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MacOS 8.1

Win98

DOS

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+--------+-------------------------+-------------------------+--------+--------+
|00000000| 00 0b 61 62 63 20 6d 65 | 64 69 63 61 6c 00 00 00 |..abc me|dical...|
|00000010| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000020| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000030| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000040| 00 44 52 57 47 4d 44 52 | 57 01 00 00 00 00 00 00 |.DRWGMDR|W.......|
|00000050| 00 00 00 00 00 1b dd 00 | 00 01 7a 98 3b 73 66 a0 |........|..z.;sf.|
|00000060| 2f 53 e8 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |/S......|........|
|00000070| 00 00 00 00 00 00 00 00 | 00 00 81 81 66 24 00 00 |........|....f$..|
|00000080| 44 52 57 47 4d 44 00 06 | 00 02 00 00 00 48 00 48 |DRWGMD..|.....H.H|
|00000090| 00 00 00 00 02 d8 02 24 | ff e0 ff e0 02 f8 02 44 |.......$|.......D|
|000000a0| 03 02 05 28 03 fc 00 02 | 00 00 00 48 00 48 00 00 |...(....|...H.H..|
|000000b0| 00 00 02 d8 02 24 00 01 | 00 00 00 64 00 00 00 01 |.....$..|...d....|
|000000c0| 00 01 01 01 00 00 00 01 | 27 0f 00 01 00 01 00 00 |........|'.......|
|000000d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 19 01 90 |........|........|
|000000e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000000f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000100| 00 00 00 00 00 00 00 00 | 00 48 00 00 00 48 00 00 |........|.H...H..|
|00000110| 00 00 00 00 02 03 02 00 | 04 0c 00 03 02 01 01 00 |........|........|
|00000120| 00 00 01 00 01 02 02 d0 | 02 1c 02 d0 02 1c 02 d0 |........|........|
|00000130| 02 1c 01 de 00 5b 01 01 | 01 01 06 00 01 00 00 00 |.....[..|........|
|00000140| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 01 |........|........|
|00000150| 00 af 00 00 2b 8f 00 01 | 00 00 00 02 fa da 02 ce |....+...|........|
|00000160| 00 00 02 1a 00 00 00 17 | 00 16 00 15 00 14 00 00 |........|........|
|00000170| 00 03 00 02 00 04 00 05 | 00 06 00 07 00 00 00 00 |........|........|
|00000180| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000190| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001a0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001b0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001c0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001d0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001e0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|000001f0| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000200| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000210| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000220| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000230| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000240| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000250| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000260| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000270| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00000280| 0a 01 00 00 02 03 01 00 | 00 01 00 00 00 02 fa da |........|........|
|00000290| 02 ce 00 00 02 1a 00 00 | 00 92 00 ae 00 00 2b 51 |........|......+Q|
|000002a0| 00 01 82 1c 00 01 82 24 | 0a 00 00 00 02 03 01 00 |.......$|........|
|000002b0| 02 a8 00 00 00 0c 00 00 | 02 bf 00 00 02 17 00 00 |........|........|
|000002c0| 00 02 00 02 00 00 01 0b | 00 01 85 1c 00 01 85 48 |........|.......H|
|000002d0| 01 00 00 00 02 03 02 00 | 00 01 87 08 00 03 02 01 |........|........|
|000002e0| 01 00 00 77 02 a8 00 0c | 02 b4 02 17 53 6f 20 74 |...w....|....So t|
|000002f0| 68 61 74 20 41 42 43 20 | 4d 65 64 69 63 61 6c 20 |hat ABC |Medical |
|00000300| 63 61 6e 20 70 72 6f 6d | 70 74 6c 79 20 72 65 76 |can prom|ptly rev|
|00000310| 69 65 77 20 79 6f 75 72 | 20 63 6c 61 69 6d 20 66 |iew your| claim f|
|00000320| 6f 72 20 62 65 6e 65 66 | 69 74 73 2c 20 70 6c 65 |or benef|its, ple|
|00000330| 61 73 65 20 72 65 76 69 | 65 77 20 74 68 65 20 66 |ase revi|ew the f|
|00000340| 6f 72 6d 20 61 6e 64 20 | 74 68 65 20 69 6e 73 74 |orm and |the inst|
|00000350| 72 75 63 74 69 6f 6e 73 | 20 74 6f 20 69 6e 73 75 |ructions| to insu|
|00000360| 72 65 20 01 00 00 00 02 | 03 02 00 00 01 84 cc 00 |re .....|........|
|00000370| 03 02 01 01 00 00 20 02 | b3 00 0e 02 bf 00 a1 69 |...... .|.......i|
|00000380| 74 20 68 61 73 20 62 65 | 65 6e 20 63 6f 6d 70 6c |t has be|en compl|
|00000390| 65 74 65 64 20 63 6f 72 | 72 65 63 74 6c 79 2e 00 |eted cor|rectly..|
|000003a0| 00 00 00 02 03 02 00 05 | 00 00 00 02 03 01 04 00 |........|........|
|000003b0| 72 1c 06 00 02 fb 55 02 | a3 05 93 02 17 0d e8 02 |r.....U.|........|
|000003c0| 00 00 00 02 03 02 00 00 | e1 4e c4 00 02 fc 47 00 |........|.N....G.|
