons attending public and private schools;
             106          (b) exclude from school attendance any person, including teachers, who is suffering
             107      from any communicable or infectious disease, whether acute or chronic, if the person is likely
             108      to convey the disease to those in attendance; and
             109          (c) (i) make regular inspections of the health-related condition of all school buildings
             110      and premises;
             111          (ii) report the inspections on forms furnished by the department to those responsible for
             112      the condition and provide instructions for correction of any conditions that impair or endanger
             113      the health or life of those attending the schools; and
             114          (iii) provide a copy of the report to the department at the time the report is made.
             115          (4) If those responsible for the health-related condition of the school buildings and
             116      premises do not carry out any instructions for corrections provided in a report in Subsection
             117      (3)(c), the local health board shall cause the conditions to be corrected at the expense of the
             118      persons responsible.
             119          (5) The local health department may exercise incidental authority as necessary to carry
             120      out the provisions and purposes of this part.


             121          Section 2. Section 58-1-307 is amended to read:
             122           58-1-307. Exemptions from licensure.
             123          (1) Except as otherwise provided by statute or rule, the following persons may engage
             124      in the practice of their occupation or profession, subject to the stated circumstances and
             125      limitations, without being licensed under this title:
             126          (a) a person serving in the armed forces of the United States, the United States Public
             127      Health Service, the United States Department of Veterans Affairs, or other federal agencies
             128      while engaged in activities regulated under this chapter as a part of employment with that
             129      federal agency if the person holds a valid license to practice a regulated occupation or
             130      profession issued by any other state or jurisdiction recognized by the division;
             131          (b) a student engaged in activities constituting the practice of a regulated occupation or
             132      profession while in training in a recognized school approved by the division to the extent the
             133      activities are supervised by qualified faculty, staff, or designee and the activities are a defined
             134      part of the training program;
             135          (c) an individual engaged in an internship, residency, preceptorship, postceptorship,
             136      fellowship, apprenticeship, or on-the-job training program approved by the division while
             137      under the supervision of qualified persons;
             138          (d) an individual residing in another state and licensed to practice a regulated
             139      occupation or profession in that state, who is called in for a consultation by an individual
             140      licensed in this state, and the services provided are limited to that consultation;
             141          (e) an individual who is invited by a recognized school, association, society, or other
             142      body approved by the division to conduct a lecture, clinic, or demonstration of the practice of a
             143      regulated occupation or profession if the individual does not establish a place of business or
             144      regularly engage in the practice of the regulated occupation or profession in this state;
             145          (f) an individual licensed under the laws of this state, other than under this title, to
             146      practice or engage in an occupation or profession, while engaged in the lawful, professional,
             147      and competent practice of that occupation or profession;
             148          (g) an individual licensed in a health care profession in another state who performs that
             149      profession while attending to the immediate needs of a patient for a reasonable period during
             150      which the patient is being transported from outside of this state, into this state, or through this
             151      state;


             152          (h) an individual licensed in another state or country who is in this state temporarily to
             153      attend to the needs of an athletic team or group, except that the practitioner may only attend to
             154      the needs of the athletic team or group, including all individuals who travel with the team or
             155      group in any capacity except as a spectator;
             156          (i) an individual licensed and in good standing in another state, who is in this state:
             157          (i) temporarily, under the invitation and control of a sponsoring entity;
             158          (ii) for a reason associated with a special purpose event, based upon needs that may
             159      exceed the ability of this state to address through its licensees, as determined by the division;
             160      and
             161          (iii) for a limited period of time not to exceed the duration of that event, together with
             162      any necessary preparatory and conclusionary periods. The requirements of Section
             163      63A-10-105 do not apply to exemptions authorized by the division pursuant to this Subsection
             164      (1)(i);
             165          (j) an individual who:
             166          (i) is certified as an athletic trainer by the National Athletic Trainers Association Board
             167      of Certification or another entity approved by the division;
             168          (ii) is employed or officially associated with an educational institution, a professional
             169      sports organization, or a bona fide amateur sports organization; and
             170          (iii) only provides athletic training services:
             171          (A) to athletes of the educational institution or sports organization to which the
             172      individual is employed or officially associated;
             173          (B) at an official athletic training, practice, or competition site; and
             174          (C) that are within the scope of the individual's certification; and
             175          (k) a law enforcement officer, as defined under Section 53-13-103 , who:
             176          (i) is operating a voice stress analyzer in the course of the officer's full-time
             177      employment with a federal, state, or local law enforcement agency;
             178          (ii) has completed the manufacturer's training course and is certified by the
             179      manufacturer to operate that voice stress analyzer; and
             180          (iii) is operating the voice stress analyzer in accordance with Section 58-64-601 ,
             181      regarding deception detection instruments.
             182          (2) A practitioner temporarily in this state who is exempted from licensure under


