<EMISWebDocTemplate><DisplayGroups></DisplayGroups><DefaultDocumentType>63301000000111</DefaultDocumentType><Description>Heart Failure referral</Description><TemplateRtf><![CDATA[{\rtf1\adeflang1025\ansi\ansicpg1252\uc1\adeff0\deff0\stshfdbch0\stshfloch36\stshfhich36\stshfbi36\deflang2057\deflangfe2057\themelang2057\themelangfe0\themelangcs0{\fonttbl{\f0\fbidi \froman\fcharset0\fprq2{\*\panose 02020603050405020304}Times New Roman;}
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Patient Work Telephone}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend PddB3kZmtQtdQlx1Nio9} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid6703067  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par }\pard \ltrpar\ql \li0\ri-421\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-421\lin0\itap0\pararsid16540497 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\cf6\insrsid16540497 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\cf6\insrsid16540497\charrsid11341219 Please ensure a daytime contact telephone number included so tests can be quickly booked.
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid16540497 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par First Language\tab {\*\bkmkstart Pa1TWLVh1EEwyfxFmfmH}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 
00020000140000001450613154574c566831454577796678466d666d4800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pa1TWLVh1EEwyfxFmfmH}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 Main Language}}}
\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend Pa1TWLVh1EEwyfxFmfmH} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid6703067  }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par Interpreter Needed? \tab {\*\bkmkstart PhUTxHXfOO2UOA47ceYj}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 
00020000140000001450685554784858664f4f32554f4134376365596a00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PhUTxHXfOO2UOA47ceYj}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 Advocacy Needs}}}
\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend PhUTxHXfOO2UOA47ceYj} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid6703067  }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497  
\par 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\ul\insrsid16540497\charrsid5929805 GP Details
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par Referring GP\tab \tab {\*\bkmkstart R1lWUKQ4BLknWiQY1bN5}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16612232  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16612232 {\*\datafield 
00020000140000001452316c57554b5134424c6b6e5769515931624e3500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname R1lWUKQ4BLknWiQY1bN5}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16612232 Referring User}}}
\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16612232 {\*\bkmkend R1lWUKQ4BLknWiQY1bN5} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497  

\par Usual GP\tab \tab {\*\bkmkstart Pi5FKhMXtZ5L2NAOHENi}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 
000200001400000014506935464b684d58745a354c324e414f48454e6900000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Pi5FKhMXtZ5L2NAOHENi}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 Usual GP Full Name}
}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend Pi5FKhMXtZ5L2NAOHENi} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid6703067  }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par Registered GP\tab {\*\bkmkstart PiI6ATrCYuTipb1ybB38}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 
000200001400000014506949364154724359755469706231796242333800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PiI6ATrCYuTipb1ybB38}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 
Registered GP Full Name}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend PiI6ATrCYuTipb1ybB38} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid6703067  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 Practice Name\tab }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 {\*\bkmkstart OxKfaI6kRWhwSl7ueBkM} FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid11809754 {\*\datafield 0002000014000000144f784b666149366b52576877536c377565426b4d00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OxKfaI6kRWhwSl7ueBkM}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid11809754 Organisation Name}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 {\*\bkmkend OxKfaI6kRWhwSl7ueBkM}  
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893 Practice}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754  Address}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893 \tab {\*\bkmkstart OliXEgnbWfw1N8AObGTe}}
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11824184  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11824184 {\*\datafield 0002000014000000144f6c695845676e62576677314e38414f6247546500000000000000000000000000}
