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Proposed Bill Would Require Payment …

Proposed Bill Would Require Payment Disclosures to Advanced Practice Nurses and Physician Assistants

A proposed bi…
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Bill would give Ohio nurses more latitude…

Bill would give Ohio nurses more latitude in treating patients

Request to buy this photoAdam Cairns | Dispatch S…
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Nursing Shortage Not as Dire as Previously…

Nursing Shortage Not as Dire as Previously Predicted

According to a recent study, although a nursing shortage is s…
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Interprofessional Legislative Update

HPU-LogoBy Lori Herf, MA

The Ohio General Assembly has dedicated much of the winter and spring months to budget (HB 59) deliberations. With the new state fiscal year beginning on July 1st, 2013, legislative leaders will focus most of their attention not only on the fiscal operations of the state of Ohio, but also on the many policy changes made as amendments to state budget provisions.

APRNs and Physician Assistants

Language was considered that would have allowed advanced practice nurses and physician assistants to admit patients to hospitals. That provision is now being considered independently of the budget as HB 139.


A number of pharmacy provisions remain part of the budget as well. One of the provisions would require that Medicaid managed care organiza-tions provide 90 days notice to pharmacies being terminated as a network provider and extends the notice to all types of health care providers. In the case of pharmacies, similarly the budget would require that 90 days advance notice be given regarding the removal of a prescribed drug from the formulary or preferred drug list used by the organization or administrator or any change in the terms governing access to the drug. The amendment that we are opposing in the budget which is HB 59 dealt with remote dispensing.

The amendment would have allowed a pharmacy that is licensed as a terminal distributor of dangerous drugs to use a remote drug dispensing system at a nursing home or residential care facility. The pharmacist would not be required to be physically present where the system is used to dispense the drugs. COHCA has strong concerns regarding this provision and asked legislators to remove the language from the budget bill. The Ohio Senate did remove the language from the substitute version of the bill; however the bill will be amended next week and then be considered by a conference committee that could reinsert the language into the final version of the bill.

Other Bills:

House Bill 44

To require the Director of Health to develop protocols regarding the authority to administer, deliver, distribute, or dispense drugs during certain public health emergencies. This is currently pending in

House Health and Aging Committee where it has received two hearings.

Requires the Director of Health to develop one or more protocols that authorize certain licensed health professionals to administer, deliver, or distribute drugs during a public health emergency; requires the Director to develop protocols as well that authorize pharmacists and pharmacy interns to dispense limited quantities of dangerous drugs without a prescription or record of a prescription during a public health emergency; and provides that an individual who administers, delivers, distributes or dispenses a drug or dangerous drug in accordance with one or more of those protocols is not liable for, nor subject to civil damages, criminal prosecution, or professional disciplinary action, unless the individual’s acts of omissions constitute willful, wanton misconduct.

House Bill 60

To require that rules governing maternity units, newborn care nurseries, and maternity homes include certain provisions pertaining to the authority to make decisions regarding the transfer of patients to other facilities and to specify procedures for granting variances or waivers of any requirement in the rules governing operation of such facilities.

Currently pending in House Health and Aging where it has received two hearings.

The bill codifies an administrative rule that authorizes the Director of Health to grant a variance from or waiver of any of the requirements of rules regarding the operation of a maternity unit, newborn care nursery, or maternity home; requires the Director to adopt rules regarding application forms to be used and procedures to be followed in applying for a variance or waiver; requires the Director to review all applications for variances and waivers and, not later than 90 days after receipt of an application, to determine whether to grant the variance or waiver and notify the applicant of the decision.

House Bill 83

To make 14 major changes to the law that gov-erns the practice of psychology. Heard in the House Health and Aging Committee; reported out of committee; passed the House 96-1; currently pending in the Senate Medicaid, Health and Hu-man Services Committee.

House Bill 94

To require a health insuring corporation, public employee benefit plan, or sickness and accident insurer to reimburse a board of health for any services provided to an individual by the board that is covered by a plan issued to the individual by the health insuring corporation, public employee benefit plan, or sickness and accident insurer upon request submitted by the Board of Health.