|000003d0| e1 4e c4 02 17 0d ae 02 | 00 00 00 02 03 02 00 01 |.N......|........|
|000003e0| c0 b0 78 00 02 fa da 01 | c0 b0 78 02 17 0d 80 02 |..x.....|..x.....|
|000003f0| 00 00 00 02 03 02 00 02 | 20 24 a7 00 03 f6 bb 02 |........| $......|
|00000400| 20 24 a7 02 17 0d 6f 02 | 00 00 00 02 03 02 00 01 | $....o.|........|
|00000410| e7 11 54 00 02 fc 66 01 | e7 11 54 02 17 0f 0e 01 |..T...f.|..T.....|
|00000420| 00 00 00 02 03 02 00 00 | 01 86 58 00 03 01 01 01 |........|..X.....|
|00000430| 00 00 0d 00 1e 00 09 00 | 29 00 52 49 4e 53 54 52 |........|).RINSTR|
|00000440| 55 43 54 49 4f 4e 53 3a | 01 00 00 00 02 03 02 00 |UCTIONS:|........|
|00000450| 00 01 86 9c 00 03 01 01 | 01 00 00 f3 00 2c 00 07 |........|.....,..|
|00000460| 00 6e 00 fd 31 2e 20 43 | 6f 6d 70 6c 65 74 65 20 |.n..1. C|omplete |
|00000470| 6f 6e 65 20 4d 65 6d 62 | 65 72 20 43 6c 61 69 6d |one Memb|er Claim|
|00000480| 20 46 6f 72 6d 20 66 6f | 72 20 65 61 63 68 20 70 | Form fo|r each p|
|00000490| 61 74 69 65 6e 74 2e 0d | 0d 32 2e 20 41 74 74 61 |atient..|.2. Atta|
|000004a0| 63 68 20 61 6e 20 69 74 | 65 6d 69 7a 65 64 20 62 |ch an it|emized b|
|000004b0| 69 6c 6c 20 63 6f 6e 74 | 61 69 6e 69 6e 67 20 70 |ill cont|aining p|
|000004c0| 61 74 69 65 6e 74 27 73 | 20 6e 61 6d 65 2c 20 70 |atient's| name, p|
|000004d0| 72 6f 76 69 64 65 72 0d | 20 20 20 20 6f 66 20 73 |rovider.|    of s|
|000004e0| 65 72 76 69 63 65 27 73 | 20 49 52 53 20 23 20 6e |ervice's| IRS # n|
|000004f0| 61 6d 65 20 61 6e 64 20 | 61 64 64 72 65 73 73 2c |ame and |address,|
|00000500| 20 74 79 70 65 20 64 61 | 74 65 20 61 6e 64 0d 20 | type da|te and. |
|00000510| 20 20 20 61 6d 6f 75 6e | 74 20 63 68 61 72 67 65 |   amoun|t charge|
|00000520| 64 20 66 6f 72 20 65 61 | 63 68 20 73 75 70 70 6c |d for ea|ch suppl|
|00000530| 79 20 6f 72 20 73 65 72 | 76 69 63 65 20 66 6f 72 |y or ser|vice for|
|00000540| 20 65 61 63 68 0d 20 20 | 20 20 6d 65 6d 62 65 72 | each.  |  member|
|00000550| 20 63 6c 61 69 6d 2e 01 | 00 00 00 02 03 02 00 00 | claim..|........|
|00000560| 01 86 8c 00 03 01 01 01 | 00 00 21 00 1e 01 5d 00 |........|..!...].|
|00000570| 29 02 0d 4d 41 49 4c 20 | 54 48 49 53 20 46 4f 52 |)..MAIL |THIS FOR|
|00000580| 4d 20 57 48 45 4e 20 43 | 4f 4d 50 4c 45 54 45 44 |M WHEN C|OMPLETED|
|00000590| 20 54 4f 3a 01 00 00 00 | 02 03 02 00 00 01 86 4c | TO:....|.......L|
|000005a0| 00 03 01 01 01 00 00 4b | 00 2f 01 96 00 5b 01 f4 |.......K|./...[..|
|000005b0| 41 42 43 20 4d 65 64 69 | 63 61 6c 20 53 65 72 76 |ABC Medi|cal Serv|
|000005c0| 69 63 65 73 0d 50 2e 4f | 2e 20 42 6f 78 20 35 30 |ices.P.O|. Box 50|
|000005d0| 30 30 32 0d 50 72 69 6e | 63 65 74 6f 6e 2c 20 43 |002.Prin|ceton, C|
|000005e0| 61 2e 20 39 35 31 35 39 | 0d 41 74 74 6e 3a 20 43 |a. 95159|.Attn: C|
|000005f0| 6c 61 69 6d 73 20 44 65 | 70 74 2e 01 00 00 00 02 |laims De|pt......|
|00000600| 03 02 00 00 01 86 5c 00 | 03 01 01 01 00 00 0e 00 |......\.|........|
|00000610| 7c 00 13 00 87 00 60 50 | 41 54 49 45 4e 54 27 53 ||.....`P|ATIENT'S|
|00000620| 20 4e 41 4d 45 01 00 00 | 00 02 03 02 00 00 01 86 | NAME...|........|
|00000630| 3c 00 03 01 01 01 00 00 | 0a 00 ab 00 11 00 b6 00 |<.......|........|
|00000640| 50 4f 43 43 55 50 41 54 | 49 4f 4e 01 00 00 00 02 |POCCUPAT|ION.....|
|00000650| 03 02 00 00 01 86 34 00 | 03 01 01 01 00 00 16 00 |......4.|........|
|00000660| c2 00 0f 00 cd 00 86 20 | 20 43 4f 56 45 52 45 44 |....... | COVERED|
|00000670| 20 42 59 20 4d 45 44 49 | 43 41 52 45 3f 02 00 00 | BY MEDI|CARE?...|
|00000680| 00 02 03 02 00 00 b2 00 | 00 00 50 00 80 00 b2 00 |........|..P.....|
|00000690| 00 00 db 83 9d 01 00 00 | 00 02 03 02 00 00 01 86 |........|........|
|000006a0| 28 00 03 01 01 01 00 00 | 1a 00 76 01 8c 00 8c 01 |(.......|..v.....|
|000006b0| e2 52 45 4c 41 54 49 4f | 4e 53 48 49 50 20 54 4f |.RELATIO|NSHIP TO|
|000006c0| 20 0d 45 4d 50 4c 4f 59 | 45 45 3a 01 00 00 00 02 | .EMPLOY|EE:.....|
|000006d0| 03 02 00 00 01 86 20 00 | 03 01 01 01 00 00 1e 00 |...... .|........|
|000006e0| 99 01 83 00 a4 02 0f 53 | 45 4c 46 20 20 20 53 50 |.......S|ELF   SP|
|000006f0| 4f 55 53 45 20 20 20 43 | 48 49 4c 44 20 20 20 20 |OUSE   C|HILD    |
|00000700| 4f 54 48 45 52 01 00 00 | 00 02 03 02 00 00 01 86 |OTHER...|........|
|00000710| 44 00 03 01 01 01 00 00 | 03 00 77 01 49 00 82 01 |D.......|..w.I...|
|00000720| 60 53 45 58 04 00 00 00 | 02 03 02 00 00 8b b1 c7 |`SEX....|........|
|00000730| 01 3a 95 a6 00 94 8d 0e | 01 43 67 50 04 00 00 00 |.:......|.CgP....|
|00000740| 02 03 02 00 00 8b b1 c7 | 01 60 cc dc 00 94 8d 0e |........|.`......|
|00000750| 01 69 9e 86 01 00 00 00 | 02 03 02 00 00 01 86 08 |.i......|........|
|00000760| 00 03 01 01 01 00 00 11 | 00 99 01 2e 00 a4 01 7c |........|.......||