             183      Subsection (1) shall comply with each requirement of the licensing jurisdiction from which the
             184      practitioner derives authority to practice. Violation of any limitation imposed by this section
             185      constitutes grounds for removal of exempt status, denial of license, or other disciplinary
             186      proceedings.
             187          (3) An individual who is licensed under a specific chapter of this title to practice or
             188      engage in an occupation or profession may engage in the lawful, professional, and competent
             189      practice of that occupation or profession without additional licensure under other chapters of
             190      this title, except as otherwise provided by this title.
             191          (4) Upon the declaration of a national, state, or local emergency, a public health
             192      emergency as defined in Section 26-23b-102 , or a declaration by the President of the United
             193      States or other federal official requesting public health-related activities, the division in
             194      collaboration with the board may:
             195          (a) suspend the requirements for permanent or temporary licensure of persons who are
             196      licensed in another state. Persons exempt under this Subsection (4)(a) shall be exempt from
             197      licensure for the duration of the emergency while engaged in the scope of practice for which
             198      they are licensed in the other state[.];
             199          (b) modify, under the circumstances described in Subsections (4) and (5), the scope of
             200      practice restrictions under this title for persons who are licensed under this title as:
             201          (i) a physician under Chapter 67, Utah Medical Practice Act, or Chapter 68, Utah
             202      Osteopathic Medical Practice Act;
             203          (ii) a nurse under Chapter 31b, Nurse Practice Act, or Chapter 31c, Nurse Licensure
             204      Compact;
             205          (iii) a certified nurse midwife under Chapter 44a, Nurse Midwife Practice Act;
             206          (iv) a pharmacist, pharmacy technician, or pharmacy intern under Chapter 17a,
             207      Pharmacy Practice Act;
             208          (v) a respiratory therapist under Chapter 57, Respiratory Care Practices Act; and
             209          (vi) a dentist and dental hygienist under Chapter 69, Dentist and Dental Hygienist
             210      Practice Act;
             211          (c) suspend the requirements for licensure under this title and modify the scope of
             212      practice in the circumstances described in Subsections (4) and (5) for medical services
             213      personnel or paramedics certified under Title 26, Chapter 8a, Utah Emergency Medical


             214      Services System Act; and
             215          (d) suspend requirements in Subsections 58-17a-620 (3) through (6) which require
             216      certain prescriptive procedures.
             217          (5) Persons exempt under Subsections (4)(a) and (c) and persons operating under
             218      modified scope of practice provisions under Subsection (4)(b):
             219          (a) shall be exempt from licensure or subject to modified scope of practice for the
             220      duration of the emergency;
             221          (b) must be engaged in the distribution of medicines or medical devises in response to
             222      the emergency or declaration; and
             223          (c) must be employed by or volunteering for a local or state department of health.
             224          Section 3. Section 58-13-2 is amended to read:
             225           58-13-2. Emergency care rendered by licensee.
             226          (1) A person licensed under Title 58, Occupations and Professions, to practice as any
             227      of the following health care professionals, who is under no legal duty to respond, and who in
             228      good faith renders emergency care at the scene of an emergency gratuitously and in good faith,
             229      is not liable for any civil damages as a result of any acts or omissions by the person in
             230      rendering the emergency care:
             231          [(1)] (a) osteopathic physician;
             232          [(2)] (b) physician and surgeon;
             233          [(3) naturopath;]
             234          (c) naturopathic physician;
             235          [(4)] (d) dentist or dental hygienist;
             236          [(5)] (e) chiropractic physician;
             237          [(6)] (f) physician assistant;
             238          [(7)] (g) optometrist; [or]
             239          [(8)] (h) nurse licensed under Section 58-31b-301 [.] or 58-31c-102 ;
             240          (i) podiatrist;
             241          (j) certified nurse midwives;
             242          (k) respiratory therapists; or
             243          (l) pharmacist, pharmacy technicians, and pharmacy interns.
             244          (2) (a) This Subsection (2) applies to health care professionals:


             245          (i) described in Subsection (1);
             246          (ii) who are under no legal duty to respond to the circumstances described in
             247      Subsection (2)(b);
             248          (iii) who are acting within the scope of the health care professional's license, or within
             249      the scope of practice as modified under Subsection 58-1-307 (4); and
             250          (iv) who are acting in good faith without compensation or remuneration as defined in
             251      Subsection 58-13-3 (2).
             252          (b) A health care professional described in Subsection (2)(a) is not liable for any civil
             253      damages as a result of any acts or omissions by the health care professional in rendering care as
             254      a result of:
             255          (i) implementation of measures to control the causes of epidemic and communicable
             256      diseases and other conditions significantly affecting the public health or necessary to protect
             257      the public health as set out in Title 26A, Chapter 1, Local Health Departments;
             258          (ii) investigating and controlling suspected bioterrorism and disease as set out in Title
             259      26, Chapter 23b, Detection of Public Health Emergencies Act; and
             260          (iii) responding to a national, state, or local emergency, a public health emergency as
             261      defined in Section 26-23b-102 , or a declaration by the President of the United States or other
             262      federal official requesting public health-related activities.
             263          Section 4. Section 58-17a-620 is amended to read:
             264           58-17a-620. Prescriptions issued within the public health system.
             265          (1) As used in this section:
             266          (a) "Department of Health" means the state Department of Health created in Section
             267      26-1-4 .
             268          (b) "Health department" means either the Department of Health or a local health
             269      department.
             270          (c) "Local health departments" means the local health departments created in Title
             271      26A, Chapter 1, Local Health Departments.
             272          (2) A health department may implement the prescription, distribution, dispensing,
             273      compounding, and administering procedure under Subsection (3) for prescription drugs, other
             274      than controlled substances, for use in:
             275          (a) clinics providing:


             276          [(a)] (i) sexually transmitted disease treatment;
             277          [(b)] (ii) fluoride treatment; [or]
             278          [(c)] (iii) travel immunization[.]; or
             279          (iv) immunization; or
             280          (b) responses to bioterrorism, epidemic or pandemic disease, or a public health
             281      emergency as defined in Section 26-23b-102 , a national, state, or local emergency, or a
             282      declaration by the President of the United States or other federal official requesting public
             283      health-related activities.
             284          (3) The following prescription, distribution, dispensing, compounding, and
             285      administering procedure shall be carried out in accordance with the requirements of Subsection
             286      (4) and may be used only in the clinics listed under Subsection (2)(a) or in response to
             287      emergencies or declarations under Subsection (2)(b):
             288          (a) a physician writes and signs a prescription for prescription drugs, other than
             289      controlled substances, without the name and address of the patient and without the date the
             290      prescription is provided to the patient; [and]
             291          (b) the physician authorizes a [registered nurse] person licensed under Chapter 31b,
             292      Nurse Practice Act, Chapter 70, Physician Assistant Act, or Chapter 31c, Nurse Licensure
             293      Compact, employed by the health department to complete the prescription written under
             294      Subsection (3)(a) by inserting the patient's name and address, and the date the prescription is
             295      provided to the patient, in accordance with the physician's standing written orders and a written
             296      health department protocol approved by the physician and the medical director of the state
             297      Department of Health[.]; and
             298          (c) a person licensed under Chapter 31b, Nurse Practice Act, Chapter 70, Physician
             299      Assistant Act, or Chapter 31c, Nurse Licensure Compact, employed by a health department
             300      personally administers the drugs or medicines other than controlled substances pursuant to a
             301      prescription issued in compliance with this section in order to supply the immediate needs of
             302      the patient.
             303          (4) When allowing prescriptions to be written, or prescription drugs other than
             304      controlled substances to be distributed, dispensed, compounded, or administered, under
             305      Subsection (3), the health department shall employ a physician who:
             306          (a) assumes specific responsibility for all prescriptions issued in his name under the


             307      procedure in Subsection (3) by the health department; and
             308          (b) enters into a written signed agreement with the health department, which agreement
             309      is approved by the division and states:
             310          (i) the terms and conditions under which the physician will prepare and sign
             311      prescriptions that do not include the name and address of the patient and the date the
             312      prescription is provided to the patient;
             313          (ii) the methods which will be used to ensure the signed prescriptions are secure and
             314      not available for unauthorized use;
             315          (iii) the minimum qualifications and training of a [registered nurse] a person described
             316      in Subsection (3)(b) authorized by the physician and department to complete and provide
             317      prescriptions to a patient;
             318          (iv) under what conditions prescriptions completed by an authorized [registered nurse]
             319      person will be provided to a patient in accordance with standing orders and written protocols,
             320      and the specific prescription drugs for which prescriptions may be written;
             321          (v) the manner in which the physician will audit and review the records of patients
             322      receiving prescriptions; and
             323          (vi) the manner in which records of prescriptions issued will be maintained for audit by
             324      the physician and division.
             325          (5) The health department shall file and maintain with the division a current copy of all
             326      agreements signed by physicians under Subsection (4).
             327          (6) (a) All prescription forms to be used by a physician and health department in
             328      accordance with this section shall be serially numbered according to a numbering system
             329      assigned to that health department by the division.
             330          (b) All prescriptions issued shall contain all information required under this chapter
             331      and rules adopted under this chapter.
             332          Section 5. Section 63-30-3 is amended to read:
             333           63-30-3. Immunity of governmental entities from suit.
             334          (1) Except as may be otherwise provided in this chapter, all governmental entities are
             335      immune from suit for any injury which results from the exercise of a governmental function,
             336      governmentally-owned hospital, nursing home, or other governmental health care facility, and
             337      from an approved medical, nursing, or other professional health care clinical training program


