1/22/16 – The Prescription

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What forms can a prescription come in?
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-Paper -Phone -Fax -Electronic
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What information is required to be on all non-controlled prescriptions?
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-Full name of patient -Date the prescription was issued -Prescriber’s printed name and address -The drug name and strength -Quantity prescribed -Directions for use -Number of refills authorized
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True or False: A manual signature is required on all paper prescriptions presented to the pharmacy OR those transmitted from a prescriber’s office fax machine to the pharmacy fax machine
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True
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True or False: Computer-generated prescriptions require a \”wet\” signature.
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False -If computer program meets requirements of section 17754 of the public health code
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True or False: Cannot accept a prescription that does not have a manual signature if FAX to FAX, or generated by prescriber computer, printed off, and then faxed
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True
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True or False: Computer to computer, or computer to fax, for controlled substance, is OK if DEA certification is verified for both machine-software.
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True
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A paper controlled substance prescription must contain which information?
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-Written in ink or indelible pencil, or printer prepared -Pre-printed, stamped, typed or manually printed name, address and phone number or pager number of the prescribing practicioner -Manually printed patient name, address, and prescriber’s signature -Prescriber’s DEA number -Quantity of drug prescribed (both written AND numerical) -Date prescription was written
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What is required on a CS Rx taken into a community pharmacy?
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-Dated and signed when issued -Name and address of the patient -Prescriber’s DEA number -Printed name, address, and professional designation -Drug name, strength, dosage form -Directions for suse -Quantity prescribed
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When a PA or NP delegates a CS, what should be on the Rx?
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-Delegating name of MD or DO -DEA Number of delegating MD or DO -DEA Number of the PA or NP
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True or False: A CS prescription delegated by a PA or NP is void if the physician does not co-sign it.
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False: No delegating physician co-signature is required
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How many drugs can be written on a manually printed non-control Rx? How many for a printer prepared Rx?
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4 for manually printed 6 for printer prepared
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True or False: You cannot mix controlled and non-controlled drugs on the same Rx
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False
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Can a CII be mixed with a CIII-V on the same Rx?
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No, CII must be separate
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What is the max day supply for non-controlled Rx’s? CIII-V? CII?
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INFINITE
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What is the duration of life for a non-control prescription?
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1 year from date written
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What is the duration of life for a CIII-IV prescription?
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6 months from date written
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What is the duration of life for a C2 prescription?
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90 days from date written
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What is the duration of life for a CV prescription?
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1 year from date written
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True or False: A physician can use a stamped signature on a paper non-control prescription.
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False: Stamped sigs for any prescription are not allowed
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True or False: If a prescriber is using a preprinted prescription, they MAY add additional prescription orders on it.
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True
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In Michigan, there are 3 categories of prescription storage. What are they?
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-CII -CIII-V -Non controlled
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Under Michigan law, how long do we hang onto paper Rx copies?
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5 years from date last filled
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True or False: the patient \”owns\” the prescription up until the medication is dispensed
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True
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Under what circumstances (with who?) can a pharmacy share the confidentiality of a prescription?
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-Working with the patient issued the Rx -The authorized prescriber who issued the Rx or licensed health professional treating the patient -To an agency or agent of the government that is responsible for the enforcement of laws related to drugs and devices -A person authorized by court order -Person engaged in research projects with protocols approved by the Board
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What are the E-Prescription requirements as of June 1st, 2010?
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-Software requirement must be met through an audit or certification review -Prescriptions must conform with requirements -Only authorized employees must enter and manipulate info and records (where permissable by DEA regs) -Pharmacist’s annotation pertaining to a prescription must be retained electronically -Must be voided if a paper prescription of the same is received (or paper Rx voided)
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What should an E-Prescription include on it?
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-Name, address, phone # of prescriber -Full name of patient -Electronic sig or other identifier of prescriber -Date and time of transmission -Identity of the intended pharmacy -Any other info required by law -Shall not include DAW as default
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How does the electronic signature work for E-prescribing a controlled substance?
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-Meet same requirements as non-controlled drug, plus a unique identifier protected by appropriate security measures such that it is only available for use by the intended individual and ensure non-repudiation so that the signature may not be rejected based on its validity
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True or False: An institution Rx may contain up to 4 prescriptions and CSII-V and non-controlled substances on the same form.
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False -May contain more than 6 Rx’s on the same form -May contain CSIII-V and non-controlled substances on the same form
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How long should you hold on to original Rx orders from a medical institution?
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5 years form the date of patient discharge and shall be readily available for any specific time period -Electronic duplicate can be made after 3 years, and becomes the original order -Electronic records shall be available within 48 hours upon request from an authorized agent for any patient of the previous 5 years
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When is a CII Rx valid as a faxed prescription?
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-Needs to be compounded for direct IM/IV/IS administration -For patients of Long Term Care Facilities -Patients in a state certified hospice care program
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When is a C III-V Rx valid as a faxed prescription?
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-Allowable as a \”written prescription\” when signed (manually) by a practitioner and transmitted by him/her or agent
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Which type of prescriptions can have telephone authorization?
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-Allowed for CSIII-V and non-controls as long as they are reduced to immediate writing by the pharmacist prior to dispensing
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What is the protocol for phone transfer of CS III-V prescriptions?
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-Allowed *once* between two separate pharmacies -Pharmacist must void the transferred electronic or paper Rx in the first pharmacy the Rx is transferred from -Record name, address, DEA number of the pharmacy the Rx was transferred to along with all patient info -Include date and name of the pharmacist transferring the Rx
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True or False: Pharmacies electronically sharing a real time online database may allow the max number of refills when transferring a Rx
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True
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True or False: If a federal government practitioner writes a Rx for a private patient (citizen), they are exempt from providing their DEA number?