|00000770| 4d 41 4c 45 20 20 20 20 | 20 20 20 46 45 4d 41 4c |MALE    |   FEMAL|
|00000780| 45 04 00 00 00 02 03 02 | 00 00 8b b1 c7 01 b2 21 |E.......|.......!|
|00000790| 8a 00 94 8d 0e 01 ba f3 | 34 04 00 00 00 02 03 02 |........|4.......|
|000007a0| 00 00 8b b1 c7 01 8c e5 | 2e 00 94 8d 0e 01 95 b6 |........|........|
|000007b0| d8 04 00 00 00 02 03 02 | 00 00 8b b1 c7 01 d9 53 |........|.......S|
|000007c0| 9a 00 94 8d 0e 01 e2 25 | 44 04 00 00 00 02 03 02 |.......%|D.......|
|000007d0| 00 00 8b b1 c7 01 fc 9a | 42 00 94 8d 0e 02 05 6b |........|B......k|
|000007e0| ec 01 00 00 00 02 03 02 | 00 00 01 85 e8 00 03 01 |........|........|
|000007f0| 01 01 00 00 0d 00 77 00 | ee 00 82 01 25 44 61 74 |......w.|....%Dat|
|00000800| 65 20 6f 66 20 42 69 72 | 74 68 01 00 00 00 02 03 |e of Bir|th......|
|00000810| 02 00 00 01 86 1c 00 03 | 01 01 01 00 00 08 00 ab |........|........|
|00000820| 00 ee 00 b6 01 24 45 4d | 50 4c 4f 59 45 52 02 00 |.....$EM|PLOYER..|
|00000830| 00 00 02 03 02 00 00 b2 | 00 00 01 23 00 4c 00 b2 |........|...#.L..|
|00000840| 00 00 02 15 ff 44 01 00 | 00 00 02 03 02 00 00 01 |.....D..|........|
|00000850| 85 ec 00 03 01 01 01 00 | 00 16 00 bd 00 f0 00 de |........|........|
|00000860| 01 25 49 46 20 59 45 53 | 2c 0d 45 46 46 45 43 54 |.%IF YES|,.EFFECT|
|00000870| 49 56 45 0d 44 41 54 45 | 01 00 00 00 02 03 02 00 |IVE.DATE|........|
|00000880| 00 01 85 d0 00 03 01 01 | 01 00 00 0d 00 b6 01 40 |........|.......@|
|00000890| 00 c1 01 85 28 48 4f 53 | 50 29 20 50 41 52 54 20 |....(HOS|P) PART |
|000008a0| 41 01 00 00 00 02 03 02 | 00 00 01 85 c4 00 03 01 |A.......|........|
|000008b0| 01 01 00 00 0c 00 b6 01 | b9 00 c1 01 f8 28 4d 45 |........|.....(ME|
|000008c0| 44 29 20 50 41 52 54 20 | 42 01 00 00 00 02 03 02 |D) PART |B.......|
|000008d0| 00 00 01 85 d4 00 03 01 | 01 01 00 00 09 00 e4 00 |........|........|
|000008e0| 14 00 ef 00 4b 47 52 4f | 55 50 20 4e 4f 2e 01 00 |....KGRO|UP NO...|
|000008f0| 00 00 02 03 02 00 00 01 | 85 bc 00 03 01 01 01 00 |........|........|
|00000900| 00 12 00 e5 00 54 00 fb | 00 8b 43 4f 56 45 52 41 |.....T..|..COVERA|
|00000910| 47 45 0d 20 20 20 20 20 | 43 4f 44 45 01 00 00 00 |GE.     |CODE....|
|00000920| 02 03 02 00 00 01 85 c0 | 00 03 01 01 01 00 00 09 |........|........|
|00000930| 00 e5 00 95 00 fb 00 b3 | 41 52 45 41 0d 43 4f 44 |........|AREA.COD|
|00000940| 45 01 00 00 00 02 03 02 | 00 00 01 85 98 00 03 01 |E.......|........|
|00000950| 01 01 00 00 0c 00 e5 00 | c0 00 fb 00 ea 50 48 4f |........|.....PHO|
|00000960| 4e 45 0d 4e 55 4d 42 45 | 52 02 00 00 00 02 03 02 |NE.NUMBE|R.......|
|00000970| 00 01 06 b3 b4 00 02 fa | da 01 06 b3 b4 01 1d 30 |........|.......0|
|00000980| 09 02 00 00 00 02 03 02 | 00 01 98 57 c2 01 1d 30 |........|...W...0|
|00000990| 1a 00 e2 4b 09 01 1d 30 | 1a 02 00 00 00 02 03 02 |...K...0|........|
|000009a0| 00 00 e1 4e d7 00 4c 78 | b8 01 05 b7 c3 00 4c 78 |...N..Lx|......Lx|
|000009b0| b8 02 00 00 00 02 03 02 | 00 00 e2 4a cf 00 8f 1a |........|...J....|
|000009c0| a0 01 05 b7 ad 00 8f 1a | a0 02 00 00 00 02 03 02 |........|........|
|000009d0| 00 00 e2 4a b0 00 b6 4c | b0 01 06 b3 af 00 b6 4c |...J...L|.......L|
|000009e0| b0 01 00 00 00 02 03 02 | 00 00 01 85 88 00 03 01 |........|........|
|000009f0| 01 01 00 00 1f 01 10 00 | 07 01 26 00 60 45 4d 50 |........|..&.`EMP|
|00000a00| 4c 4f 59 45 45 20 53 4f | 43 49 41 4c 0d 53 45 43 |LOYEE SO|CIAL.SEC|
|00000a10| 55 52 49 54 59 20 4e 55 | 4d 42 45 52 01 00 00 00 |URITY NU|MBER....|
|00000a20| 02 03 02 00 00 01 85 78 | 00 03 01 01 01 00 00 0d |.......x|........|
|00000a30| 01 30 00 09 01 3b 00 5a | 45 4d 50 4c 4f 59 45 45 |.0...;.Z|EMPLOYEE|
|00000a40| 20 4e 41 4d 45 02 00 00 | 00 02 03 02 00 01 20 4d | NAME...|...... M|
|00000a50| b0 00 67 d9 1e 01 20 4d | b0 01 0e 6d e2 01 00 00 |..g... M|...m....|
|00000a60| 00 02 03 02 00 00 01 85 | 68 00 03 01 01 01 00 00 |........|h.......|
|00000a70| 07 01 49 00 0a 01 54 00 | 39 41 44 44 52 45 53 53 |..I...T.|9ADDRESS|
|00000a80| 02 00 00 00 02 03 02 00 | 01 50 81 a9 00 3d c5 f2 |........|.P...=..|
|00000a90| 01 50 81 a9 01 13 63 96 | 01 00 00 00 02 03 02 00 |.P....c.|........|
|00000aa0| 00 01 85 70 00 03 01 01 | 01 00 00 58 01 65 00 09 |...p....|...X.e..|
|00000ab0| 01 70 00 e4 43 49 54 59 | 20 20 20 20 20 20 20 20 |.p..CITY|        |
|00000ac0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00000ad0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00000ae0| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 53 |        |       S|
|00000af0| 54 41 54 45 20 20 20 20 | 20 20 20 20 20 20 20 20 |TATE    |        |
|00000b00| 20 20 20 20 20 20 20 20 | 20 5a 49 50 02 00 00 00 |        | ZIP....|
|00000b10| 02 03 02 00 01 62 38 35 | 00 0c c8 27 01 62 38 35 |.....b85|...'.b85|