Currently pending in House Insurance Committee; has received two hearings.

House Bill 123

TELEHEALTH SERVICES (Gonzales, Wachtmann)
Regarding Medicaid and health insurance coverage of telehealth services.

Currently pending in House Health and Aging Committee where it has received two hearings.

The bill authorizes health care insurers to provide coverage of telehealth services provided by health care professionals and facilities, requires the Office of Medical Assistance to adopt rules establishing standards for Medicaid reimbursement of telehealth services provided by health care professionals and facilities; specifies that coverage of a telehealth service applies only if the service involves an immediate and direct interaction with a patient, is medically appropriate and necessary, and is provided by a licensed health care provider or facility; and requires that a health care provider seeking reimbursement for telehealth service maintain documentation of providing the service as part of the patient records the provider maintains.

House Bill 131

TANNING REGULATIONS (Johnson, Stinziano)
To regulate chemical tanning and prohibit tanning facilities from allowing the use of sun lamps by certain individuals under 18 years of age.

Currently pending in House Health and Aging Committee where it has received three hearings.

Prohibits an operator or employee of a tanning facility from allowing an individual under age 18 to use the facility’s fluorescent sun lamp tanning services unless the individual presents a prescription issued by a physician; and requires the State Board of Cosmetology to regulate chemical tanning facilities.

House Bill 139

To permit certain advanced practice registered nurses and physician assistants to admit patients to hospitals.

Currently pending in House Health and Aging Committee where it has received two hearings.

Current law allows only physicians, dentists and podiatrists who are members of the medical staff to admit patients to hospitals. The bill would add clinical nurse specialists, certified nurse midwives and certified nurse practitioners who have a standard care arrangement with a physician or podiatrist who is a member of the medical staff. The bill would also allow physician’s assistants, under the supervision, control or direction of a physician or podiatrist who is a member of the medical staff, to admit patients to hospitals. The bill also would require the APRN or PA to notify the collaborating or supervising physician or podiatrist not later than 12 hours after admitting a patient to a hospital.

House Bill 147

To require a surgeon performing a mastectomy, lymph node dissection, or lumpectomy in a hospital to guide the patient and provide referrals in accordance with the standards of the National Accreditation Program for Breast Centers and to name this act the Lizzie B. Byrd Act.”

Currently pending in the House Health and Aging Committee where it has had two hearings.

The bill, in addition to the above would require the sur-geon performing a mastectomy or lumpectomy to refer a patient if breast reconstruction is appropriate, and requires the surgeon to offer the patient a preoperative referral to a reconstructive or plastic surgeon in accordance with NAPBC standards.

House Bill 159

DENTAL SERVICES (Hacket, Schuring)
To prohibit a health insurer from establishing a fee schedule for dental providers for services that are not covered by any contract or participating provider agreement between the health insurer and the dental provider.

Currently the bill is pending in the House Insurance Committee where it has had one hearing.

Prohibits a contracting entity from requiring a dental provider to provide services to plan enrollees at a fee set by or subject to approval by the contracting entity unless certain circumstances are met; makes setting or requiring the insurer’s approval of fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances are met; and makes the offering of a health benefit plan that sets fees for dental services an unfair and deceptive act in the business of insurance unless certain circumstances apply.

House Bill 165

Exempts certified hyperbaric technologists from the laws governing the practice of respiratory care.

Currently pending in the House Health and Aging Committee. Has not been heard.

House Bill 170

DRUG OVERDOSES (Johnson, Stinziano)
To provide that a licensed health professional authorized to prescribe naloxone, if acting with reasonable care, may prescribe, administer, dispense or furnish naloxone to a person who is, or a person who is in a position to assist a person who is, apparently experiencing or who is likely to experience an opioid-related overdose without being subject to administrative action or criminal prosecution, to provide that a person who is in a position to assist a person who is apparently experiencing or who is likely to experience an opiod-related overdose is not subject to actions of professional licensing boards, administrative action, or criminal prosecution for a drug offense or practicing medicine without a license if the person acting in good faith, obtains naloxone prescription from a licensed health professional and administers it to a person for an opioid-related overdose, and to provide that peace officers and licensed emergency responders who are acting in good faith are not subject to administrative action or criminal prosecution for a drug offense or practicing medicine without a license for administering naloxone to a person who is apparently experiencing an opioid-related overdose.