{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OliXEgnbWfw1N8AObGTe}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11824184 Organisation Full Address (single line)}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11824184 {\*\bkmkend OliXEgnbWfw1N8AObGTe} }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid6703067  }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 Practice Telephone \tab {\*\bkmkstart OPsj6NRZbDK4HubaXFYU}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid678893 {\*\datafield 0002000014000000144f50736a364e525a62444b34487562615846595500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OPsj6NRZbDK4HubaXFYU}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid678893 Organisation Telephone Number}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893 {\*\bkmkend OPsj6NRZbDK4HubaXFYU} }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid6703067  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par Practice Code\tab \tab {\*\bkmkstart OhbNaI7DeXHiYyBOehrk}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893 {\*\datafield 
0002000014000000144f68624e61493744655848695979424f6568726b00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname OhbNaI7DeXHiYyBOehrk}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893 
Organisation National Practice Code}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid678893 {\*\bkmkend OhbNaI7DeXHiYyBOehrk} }{\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \fs22\insrsid6703067   }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par 
\par Date of referral \tab {\*\bkmkstart ddhjrPxLx4c9jfOCye8o}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid678893  FORMTEXT }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid678893 {\*\datafield 
0002000014000000146464686a7250784c783463396a664f437965386f00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname ddhjrPxLx4c9jfOCye8o}}}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid678893 
Short date letter merged}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid678893 {\*\bkmkend ddhjrPxLx4c9jfOCye8o} }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid6703067  }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid16540497\charrsid12530619 
\par }{\rtlch\fcs1 \af0 \ltrch\fcs0 \lang1024\langfe1024\noproof\langnp2057\langfenp2057\insrsid7160602 
{\shp{\*\shpinst\shpleft21\shptop64\shpright10118\shpbottom64\shpfhdr0\shpbxcolumn\shpbxignore\shpbypara\shpbyignore\shpwr3\shpwrk0\shpfblwtxt0\shpz0\shplid1028{\sp{\sn shapeType}{\sv 32}}{\sp{\sn fFlipH}{\sv 0}}{\sp{\sn fFlipV}{\sv 0}}
{\sp{\sn fLockRotation}{\sv 0}}{\sp{\sn fLockAspectRatio}{\sv 0}}{\sp{\sn fLockPosition}{\sv 0}}{\sp{\sn fLockAgainstSelect}{\sv 0}}{\sp{\sn fLockVerticies}{\sv 0}}{\sp{\sn fLockAdjustHandles}{\sv 0}}
{\sp{\sn fLockAgainstGrouping}{\sv 0}}{\sp{\sn fFilled}{\sv 0}}{\sp{\sn fArrowheadsOK}{\sv 1}}{\sp{\sn fLine}{\sv 1}}{\sp{\sn fLockShapeType}{\sv 1}}{\sp{\sn wzName}{\sv Straight Arrow Connector 1}}{\sp{\sn metroBlob}{\sv {\*\svb 

65762e786d6c504b05060000000004000400f3000000860500000000}}}{\sp{\sn dhgt}{\sv 251659264}}{\sp{\sn fLayoutInCell}{\sv 1}}{\sp{\sn fAllowOverlap}{\sv 1}}
{\sp{\sn fBehindDocument}{\sv 0}}{\sp{\sn fHidden}{\sv 0}}{\sp{\sn fLayoutInCell}{\sv 1}}}{\shprslt{\*\do\dobxcolumn\dobypara\dodhgt8192\dppolyline\dppolycount2\dpptx0\dppty0\dpptx10097\dppty0\dpx21\dpy64\dpxsize10097\dpysize0
\dpfillfgcr255\dpfillfgcg255\dpfillfgcb255\dpfillbgcr255\dpfillbgcg255\dpfillbgcb255\dpfillpat0\dplinew15\dplinecor0\dplinecog0\dplinecob0}}}}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid16540497 Send}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid13243696  through}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid16540497\charrsid15822970  the }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\b\fs22\insrsid16540497 RSS for booking into }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid16540497\charrsid15822970 York Hospital Foundation }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \b\fs22\insrsid16540497 Trust eReferrals  }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \b\fs22\insrsid13243696 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid16540497 The service is listed under}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid10052765  Cardiology}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid15027887 ,}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid10052765  Heart Failure}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid16540497\charrsid11291574 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid345400 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\ul\lang2057\langfe1033\langnp2057\insrsid16540497 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid13243696 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid13243696\charrsid5842420 
Once patients have had an Echo those with significant LVSD or other cardiac abnormality will be referred directly from Echo to the appropriate cardiac clinic and may be referred to community nurse specialists. 