|00000b20| 01 11 6d e2 01 00 00 00 | 02 03 02 00 00 01 85 5c |..m.....|.......\|
|00000b30| 01 03 02 01 05 00 00 10 | 01 7c 00 0c 01 88 00 88 |........|.|......|
|00000b40| 4e 41 4d 45 20 4f 46 20 | 45 4d 50 4c 4f 59 45 52 |NAME OF |EMPLOYER|
|00000b50| 02 00 00 00 02 03 02 00 | 01 75 e6 98 00 02 fa da |........|.u......|
|00000b60| 01 75 e6 98 01 1c 34 58 | 02 00 00 00 02 03 02 00 |.u....4X|........|
|00000b70| 01 99 53 b2 02 17 0d 7b | 01 99 53 b2 00 03 f6 37 |..S....{|..S....7|
|00000b80| 01 00 00 00 02 03 02 00 | 00 01 85 50 00 03 01 01 |........|...P....|
|00000b90| 01 00 00 0e 00 fe 01 22 | 01 09 01 72 50 52 4f 56 |......."|...rPROV|
|00000ba0| 49 44 45 52 20 20 4e 41 | 4d 45 01 00 00 00 02 03 |IDER  NA|ME......|
|00000bb0| 02 00 00 01 86 c8 00 03 | 01 01 01 00 00 07 01 2e |........|........|
|00000bc0| 01 24 01 39 01 53 41 44 | 44 52 45 53 53 01 00 00 |.$.9.SAD|DRESS...|
|00000bd0| 00 02 03 02 00 00 01 84 | f0 00 03 01 01 01 00 00 |........|........|
|00000be0| 28 01 48 01 26 01 53 01 | f5 43 49 54 59 5f 5f 5f |(.H.&.S.|.CITY___|
|00000bf0| 5f 5f 5f 5f 5f 5f 5f 5f | 5f 53 54 41 54 45 5f 5f |________|_STATE__|
|00000c00| 5f 5f 5f 5f 5f 5f 5a 49 | 50 5f 5f 5f 5f 5f 5f 5f |______ZI|P_______|
|00000c10| 5f 01 00 00 00 02 03 02 | 00 00 01 85 2c 00 03 01 |_.......|....,...|
|00000c20| 01 01 00 00 13 01 66 01 | 26 01 71 01 8b 44 41 54 |......f.|&.q..DAT|
|00000c30| 45 20 4f 46 20 31 53 54 | 20 53 45 52 56 49 43 45 |E OF 1ST| SERVICE|
|00000c40| 02 00 00 00 02 03 02 00 | 01 04 bb dd 01 76 5b da |........|.....v[.|
|00000c50| 01 04 bb dd 02 12 28 f5 | 02 00 00 00 02 03 02 00 |......(.|........|
|00000c60| 01 34 f3 ea 01 56 05 7e | 01 34 f3 ea 02 13 23 5e |.4...V.~|.4....#^|
|00000c70| 01 00 00 00 02 03 01 00 | 00 01 85 20 00 03 01 01 |........|... ....|
|00000c80| 01 00 00 30 01 0b 01 56 | 01 16 02 1a 50 68 79 73 |...0...V|....Phys|
|00000c90| 69 63 69 61 6e 2c 20 20 | 4c 61 62 6f 72 61 74 6f |ician,  |Laborato|
|00000ca0| 72 79 2c 20 50 68 61 72 | 6d 61 63 79 2c 20 43 6c |ry, Phar|macy, Cl|
|00000cb0| 69 6e 69 63 2c 20 65 74 | 63 2e 2e 2e 01 00 00 00 |inic, et|c.......|
|00000cc0| 02 03 02 00 00 01 85 08 | 00 03 01 01 01 00 00 07 |........|........|
|00000cd0| 01 a0 00 0e 01 ab 00 38 | 49 4c 4c 4e 45 53 53 01 |.......8|ILLNESS.|
|00000ce0| 00 00 00 02 03 02 00 00 | 01 84 d4 00 03 01 01 01 |........|........|
|00000cf0| 00 00 08 01 a0 00 8a 01 | ab 00 bb 41 43 43 49 44 |........|...ACCID|
|00000d00| 45 4e 54 01 00 00 00 02 | 03 02 00 00 01 84 ec 00 |ENT.....|........|
|00000d10| 03 01 01 01 00 00 0c 01 | a0 01 06 01 ab 01 50 57 |........|......PW|
|00000d20| 4f 52 4b 20 52 45 4c 41 | 54 45 44 01 00 00 00 02 |ORK RELA|TED.....|
|00000d30| 03 02 00 00 01 85 0c 00 | 03 01 01 01 00 00 11 01 |........|........|
|00000d40| a0 01 81 01 ab 01 e7 50 | 52 45 47 4e 41 4e 43 59 |.......P|REGNANCY|
|00000d50| 20 52 45 4c 41 54 45 44 | 01 00 00 00 02 03 02 00 | RELATED|........|
|00000d60| 00 01 84 f4 00 03 01 01 | 01 00 00 0d 01 c3 01 ae |........|........|
|00000d70| 01 ce 01 f8 44 41 54 45 | 20 4f 46 20 4f 4e 53 45 |....DATE| OF ONSE|
|00000d80| 54 01 00 00 00 02 03 02 | 00 00 01 84 f8 00 03 01 |T.......|........|
|00000d90| 01 01 00 00 0f 01 c7 00 | 0e 01 d2 00 5d 4b 49 4e |........|....]KIN|
|00000da0| 44 20 4f 46 20 49 4c 4c | 4e 45 53 53 02 00 00 00 |D OF ILL|NESS....|
|00000db0| 02 03 02 00 01 d0 6f 2e | 00 62 07 74 01 d0 6f 2e |......o.|.b.t..o.|
|00000dc0| 01 89 f3 98 02 00 00 00 | 02 03 02 00 01 e1 29 cf |........|......).|
|00000dd0| 00 0f b7 ec 01 e1 29 cf | 01 8a ee 20 01 00 00 00 |......).|... ....|
|00000de0| 02 03 02 00 00 01 84 c0 | 00 03 01 01 01 00 00 10 |........|........|
|00000df0| 01 ec 00 0e 01 f7 00 66 | 44 41 54 45 20 4f 46 20 |.......f|DATE OF |
|00000e00| 41 43 43 49 44 45 4e 54 | 01 00 00 00 02 03 02 00 |ACCIDENT|........|
|00000e10| 00 01 84 b4 00 03 01 01 | 01 00 00 15 01 ed 00 a2 |........|........|
|00000e20| 01 f8 01 1d 48 4f 57 20 | 41 43 43 49 44 45 4e 54 |....HOW |ACCIDENT|
|00000e30| 20 4f 43 43 55 52 52 45 | 44 01 00 00 00 02 03 02 | OCCURRE|D.......|
|00000e40| 00 00 01 84 ac 00 03 01 | 01 01 00 00 1c 02 08 00 |........|........|
|00000e50| a1 02 13 01 3a 57 48 41 | 54 20 49 4e 4a 55 52 49 |....:WHA|T INJURI|
|00000e60| 45 53 20 57 45 52 45 20 | 53 55 53 54 41 49 4e 45 |ES WERE |SUSTAINE|
|00000e70| 44 02 00 00 00 02 03 02 | 00 01 f4 d8 33 01 2b e2 |D.......|....3.+.|
|00000e80| e0 01 f4 d8 33 02 08 5c | 7a 02 00 00 00 02 03 02 |....3..\|z.......|
|00000e90| 00 02 01 a3 26 00 a4 aa | 08 02 01 a3 26 02 08 5c |....&...|....&..\|
|00000ea0| 7a 02 00 00 00 02 03 02 | 00 02 0f 6a 05 01 46 57 |z.......|...j..FW|
|00000eb0| de 02 0f 6a 05 02 07 61 | a0 02 00 00 00 02 03 02 |...j...a|........|
|00000ec0| 00 02 1b 39 0e 00 a2 b4 | 55 02 1b 39 0e 02 07 61 |...9....|U..9...a|