Currently pending in the House Health and Aging Committee. It has not yet been heard by the committee.

Senate Bill 4

NEWBORN SCREENINGS (Manning, Oelslager)
To require a pulse oximetry screening for each newborn born in a hospital or freestanding birthing center.

Received two hearings in Senate Medicaid, Health and Human Services Committee, reported out of Committee; passed the Senate 33-0; referred to House Health and Aging Committee where it has received 5 hearings.

Requires hospitals and freestanding birthing centers to conduct a pulse oximetry screening on each newborn (unless a parent objects on religious grounds) for purposes of detecting critical congenital health defects; requires the Director of Health to adopt rules establishing standards and procedures for the pulse oximetry screenings.

Senate Bill 43

Makes a number of changes to the laws governing the civil commitment of and treatment provided to mentally ill persons.

Currently pending in Senate Criminal Justice Committee. It has received one hearing.

Senate Bill 99

CANCER MEDICATIONS (Oelslager, Tavares)
Regarding insurance coverage for rarely administered cancer medications.

Pending in Senate Insurance and Financial Institutions Committee where it has not received a hearing.

Neurosurgery Physician Assistant at Akron Children’s

Combines the Best of Care and Cure

Holly Zeller, PA-C sits down with Julie Tsirambidis, CNP to go over privilege delineation forms at Akron Children’s Hospital.  This is one of their many overlapping moments where NP and PA practice comes together.  Becoming more frequent is this visibility- that NPs and PAs sit side by side with their physician counterparts to enhance patient care.  After years of working in silos, these disciplines agree the time to work together is long overdue.  Hence, the Center for Advanced Practice at Akron Children’s Hospital was formed in April 2011.  The goals are vast, but include the practice and regulatory oversight of APNs and PAs, on boarding programs, and integration with medical staff leadership to name but a few.

Zeller, who is a board certified physician assistant, works in partnership with Dr. Roger Hudgins, director of the Division of Neurosurgery at Children’s Hospital.  When she is not examining patients during office hours, Holly assists Hudgins in the operating room and shares on-call duties with him for after-hours emergencies.  Additionally, on a daily basis, Zeller rounds on all inpatients, formulates plans of care, interprets imaging, triages new patient referrals, and completes various types of different procedures in the NICU, PICU, patient floors and ER.  At the end of each day, all “Mommy Call” questions which have accumulated throughout the day are addressed by calling the parent of the patient back to address their questions. “Every day is a little bit different,” she says.  Zeller, 44, of Richfield,Ohio, is one of now 18 physician assistants (PAs) who work all across Akron Children’s Hospital.  There are over 150 advanced practice providers at Akron Children’s with a director leading the way.  The center actually oversees and brings together Advanced Practice Nurses (CRNA, CNP, and CNS) and Physician Assistants under one umbrella.  The director, Julie Tsirambidis, CNP, truly believes this is the way of the future.  “We have more in common that we have separate.  Coming together to promote our professional needs, despite our regulatory difference truly sets us apart, and brings improved understanding to our patients, families, and hospital staff.”  “Many years ago, MDs and DOs, would not even work together in the same hospital, and see how far they have come- this journey is a similar beginning, in my opinion.” Tsirambidis said.

As part of their master’s degree program, PAs can elect a surgical track that prepares them to work in the operating room.   After college, Zeller worked in the pharmaceutical field before taking a break to stay home with her children.  When she decided to return to work, she wanted a job in the medical field but didn’t want to travel anymore.  She embarked upon graduate school education and completed the PA program.  The PA education is very similar to that of the medical school model.