             338      conducted in either public or private facilities.
             339          (2) Subsections (2)(a) through (c) are unique or essential core governmental functions
             340      and, notwithstanding the waiver of immunity provisions of Section 63-30-10 , governmental
             341      entities, political subdivisions, and their officers and employees are immune from suit for any
             342      injury or damage resulting from the implementation of or the failure to:
             343          (a) implement measures to control the causes of epidemic and communicable diseases
             344      and other conditions significantly affecting the public health or necessary to protect the public
             345      health as set out in Title 26A, Chapter 1, Local Health Departments;
             346          (b) investigate and control suspected bioterrorism and disease as set out in Title 26,
             347      Chapter 23b, Detection of Public Health Emergencies Act; and
             348          (c) respond to a national, state, or local emergency, a public health emergency as
             349      defined in Section 26-23b-102 , or a declaration by the President of the United States or other
             350      federal official requesting public health-related activities.
             351          [(2)] (3) (a) For the purposes of this chapter only, the following state medical programs
             352      and services performed at a state-owned university hospital are unique or essential to the core
             353      of governmental activity in this state and are considered to be governmental functions:
             354          (i) care of a patient referred by another hospital or physician because of the high risk
             355      nature of the patient's medical condition;
             356          (ii) high risk care or procedures available in Utah only at a state-owned university
             357      hospital or provided in Utah only by physicians employed at a state-owned university acting in
             358      the scope of their employment;
             359          (iii) care of patients who cannot receive appropriate medical care or treatment at
             360      another medical facility in Utah; and
             361          (iv) any other service or procedure performed at a state-owned university hospital or by
             362      physicians employed at a state-owned university acting in the scope of their employment that a
             363      court finds is unique or essential to the core of governmental activity in this state.
             364          (b) If any claim under this Subsection (3) exceeds the limits established in Section
             365      63-30-34 , the claimant may submit the excess claim to the Board of Examiners and the
             366      Legislature under Title 63, Chapter 6.
             367          [(3)] (4) The management of flood waters and other natural disasters and the
             368      construction, repair, and operation of flood and storm systems by governmental entities are


             369      considered to be governmental functions, and governmental entities and their officers and
             370      employees are immune from suit for any injury or damage resulting from those activities.
             371          [(4)] (5) Officers and employees of a Children's Justice Center are immune from suit
             372      for any injury which results from their joint intergovernmental functions at a center created in
             373      Title 62A, Chapter 4a, Child and Family Services.
             374          Section 6. Section 78-11-22 is amended to read:
             375           78-11-22. Good Samaritan Act.
             376          (1) A person who renders emergency care at or near the scene of, or during an
             377      emergency, gratuitously and in good faith, is not liable for any civil damages or penalties as a
             378      result of any act or omission by the person rendering the emergency care, unless the person is
             379      grossly negligent or caused the emergency. As used in this section, "emergency" means an
             380      unexpected occurrence involving injury, threat of injury, or illness to a person or the public,
             381      including motor vehicle accidents, disasters, actual or threatened discharges, removal, or
             382      disposal of hazardous materials, and other accidents or events of a similar nature. "Emergency
             383      care" includes actual assistance or advice offered to avoid, mitigate, or attempt to mitigate the
             384      effects of an emergency.
             385          (2) A person who gratuitously, and in good faith, assists governmental agencies or
             386      political subdivisions in the activities described in Subsections (2)(a) through (c) is not liable
             387      for any civil damages or penalties as a result of any act or omission unless the person rendering
             388      assistance is grossly negligent:
             389          (a) implementation of measures to control the causes of epidemic and communicable
             390      diseases and other conditions significantly affecting the public health, or necessary to protect
             391      the public health as set out in Title 26A, Chapter 1, Local Health Departments;
             392          (b) investigating and controlling suspected bioterrorism and disease as set out in Title
             393      26, Chapter 23b, Detection of Public Health Emergencies Act; and
             394          (c) responding to a national, state, or local emergency, a public health emergency as
             395      defined in Section 26-23b-102 , or a declaration by the President of the United States or other
             396      federal official requesting public health-related activities.
             397          Section 7. Effective date.
             398          If approved by two-thirds of all the members elected to each house, this act takes effect
             399      upon approval by the governor, or the day following the constitutional time limit of Utah


             400      Constitution Article VII, Section 8, without the governor's signature, or in the case of a veto,
             401      the date of veto override.




Legislative Review Note
    as of 1-30-03 9:19 AM


A limited legal review of this legislation raises no obvious constitutional or statutory concerns.

Office of Legislative Research and General Counsel


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