|00000ed0| a0 01 00 00 00 02 03 02 | 00 00 01 84 8c 00 03 01 |........|........|
|00000ee0| 01 01 00 00 2a 02 26 00 | 0e 02 31 00 ed 44 4f 45 |....*.&.|..1..DOE|
|00000ef0| 53 20 50 41 54 49 45 4e | 54 20 48 41 56 45 20 4f |S PATIEN|T HAVE O|
|00000f00| 54 48 45 52 20 48 45 41 | 4c 54 48 20 20 49 4e 53 |THER HEA|LTH  INS|
|00000f10| 55 52 41 4e 43 45 3f 0a | 00 00 00 02 03 01 00 02 |URANCE?.|........|
|00000f20| 25 00 00 01 1b 3a 66 02 | 30 00 00 01 70 00 00 00 |%....:f.|0...p...|
|00000f30| 04 00 04 00 00 00 d8 00 | 01 84 84 00 01 84 74 04 |........|......t.|
|00000f40| 00 00 00 02 03 02 00 02 | 25 26 f0 01 1b 3a 66 02 |........|%&...:f.|
|00000f50| 2d eb 82 01 24 43 ca 01 | 00 00 00 02 03 02 00 00 |-...$C..|........|
|00000f60| 01 84 7c 00 03 01 01 01 | 00 00 05 02 25 01 28 02 |..|.....|....%.(.|
|00000f70| 30 01 43 20 20 59 45 53 | 04 00 00 00 02 03 02 00 |0.C  YES|........|
|00000f80| 02 25 26 f0 01 4a 6b 74 | 02 2d eb 82 01 54 75 e4 |.%&..Jkt|.-...Tu.|
|00000f90| 01 00 00 00 02 03 02 00 | 00 01 84 70 00 03 01 01 |........|...p....|
|00000fa0| 01 00 00 03 02 25 01 5c | 02 30 01 70 20 4e 4f 00 |.....%.\|.0.p NO.|
|00000fb0| 00 00 00 02 03 02 00 0a | 00 00 00 02 03 01 00 02 |........|........|
|00000fc0| 3e a6 2c 00 94 00 00 02 | 4c 00 00 01 42 00 00 00 |>.,.....|L...B...|
|00000fd0| 04 00 04 00 00 00 eb 00 | 01 84 68 00 01 84 54 02 |........|..h...T.|
|00000fe0| 00 00 00 02 03 02 00 02 | 3e a6 2c 00 94 da 87 02 |........|>.,.....|
|00000ff0| 3e a6 2c 01 41 71 56 01 | 00 00 00 02 03 02 00 00 |>.,.AqV.|........|
|00001000| 01 84 60 00 03 01 01 01 | 00 00 04 02 41 00 94 02 |..`.....|....A...|
|00001010| 4c 00 af 4c 41 53 54 01 | 00 00 00 02 03 02 00 00 |L..LAST.|........|
|00001020| 01 84 58 00 03 01 01 01 | 00 00 05 02 41 00 e1 02 |..X.....|....A...|
|00001030| 4c 00 ff 46 49 52 53 54 | 01 00 00 00 02 03 02 00 |L..FIRST|........|
|00001040| 00 01 84 50 00 03 01 01 | 01 00 00 06 02 41 01 1c |...P....|.....A..|
|00001050| 02 4c 01 42 4d 49 44 44 | 4c 45 00 00 00 00 02 03 |.L.BMIDD|LE......|
|00001060| 02 00 01 00 00 00 02 03 | 02 00 00 01 84 48 00 03 |........|.....H..|
|00001070| 01 01 01 00 00 14 02 3a | 00 0e 02 45 00 7d 50 4f |.......:|...E.}PO|
|00001080| 4c 49 43 59 20 48 4f 4c | 44 45 52 27 53 20 4e 41 |LICY HOL|DER'S NA|
|00001090| 4d 45 01 00 00 00 02 03 | 02 00 00 01 84 40 00 03 |ME......|.....@..|
|000010a0| 01 01 01 00 00 0d 02 3a | 01 4a 02 45 01 97 50 4f |.......:|.J.E..PO|
|000010b0| 4c 49 43 59 20 4e 55 4d | 42 45 52 02 00 00 00 02 |LICY NUM|BER.....|
|000010c0| 03 02 00 02 41 99 e9 01 | 9f 83 5c 02 41 99 e9 02 |....A...|..\.A...|
|000010d0| 09 57 54 01 00 00 00 02 | 03 02 00 00 01 84 34 00 |.WT.....|......4.|
|000010e0| 03 01 01 01 00 00 16 02 | 52 00 0e 02 5d 00 8f 49 |........|R...]..I|
|000010f0| 4e 53 55 52 41 4e 43 45 | 20 43 4f 4d 50 41 4e 59 |NSURANCE| COMPANY|
|00001100| 20 4e 41 4d 45 02 00 00 | 00 02 03 02 00 02 5a 33 | NAME...|......Z3|
|00001110| e5 00 a2 b3 a8 02 5a 33 | e5 01 32 be 66 01 00 00 |......Z3|..2.f...|
|00001120| 00 02 03 02 00 00 01 84 | 28 00 03 01 01 01 00 00 |........|(.......|
|00001130| 4b 02 5e 01 3d 02 69 02 | 14 53 54 52 45 45 54 20 |K.^.=.i.|.STREET |
|00001140| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00001150| 20 20 20 20 20 20 20 20 | 20 20 20 20 20 20 20 20 |        |        |
|00001160| 20 43 49 54 59 20 20 20 | 20 20 20 20 20 20 20 20 | CITY   |        |
|00001170| 20 20 20 53 54 41 54 45 | 20 20 20 20 20 20 20 20 |   STATE|        |
|00001180| 20 5a 49 50 02 00 00 00 | 02 03 02 00 02 59 37 fa | ZIP....|.....Y7.|
|00001190| 01 3e 81 b4 02 59 37 fa | 02 06 66 31 01 00 00 00 |.>...Y7.|..f1....|
|000011a0| 02 03 02 00 00 01 84 1c | 01 03 02 01 06 00 00 26 |........|.......&|
|000011b0| 00 01 00 c7 00 19 01 59 | 41 42 43 20 4d 45 44 49 |.......Y|ABC MEDI|
|000011c0| 43 41 4c 20 53 45 52 56 | 49 43 45 53 0d 4d 45 4d |CAL SERV|ICES.MEM|
|000011d0| 42 45 52 20 43 4c 41 49 | 4d 20 46 4f 52 4d 02 00 |BER CLAI|M FORM..|
|000011e0| 00 00 02 03 02 00 02 66 | f3 b5 00 02 fa da 02 66 |.......f|.......f|
|000011f0| f3 b5 02 16 13 c9 01 00 | 00 00 02 03 02 00 00 01 |........|........|
|00001200| 84 10 00 03 01 01 01 00 | 00 d5 02 6b 00 0e 02 8c |........|...k....|
|00001210| 01 db 49 20 43 45 52 54 | 49 46 59 20 54 48 41 54 |..I CERT|IFY THAT|
|00001220| 20 54 48 45 20 49 4e 46 | 4f 52 4d 41 54 49 4f 4e | THE INF|ORMATION|
|00001230| 20 4f 4e 20 54 48 49 53 | 20 43 4c 41 49 4d 20 46 | ON THIS| CLAIM F|
|00001240| 4f 52 4d 20 49 53 20 54 | 52 55 45 20 41 4e 44 20 |ORM IS T|RUE AND |
|00001250| 43 4f 52 52 45 43 54 20 | 54 4f 20 54 48 45 20 42 |CORRECT |TO THE B|
|00001260| 45 53 54 20 4f 46 20 4d | 59 0d 4b 4e 4f 57 4c 45 |EST OF M|Y.KNOWLE|