\par 
\par Where Echo is normal the patient will be requested to return to primary care for further investigation of symptoms.}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid13243696 
\par }\pard\plain \ltrpar\s25\ql \li0\ri0\widctlpar\wrapdefault\faauto\rin0\lin0\itap0\pararsid4924481 \rtlch\fcs1 \af1\afs24\alang1025 \ltrch\fcs0 \f1\fs24\cf1\lang2057\langfe2057\cgrid\langnp2057\langfenp2057 {\rtlch\fcs1 \af1 \ltrch\fcs0 \insrsid4924481 

\par }{\rtlch\fcs1 \af1\afs23 \ltrch\fcs0 \b\fs23\insrsid4924481\charrsid4924481 Investigations prior to referral: ECG, FBC, U & E, TFT, LFT, Lipids and glucose/ HbA1c, BNP, CXR.
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid345400 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\b\ul\lang2057\langfe1033\langnp2057\insrsid13243696 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af0 \ltrch\fcs0 \b\ul\lang2057\langfe1033\langnp2057\insrsid16540497 \page 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid5842420 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\ul\insrsid9964780 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\ul\insrsid5842420\charrsid5842420 Patient Details
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid5842420\charrsid5842420 
\par }\pard \ltrpar\ql \li0\ri-421\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin-421\lin0\itap0\pararsid2959337 {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337\charrsid8980151 Patient Name}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid2959337  \tab \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid11809754 {\*\bkmkstart POMNVu5t89UgywSWexcm}\tab }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 000200001400000014504f4d4e5675357438395567797753576578636d00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname POMNVu5t89UgywSWexcm}}}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 
\ltrch\fcs0 \fs22\insrsid2626058 Full Name}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend POMNVu5t89UgywSWexcm} }{\rtlch\fcs1 
\af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337  
\par Patient Gender}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid11809754 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337 \tab {\*\bkmkstart P1WLX8pAmgCf1U2RSaiE}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 0002000014000000145031574c583870416d674366315532525361694500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname 
P1WLX8pAmgCf1U2RSaiE}}}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058 Gender}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid2626058 {\*\bkmkend P1WLX8pAmgCf1U2RSaiE} }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337  
\par }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337\charrsid8980151 Date of Birth}{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337  \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid11809754 \tab }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 
\fs22\insrsid2959337 \tab {\*\bkmkstart P8Hte1P6Afih1xxe8xlC}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 
0002000014000000145038487465315036416669683178786538786c4300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname P8Hte1P6Afih1xxe8xlC}}}}}{\fldrslt {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058 Date of Birth}}}
\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\bkmkend P8Hte1P6Afih1xxe8xlC} }{\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337  }{
\rtlch\fcs1 \af0\afs22 \ltrch\fcs0 \fs22\insrsid2959337\charrsid8980151 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2959337 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2959337\charrsid8980151 NHS Number }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid2959337 \tab }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 \tab }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2959337 \tab {\*\bkmkstart PooISnUfGjuVh6d5h73H}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid2626058  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 {\*\datafield 000200001400000014506f6f49536e5566476a7556683664356837334800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname 
PooISnUfGjuVh6d5h73H}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid2626058 NHS Number}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid2626058 {\*\bkmkend PooISnUfGjuVh6d5h73H} }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid5842420 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 Patient Home Address\tab }{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 {\*\bkmkstart PUYyIJY4Eha59hQzWU2H} FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid11809754 {\*\datafield 00020000140000001450555979494a5934456861353968517a5755324800000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname PUYyIJY4Eha59hQzWU2H}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\insrsid11809754 Home Full Address (single line)}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754 {\*\bkmkend PUYyIJY4Eha59hQzWU2H} }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\insrsid11809754\charrsid5842420 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid345400 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\ul\lang2057\langfe1033\langnp2057\insrsid5842420\charrsid5842420 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\ul\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 Clinical Information}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\ul\lang2057\langfe1033\langnp2057\insrsid1796921\charrsid5842420 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4544304\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2802\clshdrawnil \cellx2694\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5714\clshdrawnil 
\cellx8408\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid345400\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 Symptoms\cell {\*\bkmkstart Text23}}{\field{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMTEXT }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 00000000140000000654657874323300000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text23}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \fs22\lang1024\langfe1024\noproof\langnp2057\insrsid2453706 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \b\fs22\ul\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 {\*\bkmkend Text23}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8856952\charrsid5842420 \trowd \irow0\irowband0\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4544304\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb
\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2802\clshdrawnil \cellx2694\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5714\clshdrawnil \cellx8408\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid345400\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 Date of Onset\cell {\*\bkmkstart Text24}}{\field{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMTEXT }{\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 00000000140000000654657874323400000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text24}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang1024\langfe1024\noproof\langnp2057\insrsid2453706 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid8142435\charrsid5842420 {\*\bkmkend Text24}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8856952\charrsid5842420 \trowd \irow1\irowband1\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4544304\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb
\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2802\clshdrawnil \cellx2694\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5714\clshdrawnil \cellx8408\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid345400\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 NYHA Class:\cell {\*\bkmkstart Dropdown1}}{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMDROPDOWN }{\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 
66800000000000000944726f70646f776e3100000000000000000000000000dc000500050000000a000a0023004d007b00a90018506c656173652073656c65637420636c61737320202020202931202d206e6f206c696d69746174696f6e206f6620706879736963616c2061637469766974792020202d32202d20736c6967
6874206c696d69746174696f6e206f6620706879736963616c2061637469766974792020202d33202d206d61726b6564206c696d69746174696f6e206f6620706879736963616c2061637469766974792020203234202d20696e6162696c69747920746f206361727279206f757420616e7920706879736963616c20616374
69766974792020}{\*\formfield{\fftype2\ffres25\fftypetxt0\ffhaslistbox{\*\ffname Dropdown1}\ffdefres0{\*\ffl Please select class     }{\*\ffl 1 - no limitation of physical activity   }{\*\ffl 2 - slight limitation of physical activity   }{\*\ffl 
3 - marked limitation of physical activity   }{\*\ffl 4 - inability to carry out any physical activity  }}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 {\*\bkmkend Dropdown1}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8856952\charrsid5842420 \trowd \irow2\irowband2\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4544304\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb
\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2802\clshdrawnil \cellx2694\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5714\clshdrawnil \cellx8408\row \ltrrow}\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid345400\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 Relevant physical signs:\cell {\*\bkmkstart Text25}}{\field{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMTEXT }{\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 00000000140000000654657874323500000000000000000000000000}{\*\formfield{\fftype0\fftypetxt0\ffhps20{\*\ffname Text25}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang1024\langfe1024\noproof\langnp2057\insrsid2453706 \u8194\'20\u8194\'20\u8194\'20\u8194\'20\u8194\'20}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 {\*\bkmkend Text25}\cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid8856952\charrsid5842420 \trowd \irow3\irowband3\lastrow \ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4544304\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb
\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth2802\clshdrawnil \cellx2694\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth5714\clshdrawnil \cellx8408\row }\pard \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid345400 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid8856952 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 
If Red flag symptoms or signs are present (see RSS Guideline) please consider urgent hospital advice or admission
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid345400 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\ul\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 Risk factors for Heart Failure}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 \tab }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid1796921\charrsid5842420  \tab \tab \tab }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 \tab \tab 
\par \ltrrow}\trowd \irow0\irowband0\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 
\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil \cellx8408\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid160392 Previous MI\cell {\*\bkmkstart TI5e359qHqFIkXaIgA8Z}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid160392\charrsid160392  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid160392\charrsid160392 {\*\datafield 
0002000014000000145449356533353971487146496b5861496741385a00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TI5e359qHqFIkXaIgA8Z}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid160392\charrsid160392 Single Code Entry: Acute myocardial infarction}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid160392\charrsid160392 {\*\bkmkend TI5e359qHqFIkXaIgA8Z}  \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid160392\charrsid5842420 \trowd \irow0\irowband0\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil \cellx8408\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid16612232 Previous angina\cell {\*\bkmkstart T7fgakA4GDz1sNLNjCfu}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232  FORMTEXT }{\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232 {\*\datafield 00020000140000001454376667616b413447447a31734e4c4e6a43667500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname 
T7fgakA4GDz1sNLNjCfu}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232 Single Code Entry: Angina pectoris}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232 {\*\bkmkend T7fgakA4GDz1sNLNjCfu}  \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16612232\charrsid5842420 