Zeller initially practiced with the congenital heart surgical team at Rainbow Babies and Children’s Hospital inClevelandbefore joining Akron.  When Dr. Hudgins joined Children’s two years ago, he requested a PA for his team.  He has especially relied on Zeller to share the patient load since the death this summer of the hospital’s only other neurosurgeon, Dr. Henry Bartkowski.  When Dr. Bartkowski became ill, Dr. Hudgins and Zeller formulated a plan to continue the quality care provided to the neurosurgery patients, by trying to split the evening and weekend call, thus allowing the other some “off time.” The two divide and conquer on office days, with each visiting patients and talking with families.  They frequently huddle to compare notes and examine patients’ images and other test results.  Zeller will assist in the OR on surgery days, and often performs the closing procedures.  This teamwork allows Hudgins to dictate this post-operative notes and get ready for the next patient while Zeller finishes the procedures.  “It really becomes a seamless way for getting a lot more work done than you could by yourself, plus the families love her,” Hudgins said

For information, or to join our neurosurgery team, check us out at

COHCA On Facebook

Testimony presented on APRN HB 216 yesterday in House Health and Aging committee as reported by Hannah News Service

HB216 ADVANCED PRACTICE REGISTERED NURSES (Pelanda D) To revise the law governing advanced practice registered nurses.

Testimony opposing HB216 was given by Tim Maglione, senior director for government relations for the Ohio State Medical Association (OSMA); Dr. Geraldine Urse, president-elect of the Ohio Osteopathic Association (OOA); Dr. Steven Schneir, Ohio Psychiatric Physicians Association (OPPA); Dr. Ami Orr, a pediatrician in private practice; Dr. Erica Stein, Ohio Society of Anesthesiologists (OSA); and Elizabeth Snajdar, a licensed registered nurse and a first year medical student at Ohio University Heritage College of Osteopathic Medicine.

Maglione said, “Ohio’s physicians value the abilities and contributions of [Advance Practice Registered Nurses (APRNs)] and all nurses. However, HB216 goes too far and upsets the collaborative, team-based model of care … the APRNs want independent practice with an expanded scope that does not support a team-based approach to care.”

Disputing proponent claims, Maglione said no data shows APRNs leaving Ohio: the number of APRNs in Ohio has increased by 40 percent since 2011. Of 13,372 APRNs responding to a workforce survey, only 21 indicated they can’t find a job. APRNs are not going to rural areas, even though they may do so under the current rules for collaboration. Only 13 percent chose primary care as their main area of practice. He argued that Ohio needs greater accountability of prescribing Schedule II opioids, not less.

Urse said, “I am testifying today as to why [the proponents’] claims are misleading, undermine the educational standards needed for comprehensive and efficient health care delivery, endanger patient safety, impede communication between professionals, and promote the delivery of primary health care in independent silos of practice.”

During her previous experience as a Certified Registered Nurse Anesthetist (CRNA), Urse said, “I observed the depth and breadth of knowledge of the physicians and surgeons with whom I practiced. I truly didn’t know what I didn’t know. As a faculty development teacher for medical students and residents, we often refer to this as ‘unconscious incompetence.’”

Schneir said, “Collaboration should not be, as the proponents have stated, a ‘financial or legal agreement.’ It is the responsibility of the APRN and the physician for the collaboration agreement to be so much more … Practicing independently or in remote areas is a logistical obstruction to collaboration and makes formalization of such even more important … If passed, HB216 would allow APRNs to open their own practices to evaluate, diagnose and provide treatment for patients with potentially complex and multi-faceted diseases … Access to care remains a significant issue in our state. We all must come together to identify creative ways to address this issue, however, permitting APRNs to practice independently will not improve access and may sacrifice patient safety in the process.”

Orr said APRNs, CRNAs and Certified Mid-Wives are trained in a significantly narrower skill set than a physician. Physicians receive between 11,520 and 26,880 hours of clinical practice training, depending on their specialty, following their four-year medical degree and four-year undergraduate degree. APRNs typically receive only 975 to 2,500 hours of clinical experience at the completion of their two- to three-year certification program following a Bachelor of Science in Nursing degree. Continuing education requirements for APRNs are also less than for physicians.

“There is no doubt that advanced practice nurses,” said Orr, “of all varieties, are valuable members of the health care team. However, patient centered health care should be orchestrated by physicians. As physicians, we have the additional training and education to make critical patient care decisions.”