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False
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True or False: To write for CS prescriptions, mid-level practitioners must have the supervisor’s name, DEA number, and signature on both paper and electronic Rx’s
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False: A signature is not required
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What information must be included on a CS Rx for an animal?
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-Species of the animal -Full name and address of owner
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What is the form used to order C2 drugs for a pharmacy?
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Form 222 -Pharmacy must be careful of the 5% rule!
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True or False: Verbal orders for full quantity C2 Rx’s are valid
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False -For emergencies only -3 day supply max for C2 taken over the phone -Need the Rx hardcopy within the next 7 days from the doctor
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What information is required for a verbal order CIII-V Rx?
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All info required of the written Rx with the exception of the manual signature
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How many refills can be ordered for C3, C4 drugs?
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Up to 5 refills in 6 months from the date written
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How many refills can be ordered for C5 drugs?
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Refill same as non-controls
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How many refills can be ordered for C2 drugs?
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No refills
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True or False: For C2 drugs, a prescriber may issue multiple prescriptions for a total of up to 90 day supply
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True
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What are the emergency rules for a C2 Rx?
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-Only the prescriber may phone in the emergency prescription -Prescriber must write the phoned order on a Rx form and forward to the dispensing pharmacy within 7 days of verbal transmission -Must record on the face of the Rx \”Authorization for Emergency Dispensing\” and date of verbal order -Pharmacist must make reasonable effort to determine authenticity; report to state if paper Rx is not received within 7 days
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How is an emergency situation defined by the Controlled Substance Rule?
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-Immediate administration necessary for proper treatment -Alternative therapy is not available -Not reasonably possible to provide written Rx -Quantity prescribed and dispensed limited to amount adequate to treat patient during emergency period
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True or False: A C2 Rx for a terminally ill patient (with pharmacist documentation) may be partially filled in increcments for not more than 90 days after the date on which the Rx was issued
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False -No more than *60 days*
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True or False: A compounded C2 product for direct administration to a terminally ill patient (injectable morphine drip infusion) can have a fax Rx that serves as the written Rx
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True
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True or False: For C2 drugs used in a terminally ill patient at a long term care facility, the fax Rx can serve as the written Rx
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True
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True or False: In a non-emergency situation, a prescriber can fax a C2 prescription to the pharmacy in order for the pharmacist to fill the Rx in a timely manner.
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False: The pharmacist CANNOT dispense until the original written Rx is presented to the pharmacy
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What changes can a pharmacist make to a CS Rx?
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After consultation and agreement from the prescriber, the pharmacist may add or change: -Patient address -Dosage form -Drug strength -Drug quantity -Directions for use -Issue date Any notations needed can be made on the Rx
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True or False: Unless authorized by the physician to dispense a lower cost, generically equivalent drug product, the pharmacist may not change the CS prescribed to a patient
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True
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True or False: If necessary, a pharmacist can change the \”do not fill until date’ and/or the patient’s name in order to prepare a legal Rx
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False
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If a PA writes a Rx for a C2, does the script need both doctor and PA sigs?
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No – just the PA sig
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Is a stamped sig allowed for a CS Rx?
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Nope
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An employee (delegated agent) of a prescriber may transmit verbally to a pharmacist what CS drugs?
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C3-5 C2 must be done by the prescriber
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Who in the pharmacy can accept a verbal C3-5 Rx?
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Techs aren’t technically (get it?) allowed to fill these orders, but a pharmacy intern can!
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An electronically prepared Rx is printed out in the physician’s office and is brought to the pharmacy by the patient. What type of signature is required?
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-Electronic -Manual
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A NP working as a hospice practitioner for in-home hospice care. Can she write a C2 Rx for a 7 day supply?
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No -In home hospice is NOT considered a licensed health facility
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Can a MI pharmacist accept a C2 Rx from Florida? Who can it be written by?
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Yes if it is written by a MD or DDS (no mid-level practitioners in FL)
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Are prescribers allowed to write for a 90 day supply of a C2 via multiple Rx issuances?
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Yes (under certain circumstances)
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Can a MI pharmacist fill a non-control Rx written by an out of state vet? What about a CS Rx?
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Yes for non-control No for CS
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True or False: A CS Rx phoned into a pharmacy needs to contain the drug quantity in both numeric and word form
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False
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True or False: For a C2 Rx presented at the pharmacy without the prescriber DEA number, the DEA number can be added to the Rx by the pharmacist after consultation/approval by the prescriber
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True
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True or False: A pharmacist may fill a prescription that was emailed from a delegated employee of a physician to the email of the pharmacy?
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False
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True or False: A pharmacy can accept a transfer Rx for a CS from an out of state pharmacy
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True
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True or False: A Rx written by a PA or NP is valid if the name of the delegating prescriber is pre-printed and not handwritten on the Rx
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True
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True or False: A pharmacist can fill a Rx for a CS written by an out of state mid-level prescriber
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True (but it depends on the state!)
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True or False: A MI licensed PA can receive delegation from a doctor licensed in a different state
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False
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True or False: Non-control Rx’s written by an out of state mid level prescriber are not valid
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False
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True or False: A Rx written by a mid level prescriber containing multiple physicians on the top of the Rx is not valid
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False -There can be multiple physicians on the Rx, but you MUST indicate out of the list who the delegating physician is
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Is a pre-printed CS Rx with a checkbox next to the quantity OK?
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Yes, as long as the number quantity is written next to it as well
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If a computer generated prescription has one E-prescription, but 4 handwritten meds added to it, is the Rx legal?
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Technically no -It would be best to transcribe one of the order to a separate Rx

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