\trowd \irow1\irowband1\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil 
\cellx8408\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid5379207 Hypertension}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid160392 \cell {\*\bkmkstart TjRNAz1b7u2m2mQaOUiq}}{\field\fldedit{\*\fldinst {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780\charrsid9964780  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780\charrsid9964780 {\*\datafield 
000200001400000014546a524e417a31623775326d326d51614f55697100000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TjRNAz1b7u2m2mQaOUiq}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780\charrsid9964780 Single Code Entry: Hypertensive disease}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780\charrsid9964780 {\*\bkmkend TjRNAz1b7u2m2mQaOUiq}  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid160392\charrsid9964780 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid160392\charrsid5842420 
\trowd \irow2\irowband2\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil 
\cellx8408\row \ltrrow}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5379207\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid5379207\charrsid5842420 Alcohol intake \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 
{\*\bkmkstart Tw4nMOfW6DESZRaHuiru}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid5379207\charrsid9964780  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid5379207\charrsid9964780 {\*\datafield 0002000014000000145477346e4d4f6657364445535a5261487569727500000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname Tw4nMOfW6DESZRaHuiru}}}}
}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid5379207\charrsid9964780 Single Code Entry: Alcohol consumption}}}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid5379207\charrsid9964780 {\*\bkmkend Tw4nMOfW6DESZRaHuiru}    }{\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid5379207 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid5379207\charrsid5842420 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid5379207\charrsid5842420 \trowd \irow3\irowband3\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid730223\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil \cellx8408\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid5842420 Arrhythmia\cell {\*\bkmkstart TjVcOMzYJ8FvQK3cKcTw}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid4797418  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid4797418 {\*\datafield 
000200001400000014546a56634f4d7a594a384676514b33634b63547700000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TjVcOMzYJ8FvQK3cKcTw}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid4797418 Single Code Entry: Cardiac dysrhythmias}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid4797418 {\*\bkmkend TjVcOMzYJ8FvQK3cKcTw}  \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4797418\charrsid5842420 \trowd \irow4\irowband4\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil \cellx8408\row \ltrrow
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid11809754 ECG\cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid4609728\yts18 
{\*\bkmkstart TQK7kwhpcIBeDJrnlTKc}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 
{\*\datafield 00020000140000001454514b376b77687063494265444a726e6c544b6300000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TQK7kwhpcIBeDJrnlTKc}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 Single Code Entry: Electrocardiography}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 {\*\bkmkend TQK7kwhpcIBeDJrnlTKc}  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4797418\charrsid5842420 
\trowd \irow5\irowband5\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil 
\cellx8408\row \ltrrow}\trowd \irow6\irowband6\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6115458\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0
\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth1988\clshdrawnil \cellx3518\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3184\clshdrawnil \cellx6702\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl 
\clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth393\clshdrawnil \cellx7095\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth469\clshdrawnil \cellx7564\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl 
\clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth375\clshdrawnil \cellx7939\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth469\clshdrawnil \cellx8408\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 Abnormal?}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid5842420   \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid4797418\yts18 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 Y }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid4797418    }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid4797418 N}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418  }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 {\*\datafield 
650000001400000006436865636b3200000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check2}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 \cell }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid11809754\yts18 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid5842420 ECG result attached  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418\charrsid5842420 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid4609728\yts18 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 Y}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 \cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 {\*\datafield 650000001400000006436865636b3100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check1}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 \cell }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 N}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 \cell }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid4797418  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid4797418 {\*\datafield 650000001400000006436865636b3200000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check2}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid4797418 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid4797418\charrsid5842420 \trowd \irow6\irowband6\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid6115458\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1988\clshdrawnil \cellx3518\clvertalt\clbrdrt