|00001270| 44 47 45 20 2e 20 49 20 | 41 55 54 48 4f 52 49 5a |DGE . I |AUTHORIZ|
|00001280| 45 20 54 48 45 20 52 45 | 4c 45 41 53 45 20 4f 46 |E THE RE|LEASE OF|
|00001290| 20 41 4e 59 20 4d 45 44 | 49 43 41 4c 20 49 4e 46 | ANY MED|ICAL INF|
|000012a0| 4f 52 4d 41 54 49 4f 4e | 20 4e 45 43 45 53 53 41 |ORMATION| NECESSA|
|000012b0| 52 59 20 54 4f 20 50 52 | 4f 43 45 53 53 20 54 48 |RY TO PR|OCESS TH|
|000012c0| 49 53 0d 43 4c 41 49 4d | 20 46 4f 52 20 54 48 45 |IS.CLAIM| FOR THE|
|000012d0| 20 44 55 52 41 54 49 4f | 4e 20 4d 41 52 4b 45 44 | DURATIO|N MARKED|
|000012e0| 20 41 42 4f 56 45 2e 01 | 00 00 00 02 03 02 00 00 | ABOVE..|........|
|000012f0| 01 84 08 00 03 01 01 01 | 00 00 00 02 6f 01 ba 02 |........|....o...|
|00001300| 7a 01 c8 01 00 00 00 02 | 03 02 00 00 01 84 00 00 |z.......|........|
|00001310| 03 01 01 01 00 00 3e 02 | 96 00 18 02 a1 01 4d 4d |......>.|......MM|
|00001320| 45 4d 42 45 52 27 53 20 | 53 49 47 4e 41 54 55 52 |EMBER'S |SIGNATUR|
|00001330| 45 20 20 28 50 41 52 45 | 4e 54 27 53 20 53 49 47 |E  (PARE|NT'S SIG|
|00001340| 4e 41 54 55 52 45 20 49 | 46 20 50 41 54 49 45 4e |NATURE I|F PATIEN|
|00001350| 54 20 49 53 20 41 20 4d | 49 4e 4f 52 29 02 00 00 |T IS A M|INOR)...|
|00001360| 00 02 03 02 00 02 92 56 | 71 00 10 b2 c6 02 92 56 |.......V|q......V|
|00001370| 71 01 5b e6 9a 04 00 00 | 00 02 09 09 00 00 f6 f4 |q.[.....|........|
|00001380| fe 01 76 5b 98 01 03 bf | f2 02 11 2e 24 04 00 00 |..v[....|....$...|
|00001390| 00 02 09 09 00 01 10 8a | e6 00 68 e3 e0 01 1d 55 |........|..h....U|
|000013a0| d7 01 10 72 fe 04 00 00 | 00 02 09 09 00 01 25 35 |...r....|......%5|
|000013b0| 35 00 67 e8 90 01 32 fc | 0c 01 12 68 ae 02 00 00 |5.g...2.|...h....|
|000013c0| 00 02 03 02 00 01 34 f3 | ef 00 68 00 8b 01 34 f3 |......4.|..h...4.|
|000013d0| ef 01 12 68 76 01 00 00 | 00 02 03 02 00 00 01 83 |...hv...|........|
|000013e0| e4 00 03 01 01 01 00 00 | 04 01 38 00 65 01 43 00 |........|..8.e.C.|
|000013f0| 80 4c 41 53 54 01 00 00 | 00 02 03 02 00 00 01 83 |.LAST...|........|
|00001400| dc 00 03 01 01 01 00 00 | 05 01 38 00 b2 01 43 00 |........|..8...C.|
|00001410| d0 46 49 52 53 54 01 00 | 00 00 02 03 02 00 00 01 |.FIRST..|........|
|00001420| 83 d4 00 03 01 01 01 00 | 00 06 01 38 00 ed 01 43 |........|...8...C|
|00001430| 01 13 4d 49 44 44 4c 45 | 01 00 00 00 02 03 02 00 |..MIDDLE|........|
|00001440| 00 01 83 cc 00 03 01 01 | 01 00 00 03 01 68 01 a0 |........|.....h..|
|00001450| 01 73 01 b4 4d 6f 2e 01 | 00 00 00 02 03 02 00 00 |.s..Mo..|........|
|00001460| 01 83 c4 00 03 01 01 01 | 00 00 03 01 68 01 bb 01 |........|....h...|
|00001470| 73 01 d0 44 61 79 01 00 | 00 00 02 03 02 00 00 01 |s..Day..|........|
|00001480| 83 bc 00 03 01 01 01 00 | 00 02 01 68 01 e1 01 73 |........|...h...s|
|00001490| 01 ef 59 72 02 00 00 00 | 02 03 02 00 01 65 f2 44 |..Yr....|.....e.D|
|000014a0| 01 a0 f9 93 01 65 f2 44 | 01 f8 ae a9 02 00 00 00 |.....e.D|........|
|000014b0| 02 03 02 00 01 5d 4c 9d | 01 b9 d3 48 01 70 52 a9 |.....]L.|...H.pR.|
|000014c0| 01 b9 d3 48 02 00 00 00 | 02 03 02 00 01 5d 4c 9d |...H....|.....]L.|
|000014d0| 01 de 5e bc 01 70 52 a9 | 01 de 5e bc 01 00 00 00 |..^..pR.|..^.....|
|000014e0| 02 03 02 00 00 01 83 a8 | 00 03 01 01 01 00 00 03 |........|........|
|000014f0| 02 92 01 a0 02 9d 01 b4 | 4d 6f 2e 01 00 00 00 02 |........|Mo......|
|00001500| 03 02 00 00 01 83 a0 00 | 03 01 01 01 00 00 03 02 |........|........|
|00001510| 92 01 bd 02 9d 01 d2 44 | 61 79 01 00 00 00 02 03 |.......D|ay......|
|00001520| 02 00 00 01 83 98 00 03 | 01 01 01 00 00 02 02 92 |........|........|
|00001530| 01 dc 02 9d 01 ea 59 72 | 02 00 00 00 02 03 02 00 |......Yr|........|
|00001540| 02 8f 9d 31 01 9c 13 51 | 02 8f 9d 31 01 f3 c8 67 |...1...Q|...1...g|
|00001550| 02 00 00 00 02 03 02 00 | 02 87 78 31 01 b4 ed 06 |........|..x1....|
|00001560| 02 95 0e c3 01 b4 ed 06 | 02 00 00 00 02 03 02 00 |........|........|
|00001570| 02 88 74 1c 01 d3 97 5e | 02 96 0a ae 01 d3 97 5e |..t....^|.......^|
|00001580| 01 00 00 00 02 03 02 00 | 00 01 83 7c 00 03 01 01 |........|...|....|
|00001590| 01 00 00 03 01 d8 01 a4 | 01 e3 01 b8 4d 6f 2e 01 |........|....Mo..|
|000015a0| 00 00 00 02 03 02 00 00 | 01 83 74 00 03 01 01 01 |........|..t.....|
|000015b0| 00 00 03 01 d8 01 c0 01 | e3 01 d5 44 61 79 01 00 |........|...Day..|
|000015c0| 00 00 02 03 02 00 00 01 | 83 6c 00 03 01 01 01 00 |........|.l......|
|000015d0| 00 02 01 d8 01 e6 01 e3 | 01 f4 59 72 02 00 00 00 |........|..Yr....|
|000015e0| 02 03 02 00 01 d6 21 14 | 01 a5 df d5 01 d6 21 14 |......!.|......!.|
|000015f0| 01 fd 94 eb 02 00 00 00 | 02 03 02 00 01 cd 7b 6d |........|......{m|
|00001600| 01 be b9 8a 01 e0 81 78 | 01 be b9 8a 02 00 00 00 |.......x|........|
|00001610| 02 03 02 00 01 cd 7b 6d | 01 e3 44 fe 01 e0 81 78 |......{m|..D....x|