Snajdar said, “I am testifying that these [HB216] changes are dangerous to patient safety as they do not take into consideration significant educational differences between APRNs and physicians. Moreover, I do not believe these changes will fix the access problems Ohio patients presently face.”

Rep. Sears said she would like to hear from physicians with actual remote consultation experience with APRNs. Maglione said he would arrange it.

In response to Rep. Butler, Orr said national data indicates that 250,000 APRNs prescribe Schedule II opioids at a rate of about 128 prescriptions per year per APRN compared with 67 per year per physician for 900,000 physicians.

In response to Rep. Sykes, Maglione said the solution to the medical provider shortage is more federal funding for training. In response to Rep Antonio, Maglione said that unlike Ohio, all of the states that have approved independent APRN practice are smaller states.

In response to Rep. Brown’s question about patient satisfaction surveys for physicians and APRNs, Maglione said “go to Angie’s list.”

Rep. T. Johnson said he observed a trend among medical students to pay less attention to areas they don’t plan to practice in. Urse told Johnson that APRNs and consulting physicians need to be accountable to each other.
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23 hours ago  ·  

Doctors Say Expanded Role For Advanced Practice Nurses Isn’t Necessary

Doctors testified Wednesday against a bill that would grant more authority to advanced practice registered nurses, saying the current system in which doctors and nurses have collaborative agreements works fine.

Tim Maglione, senior director of government relations with the Ohio State Medical Association, told the House Health and Aging Committee that the bill (HB 216) would likely not do much to help address the problem of having primary care providers in underserved, rural areas. It could also hamper the state’s efforts to cut down on the over-prescription of opioid pain medication, he said.

“From our perspective, a case really hasn’t been made for why independent practice should be allowed in this state,” he said.

As it stands now, advanced practice registered nurses, or APRNs, are able to practice as long as they have a standing collaborative agreement with a physician, regardless of whether or not they work in the same practice. The relationship is collaborative, not supervisory, and requires only a written document detailing the protocol of the collaboration and that the physician always be available for communication with the nurse.

Supporters of the bill have said ending the requirement for the collaborative agreement would allow more APRNs to open up primary care practices in rural areas that don’t have easy access to physicians. (See Gongwer Ohio Report, January 20, 2016)

Mr. Maglione said there’s nothing stopping them under current law.

“There’s really nothing in the collaboration requirement today that prevents a nurse from going to a rural area,” he said. “They can go to the rural areas today under the current status, but for a lot of reasons are choosing not to.”

Rep. Tim Brown (R-Bowling Green) said the collaboration agreement requirement seemed to be anti-business, because if the physician decides for any reason to terminate the agreement, or retires, the APRN is immediately unable to serve patients until finding another physician to collaborate with.

“It seems to me, why would someone open a business when it could be yanked out from under them the very next day?” he asked Mr. Maglione.

Workers in all fields face that same threat from their employers, Mr. Maglione said, adding that that the number of APRNs in the state has rose from 8,579 in 2009 to 13,372 in 2015, according to a survey by the Ohio Board of Nursing.

Of those surveyed, he said, only 21 indicated they weren’t able to find a job.

“There’s just not that many that are having a difficult time finding employment,” he said.

Dr. Ami Orr, with Blanchard Valley Pediatrics in Findlay, said the bill’s proposal to expand prescription power for nurse practitioners could lead to more over-prescription of drugs like opioids and antibiotics. She cited research from the American Journal of Medicine in 2005, showing that nurses were more likely to prescribe antibiotics for inappropriate conditions.

“We are really opening up a large field of prescriptions for people who do not have the same degree of training as physicians do,” she said.

Dr. Steven Schnier, on behalf of Ohio Psychiatric Physicians Association, said he was concerned with APRNs being able to prescribe Schedule II drugs without having a collaborating physician to consult.

“At a time when our state is currently working to combat prescription drug abuse, it does not make sense to allow APRNs to prescribe such drugs with no oversight and no restrictions as HB216 would allow,” he said.

Mr. Maglione suggested the formulary for what drugs APRNs can prescribe be kept, but modified so that it’s exclusive, not inclusive, meaning a panel would decide what drugs they cannot prescribe. That, he said, would make sure nurses are able to prescribe more current medications.