\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth3184\clshdrawnil \cellx6702\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth393\clshdrawnil \cellx7095
\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth469\clshdrawnil \cellx7564\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth375\clshdrawnil \cellx7939\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth469\clshdrawnil \cellx8408\row \ltrrow}\trowd \irow7\irowband7\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil \cellx8408\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid11809754 BNP result*\cell {\*\bkmkstart TMmnAK7AAMpIk9O1Fa1B}}{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232\charrsid11809754  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232\charrsid11809754 {\*\datafield 
000200001400000014544d6d6e414b3741414d70496b394f314661314200000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname TMmnAK7AAMpIk9O1Fa1B}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232\charrsid11809754 Single Code Entry: Serum pro-brain natriuretic peptide level...}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16612232\charrsid11809754 {\*\bkmkend TMmnAK7AAMpIk9O1Fa1B}  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid11809754 \cell 
}\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 
\insrsid16669822\charrsid5842420 \trowd \irow7\irowband7\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1638\clshdrawnil \cellx1530\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6878\clshdrawnil \cellx8408\row \ltrrow
}\trowd \irow8\irowband8\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6810\clshdrawnil \cellx6702\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil 
\cellx8408\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid9964780\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid11809754\charrsid11809754 {\*\bkmkstart T3iIsE6glwz8GVuCVu3n}CXR?}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid11809754                  }
{\field\fldedit{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780  FORMTEXT }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780 {\*\datafield 
00020000140000001454336949734536676c777a38475675435675336e00000000000000000000000000}{\*\formfield{\fftype0\ffprot\fftypetxt0\ffhps20{\*\ffname T3iIsE6glwz8GVuCVu3n}}}}}{\fldrslt {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780 Single Code Entry: Standard chest X-ray}}}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780 {\*\bkmkend T3iIsE6glwz8GVuCVu3n}  
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid9964780\charrsid11809754 CXR result attached}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780     Y }
{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780 {\*\datafield 
650000001400000006436865636b3900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check9}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780     N }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780  FORMCHECKBOX }{\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid9964780 {\*\datafield 650000001400000007436865636b313000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check10}\ffdefres0}}}}{\fldrslt }}
\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\ul\lang2057\langfe1033\langnp2057\insrsid9964780\charrsid5842420 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid5842420\yts18 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid5842420\charrsid5842420 \cell }\pard \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 \cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16669822\charrsid5842420 
\trowd \irow8\irowband8\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt
\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6810\clshdrawnil \cellx6702\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1706\clshdrawnil 
\cellx8408\row \ltrrow}\trowd \irow9\irowband9\ltrrow\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0
\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6631\clshdrawnil \cellx6523\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl 
\cltxlrtb\clftsWidth3\clwWidth1885\clshdrawnil \cellx8408{\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \f3\fs22\lang2057\langfe1033\langfenp1033\insrsid16669822\charrsid5842420 \loch\af3\dbch\af0\hich\f3 \'b7\tab}
\pard\plain \ltrpar\s19\ql \fi-360\li720\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin720\pararsid5842420\yts18\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 This patient has had a previous MI or has an NT-proBNP > 2,000 pg/ml and }{\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid5842420\charrsid5842420 so }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 I am requesting referral via the }{\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \b\fs22\ul\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 URGENT}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420  pathway
\par }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 
\af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 \cell }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 Y }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 
\ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 650000001400000006436865636b3900000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check9}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337     N }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 650000001400000007436865636b313000000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check10}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 
\par }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 
\ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16669822\charrsid5842420 \trowd \irow9\irowband9\ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6631\clshdrawnil \cellx6523\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1885\clshdrawnil \cellx8408\row \ltrrow
{\listtext\pard\plain\ltrpar \s19 \intbl\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \f3\fs22\lang2057\langfe1033\langfenp1033\insrsid16669822\charrsid5842420 \loch\af3\dbch\af0\hich\f3 \'b7\tab}}\pard\plain \ltrpar