|00001620| 01 e3 44 fe 0a 00 00 00 | 02 03 01 00 02 05 92 d5 |..D.....|........|
|00001630| 00 0e 00 00 02 1b 00 00 | 00 66 ed 85 00 06 00 06 |........|.f......|
|00001640| 00 00 01 40 00 01 83 58 | 00 01 83 38 01 00 00 00 |...@...X|...8....|
|00001650| 02 03 02 00 00 01 83 54 | 00 03 01 01 01 00 00 03 |.......T|........|
|00001660| 02 10 00 0e 02 1b 00 22 | 4d 6f 2e 01 00 00 00 02 |......."|Mo......|
|00001670| 03 02 00 00 01 83 4c 00 | 03 01 01 01 00 00 03 02 |......L.|........|
|00001680| 10 00 29 02 1b 00 3e 44 | 61 79 01 00 00 00 02 03 |..)...>D|ay......|
|00001690| 02 00 00 01 83 44 00 03 | 01 01 01 00 00 02 02 10 |.....D..|........|
|000016a0| 00 4f 02 1b 00 5d 59 72 | 02 00 00 00 02 03 02 00 |.O...]Yr|........|
|000016b0| 02 0e 38 7c 00 0f 38 6f | 02 0e 38 7c 00 66 ed 85 |..8|..8o|..8|.f..|
|000016c0| 02 00 00 00 02 03 02 00 | 02 05 92 d5 00 28 12 24 |........|.....(.$|
|000016d0| 02 18 98 e0 00 28 12 24 | 02 00 00 00 02 03 02 00 |.....(.$|........|
|000016e0| 02 05 92 d5 00 4c 9d 98 | 02 18 98 e0 00 4c 9d 98 |.....L..|.....L..|
|000016f0| 00 00 00 00 02 03 02 00 | 01 00 00 00 02 03 02 00 |........|........|
|00001700| 00 01 83 30 00 03 01 01 | 01 00 00 03 00 92 00 e9 |...0....|........|
|00001710| 00 9d 00 fd 4d 6f 2e 01 | 00 00 00 02 03 02 00 00 |....Mo..|........|
|00001720| 01 83 28 00 03 01 01 01 | 00 00 03 00 92 00 fc 00 |..(.....|........|
|00001730| 9d 01 11 44 61 79 01 00 | 00 00 02 03 02 00 00 01 |...Day..|........|
|00001740| 83 20 00 03 01 01 01 00 | 00 02 00 92 01 15 00 9d |. ......|........|
|00001750| 01 23 59 72 02 00 00 00 | 02 03 02 00 00 8f 8c ab |.#Yr....|........|
|00001760| 00 ea 3b d2 00 8f 8c ab | 01 25 06 ea 02 00 00 00 |..;.....|.%......|
|00001770| 02 03 02 00 00 86 e7 04 | 00 fa e4 4c 00 99 ed 0f |........|...L....|
|00001780| 00 fa e4 4c 02 00 00 00 | 02 03 02 00 00 86 e7 04 |...L....|........|
|00001790| 01 13 63 96 00 99 ed 0f | 01 13 63 96 04 00 00 00 |..c.....|..c.....|
|000017a0| 02 03 02 00 01 b2 04 5e | 00 81 62 b4 01 ba c8 f0 |.......^|..b.....|
|000017b0| 00 8a 6c 18 01 00 00 00 | 02 03 02 00 00 01 83 08 |..l.....|........|
|000017c0| 00 03 01 01 01 00 00 05 | 01 b2 00 8e 01 bd 00 a9 |........|........|
|000017d0| 20 20 59 45 53 04 00 00 | 00 02 03 02 00 01 b2 04 |  YES...|........|
|000017e0| 5e 00 b0 93 c2 01 ba c8 | f0 00 ba 9e 32 01 00 00 |^.......|....2...|
|000017f0| 00 02 03 02 00 00 01 82 | fc 00 03 01 01 01 00 00 |........|........|
|00001800| 03 01 b2 00 c2 01 bd 00 | d6 20 4e 4f 04 00 00 00 |........|. NO....|
|00001810| 02 03 02 00 01 b2 04 5e | 00 10 b2 c6 01 ba c8 f0 |.......^|........|
|00001820| 00 19 bc 2a 01 00 00 00 | 02 03 02 00 00 01 82 f0 |...*....|........|
|00001830| 00 03 01 01 01 00 00 05 | 01 b2 00 1d 01 bd 00 38 |........|.......8|
|00001840| 20 20 59 45 53 04 00 00 | 00 02 03 02 00 01 b2 04 |  YES...|........|
|00001850| 5e 00 3f e3 d4 01 ba c8 | f0 00 49 ee 44 01 00 00 |^.?.....|..I.D...|
|00001860| 00 02 03 02 00 00 01 82 | e4 00 03 01 01 01 00 00 |........|........|
|00001870| 03 01 b2 00 51 01 bd 00 | 65 20 4e 4f 04 00 00 00 |....Q...|e NO....|
|00001880| 02 03 02 00 01 b2 04 5e | 01 06 a6 84 01 ba c8 f0 |.......^|........|
|00001890| 01 0f af e8 01 00 00 00 | 02 03 02 00 00 01 82 d8 |........|........|
|000018a0| 00 03 01 01 01 00 00 05 | 01 b2 01 13 01 bd 01 2e |........|........|
|000018b0| 20 20 59 45 53 04 00 00 | 00 02 03 02 00 01 b2 04 |  YES...|........|
|000018c0| 5e 01 35 d7 92 01 ba c8 | f0 01 3f e2 02 01 00 00 |^.5.....|..?.....|
|000018d0| 00 02 03 02 00 00 01 82 | cc 00 03 01 01 01 00 00 |........|........|
|000018e0| 03 01 b2 01 47 01 bd 01 | 5b 20 4e 4f 04 00 00 00 |....G...|[ NO....|
|000018f0| 02 03 02 00 01 b2 04 5e | 01 84 13 84 01 ba c8 f0 |.......^|........|
|00001900| 01 8d 1c e8 01 00 00 00 | 02 03 02 00 00 01 82 c0 |........|........|
|00001910| 00 03 01 01 01 00 00 05 | 01 b2 01 91 01 bd 01 ac |........|........|
|00001920| 20 20 59 45 53 04 00 00 | 00 02 03 02 00 01 b2 04 |  YES...|........|
|00001930| 5e 01 b3 44 92 01 ba c8 | f0 01 bd 4f 02 01 00 00 |^..D....|...O....|
|00001940| 00 02 03 02 00 00 01 82 | b4 00 03 01 01 01 00 00 |........|........|
|00001950| 03 01 b2 01 c5 01 bd 01 | d9 20 4e 4f 02 00 00 00 |........|. NO....|
|00001960| 02 03 02 00 00 8f a1 75 | 00 12 a8 7a 00 8f a1 75 |.......u|...z...u|
|00001970| 00 d9 93 54 01 00 00 00 | 02 03 02 00 00 01 82 a8 |...T....|........|
|00001980| 00 03 01 01 01 00 00 04 | 00 93 00 12 00 9e 00 2d |........|.......-|
|00001990| 4c 41 53 54 01 00 00 00 | 02 03 02 00 00 01 82 a0 |LAST....|........|
|000019a0| 00 03 01 01 01 00 00 05 | 00 93 00 6a 00 9e 00 88 |........|...j....|
|000019b0| 46 49 52 53 54 01 00 00 | 00 02 03 02 00 00 01 82 |FIRST...|........|