Dr. Geraldine N. Urse, with the Ohio Osteopathic Association, said she trained and worked as a certified registered nurse anesthetist before going to medical school and becoming a doctor. She said doctors receive a lot of training about the root causes of conditions and the function of the human body that nurses don’t.

“It was during my years on ‘the other side of the ether screen’ I observed the depth and breadth of knowledge of the physicians and surgeons with whom I practiced,” she said. “I truly didn’t know what I didn’t know.”

She said it was important for medical professionals to continue to collaborate together, and the requirement for APRNs to have a collaborating physician ensures that.

“I think the collaboration is the key,” she said. “The only way that we as health care professionals can be totally accountable is to be accountable to each other.”

Elizabeth Snajdar, a nurse and medical student, explained that nurses aren’t necessarily trained on all of the science and concepts needed to make complex diagnoses.

“From my experiences, the field of nursing in general is more focused on assessment, symptom recognition, and interpersonal communication,” she said.

Dr. Erica Stein, representing the Ohio Society of Anesthesiologists, said it was not necessary to expand the ability to order drugs to certified registered nurse anesthetists, or CRNAs, because they will always be working with the close supervision of an anesthesiologist or a surgeon.

“Although the CRNA is a valuable member of this team, the CRNA does not need prescriptive authority to provide care as there is a physician leading this team,” she said. “The physician is responsible for prescribing all medications used immediately before, during and after the surgery.”

Rep. Barbara Sears (R-Maumee) said she would like to hear from a physician who has collaborating relationships with APRNs. Mr. Maglione said they could have one testify.

Rep. Nickie Antonio (D-Lakewood) asked if there is anything Ohio can learn from the other states that allow APRNs to work independently.

Mr. Maglione said most of those states are large and rural.

“Of the states that have moved to independent practice, they look a lot different than Ohio,” he said.

Ms. Miller, with the Ohio Association of Advanced Practice Nurses, said in an interview that APRNs know what they’re trained to do and what they aren’t trained to do.

“We aren’t trying to be physicians,” she said. “We are very apt at knowing what we can and cannot do.”

As reported by Gongwer News Service
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2 days ago  ·  

House Health Committee to hear Two Pharmacy bills and APRN Scope of Practice bill this week

Rep. Gonzales: 614-466-4847
Wed., Feb. 10, 2016, 9:30 AM, Hearing Room 116

HB216 ADVANCED PRACTICE REGISTERED NURSES (PELANDA D) To revise the law governing advanced practice
registered nurses.
Third Hearing, Opponent Testimony

HB285 PHARMACISTS-PRESCRIPTION REFILLS (SPRAGUE R) To authorize pharmacists to dispense multiple
refills of a prescription simultaneously under certain circumstances.
Third Hearing, Opponent Testimony

HB421 PHARMACISTS-INJECTION DRUGS (LATOURETTE S) To authorize a pharmacist to administer by
injection certain prescribed drugs.
Second Hearing, Proponent Testimony
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3 days ago  ·  

Legislation introduced to prohibit the over-the-counter sale, without a prescription, of dextromethorphan to people younger than 18.

First Hearing, Sponsor Testimony
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3 days ago  ·  


Health Care Professions…


COHCA – Partnering

in Patient Care

COHCA, a interprofessional group, are partners in patient care: better care, lower costs, a partnership that will help improve the quality, safety, and affordability of health care for all Ohioans. Nationally, healthcare initiatives are fostering partnerships in patient care.


COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST SUSTAINING ORGANIZATIONAL SPONSOR - Cleveland Clinic's Zielony Nursing Institute

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…


COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA’S FIRST PLATINUM ORGANIZATIONAL SPONSOR - The Southern Ohio Chapter of the American College of Nurse-Midwives 

COHCA Health Policy Update!!  Senate Bill 83  APN Schedule II - Read More…

COHCA PLATINUM ORGANIZATIONAL SPONSOR - Ohio Chapter of the National Association of Pediatric Nurse Practitioners (NAPNAP)


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