\s19\ql \fi-360\li720\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\ls4\adjustright\rin0\lin720\pararsid5842420\yts18\contextualspace \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 This patient has an NT-proBNP 400-2000 pg/ml and I am referring via the standard pathway (see RSS Heart Failure Guidelines)\cell }\pard\plain \ltrpar
\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\pararsid16669822\yts18 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 \f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 Y }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 650000001400000006436865636b3900000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check9}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect
\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337     N }{\field\flddirty\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 650000001400000007436865636b313000000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check10}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\fs22\lang2057\langfe1033\langnp2057\insrsid16669822\charrsid5842420 \cell }\pard\plain \ltrpar\ql \li0\ri0\widctlpar\intbl\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0 \rtlch\fcs1 \af0\afs24\alang1025 \ltrch\fcs0 
\f1\fs24\lang1033\langfe1033\cgrid\langnp1033\langfenp1033 {\rtlch\fcs1 \af0 \ltrch\fcs0 \insrsid16669822\charrsid5842420 \trowd \irow10\irowband10\lastrow \ltrrow
\ts18\trgaph108\trleft-108\trftsWidth1\trftsWidthB3\trftsWidthA3\trautofit1\trpaddl108\trpaddr108\trpaddfl3\trpaddft3\trpaddfb3\trpaddfr3\tblrsid4797418\tbllkhdrrows\tbllkhdrcols\tbllknocolband\tblind0\tblindtype3 \clvertalt\clbrdrt\brdrtbl \clbrdrl
\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth6631\clshdrawnil \cellx6523\clvertalt\clbrdrt\brdrtbl \clbrdrl\brdrtbl \clbrdrb\brdrtbl \clbrdrr\brdrtbl \cltxlrtb\clftsWidth3\clwWidth1885\clshdrawnil \cellx8408\row }\pard \ltrpar
\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid938242 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 \tab \tab \tab \tab \tab \tab \tab \tab \tab }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid5774367\charrsid5842420 \tab }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid938242\charrsid5842420                                     }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid8991473\charrsid5842420  }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid938242\charrsid5842420 
                                                 
\par }\pard \ltrpar\qc \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid345400 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid10975497 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420 For further informatio}{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid8856952\charrsid5842420 n please see RSS Suspected}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid345400\charrsid5842420  Heart Failure}{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid12013510\charrsid5842420  Guideline}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid10975497\charrsid5842420 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid10975497\charrsid5842420 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2959337 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 Results
\par }\pard \ltrpar\ql \fi-567\li567\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin567\itap0\pararsid2959337 {\*\bkmkstart Check11}{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 650000001400000007436865636b313100000000000000000000000000}
{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 
\b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\bkmkend Check11}    }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 
Normal left ventricular systolic function (echo does not support diagnosis of heart failure so no cardiology follow up arranged)
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 
650000001400000007436865636b313100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337     Mild left ventricular systolic dysfunction (echo does not support diagnosis of heart failure so no cardiology follow up arranged)
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 
650000001400000007436865636b313100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337     Moderate (supports the diagnosis of heart failure \endash  cardiology follow up will be arranged) 
\par }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 
650000001400000007436865636b313100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337     Severe (supports the diagnosis of heart failure \endash  cardiology follow up will be arranged) 
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2959337 {\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 650000001400000007436865636b313100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}
}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 
    Other significant cardiac abnormalities (see attached echo report)
\par }\pard \ltrpar\ql \li0\ri0\widctlpar\tx567\wrapdefault\aspalpha\aspnum\faauto\adjustright\rin0\lin0\itap0\pararsid2959337 {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337 \tab }{\field\fldpriv{\*\fldinst {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 
650000001400000007436865636b313100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337     Cardiology follow up being arranged
\par \tab }{\field\fldpriv{\*\fldinst {\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337  FORMCHECKBOX }{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\lang2057\langfe1033\langnp2057\insrsid2959337 {\*\datafield 
650000001400000007436865636b313100000000000000000000000000}{\*\formfield{\fftype1\ffres25\fftypetxt0\ffhps20{\*\ffname Check11}\ffdefres0}}}}{\fldrslt }}\sectd \ltrsect\linex0\headery709\footery709\colsx708\endnhere\sectdefaultcl\sectrsid15027887\sftnbj {
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \fs22\lang2057\langfe1033\langnp2057\insrsid2959337     Cardiology follow up not being arranged (GP to consider need)}{\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\ul\lang2057\langfe1033\langnp2057\insrsid2959337  }{
\rtlch\fcs1 \af1\afs22 \ltrch\fcs0 \b\fs22\ul\lang2057\langfe1033\langnp2057\insrsid5842420\charrsid13243696 
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