|000019c0| 98 00 03 01 01 01 00 00 | 06 00 93 00 af 00 9e 00 |........|........|
|000019d0| d5 4d 49 44 44 4c 45 04 | 00 00 00 02 03 02 00 00 |.MIDDLE.|........|
|000019e0| c1 d1 59 00 92 0b 2e 00 | cb 8f 54 00 9b 14 92 01 |..Y.....|..T.....|
|000019f0| 00 00 00 02 03 02 00 00 | 01 82 84 00 03 01 01 01 |........|........|
|00001a00| 00 00 05 00 c2 00 9f 00 | cd 00 ba 20 20 59 45 53 |........|...  YES|
|00001a10| 04 00 00 00 02 03 02 00 | 00 c1 d1 59 00 c1 3c 3c |........|...Y..<<|
|00001a20| 00 cb 8f 54 00 cb 46 ac | 01 00 00 00 02 03 02 00 |...T..F.|........|
|00001a30| 00 01 82 78 00 03 01 01 | 01 00 00 03 00 c2 00 d3 |...x....|........|
|00001a40| 00 cd 00 e7 20 4e 4f 0a | 00 00 00 02 03 01 00 00 |.... NO.|........|
|00001a50| c1 b9 23 01 43 00 00 00 | d7 00 00 01 7f 2d 42 00 |..#.C...|.....-B.|
|00001a60| 06 00 06 00 00 01 40 00 | 01 82 70 00 01 82 50 01 |......@.|..p...P.|
|00001a70| 00 00 00 02 03 02 00 00 | 01 82 6c 00 03 01 01 01 |........|..l.....|
|00001a80| 00 00 03 00 cc 01 43 00 | d7 01 57 4d 6f 2e 01 00 |......C.|..WMo...|
|00001a90| 00 00 02 03 02 00 00 01 | 82 64 00 03 01 01 01 00 |........|.d......|
|00001aa0| 00 03 00 cb 01 59 00 d6 | 01 6e 44 61 79 01 00 00 |.....Y..|.nDay...|
|00001ab0| 00 02 03 02 00 00 01 82 | 5c 00 03 01 01 01 00 00 |........|\.......|
|00001ac0| 02 00 cb 01 71 00 d6 01 | 7f 59 72 02 00 00 00 02 |....q...|.Yr.....|
|00001ad0| 03 02 00 00 c9 35 23 01 | 44 62 2a 00 c9 35 23 01 |.....5#.|Db*..5#.|
|00001ae0| 7f 2d 42 02 00 00 00 02 | 03 02 00 00 d2 d0 ba 01 |.-B.....|........|
|00001af0| 55 0a a4 00 c1 b9 2c 01 | 55 0a a4 02 00 00 00 02 |U.....,.|U.......|
|00001b00| 03 02 00 00 d2 d0 ba 01 | 6d 89 ee 00 c1 b9 23 01 |........|m.....#.|
|00001b10| 6d 89 ee 00 00 00 00 02 | 03 02 00 0a 00 00 00 02 |m.......|........|
|00001b20| 03 01 00 00 c1 b9 23 01 | b5 00 00 00 d7 00 00 01 |......#.|........|
|00001b30| f1 00 00 00 06 00 06 00 | 00 01 40 00 01 82 48 00 |........|..@...H.|
|00001b40| 01 82 28 01 00 00 00 02 | 03 02 00 00 01 82 44 00 |..(.....|......D.|
|00001b50| 03 01 01 01 00 00 03 00 | cc 01 b5 00 d7 01 c9 4d |........|.......M|
|00001b60| 6f 2e 01 00 00 00 02 03 | 02 00 00 01 82 3c 00 03 |o.......|.....<..|
|00001b70| 01 01 01 00 00 03 00 cb | 01 cb 00 d6 01 e0 44 61 |........|......Da|
|00001b80| 79 01 00 00 00 02 03 02 | 00 00 01 82 34 00 03 01 |y.......|....4...|
|00001b90| 01 01 00 00 02 00 cb 01 | e3 00 d6 01 f1 59 72 02 |........|.....Yr.|
|00001ba0| 00 00 00 02 03 02 00 00 | c9 35 23 01 b6 0c f2 00 |........|.5#.....|
|00001bb0| c9 35 23 01 f0 d8 0a 02 | 00 00 00 02 03 02 00 00 |.5#.....|........|
|00001bc0| d2 d0 ba 01 c6 b5 6c 00 | c1 b9 2c 01 c6 b5 6c 02 |......l.|..,...l.|
|00001bd0| 00 00 00 02 03 02 00 00 | d2 d0 ba 01 df 34 b6 00 |........|.....4..|
|00001be0| c1 b9 23 01 df 34 b6 00 | 00 00 00 02 03 02 00 01 |..#..4..|........|
|00001bf0| 00 00 00 02 03 02 00 00 | 01 82 20 00 04 01 01 01 |........|.. .....|
|00001c00| 00 00 42 02 c3 00 83 02 | ce 01 97 54 68 69 73 20 |..B.....|...This |
|00001c10| 64 6f 63 75 6d 65 6e 74 | 20 77 61 73 20 63 72 65 |document| was cre|
|00001c20| 61 74 65 64 20 75 73 69 | 6e 67 20 74 68 65 20 41 |ated usi|ng the A|
|00001c30| 70 70 6c 65 20 4c 61 73 | 65 72 57 72 69 74 65 72 |pple Las|erWriter|
|00001c40| 20 61 6e 64 20 4d 61 63 | 44 72 61 77 2e 00 00 00 | and Mac|Draw....|
|00001c50| 00 02 03 02 00 00 00 00 | 00 02 03 02 00 00 00 00 |........|........|
|00001c60| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001c70| 00 00 00 00 00 00 00 00 | 00 00 00 00 00 00 00 00 |........|........|
|00001c80| 00 00 01 00 00 00 01 3c | 00 00 00 3c 00 00 00 3e |.......<|...<...>|
|00001c90| 08 16 28 32 33 49 20 08 | 66 70 00 04 29 a0 d0 08 |..(23I .|fp..)...|
|00001ca0| 66 c0 00 80 17 b0 28 08 | 75 01 00 0d 80 01 3c 14 |f.....(.|u.....<.|
|00001cb0| 0b 61 62 63 20 6d 65 64 | 69 63 61 6c 02 00 00 00 |.abc med|ical....|
|00001cc0| 44 52 57 47 4d 44 52 57 | 01 00 ff ff ff ff 1e 17 |DRWGMDRW|........|
|00001cd0| 00 00 44 52 57 47 4d 44 | 52 57 01 00 ff ff ff ff |..DRWGMD|RW......|
|00001ce0| 1e 17 70 d0 00 00 00 00 | 00 00 00 00 00 00 00 00 |..p.....|........|
|00001cf0| 00 00 98 3b 73 66 00 00 | 1b dd 00 00 01 7a 0c 35 |...;sf..|.....z.5|
|00001d00| 0a fa a0 12 40 09 55 09 | 28 9f 00 01 0a 65 04 c4 |....@.U.|(....e..|
|00001d10| 1e c0 00 80 09 55 06 0a | 81 a0 02 0a 65 0d ee 80 |.....U..|....e...|
|00001d20| 50 04 80 09 55 03 c7 80 | 00 0a 0a 46 38 00 20 15 |P...U...|...F8. .|
|00001d30| 0a 55 18 00 80 08 29 0a | 55 06 01 50 11 f0 0a 65 |.U....).|U..P...e|
|00001d40| 01 fe 20 06 40 80 09 55 | 08 04 88 07 80 0a 55 06 |.. .@..U|......U.|
|00001d50| 07 10 00 83 0a 25 01 fc | 22 01 e0 09 38 10 07 d0 |.....%..|"...8...|
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