ࡱ>  g <Zbjbj٘ .@Ec<  z%z%z%z%z%4%%%h( %\&Vl4(4445V6L6(]X?[?[?[?[?[?[$^ac[5z%65566c[z%z%444\p9p9p96z%4z%4]Xp96]Xp9p9NXQ4V6F^7QP(IX\0\yP$b^7 bPQbz%Q66p966666c[c[j8666\6666b666666666  @$:  WELL CHILD EXAM INFANCY: 4 MONTH VISITAuthority: P.A. 116 of 1973 Completion: Required Consequences of non-completion: Non-compliance of licensing rules.Michigan Department of Human ServicesWell Child Exam Date FORMTEXT      Patient NameDOBSexParent Name FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      AllergiesCurrent Medications FORMTEXT       FORMTEXT      Prenatal/Family History FORMTEXT      WeightPercentileLengthPercentileHCPercentileTemp.PulseResp.BP (if risk) FORMTEXT       FORMTEXT      % FORMTEXT       FORMTEXT      % FORMTEXT       FORMTEXT      % FORMTEXT       FORMTEXT       FORMTEXT       FORMTEXT      Birth HistoryBirth WeightGestation FORMCHECKBOX VaginalComplications FORMCHECKBOX Yes FORMTEXT       FORMTEXT       FORMCHECKBOX C-Section FORMCHECKBOX No Interval History:(Include injury/illness, visits to other health care providers, changes in family or home) FORMTEXT      Apnea FORMCHECKBOX Yes FORMCHECKBOX No FORMCHECKBOX Monitor FORMCHECKBOX Breast every FORMTEXT      hours FORMCHECKBOX Formula FORMTEXT   oz every  FORMTEXT      hoursWith iron FORMCHECKBOX Yes FORMCHECKBOX NoType or brand FORMTEXT       FORMCHECKBOX City Water FORMCHECKBOX Well WaterSolids FORMCHECKBOX Yes FORMCHECKBOX NoElimination FORMCHECKBOX Normal FORMCHECKBOX AbnormalSleep FORMCHECKBOX Normal (5 6 hours) FORMCHECKBOX AbnormalAdditional area for comments on page 2WIC FORMCHECKBOX Yes FORMCHECKBOX NoMaternal Infant Health Program FORMCHECKBOX Yes FORMCHECKBOX NoScreening and Procedures FORMCHECKBOX Subjective Hearing-Parental observation/concerns FORMCHECKBOX Subjective Vision- Parental observation/concernsDevelopmental Surveillance FORMCHECKBOX Social-Emotional FORMCHECKBOX Communicative FORMCHECKBOX Physical Development FORMCHECKBOX CognitivePsychosocial/Behavioral Assessment FORMCHECKBOX Yes FORMCHECKBOX NoScreening for Abuse FORMCHECKBOX Yes FORMCHECKBOX NoScreening If At Risk FORMCHECKBOX Hct or HGB FORMTEXT      Immunizations: FORMCHECKBOX Immunizations Reviewed FORMCHECKBOX Immunizations Given & Charted  if not given, document rationale FORMCHECKBOX DTaP FORMCHECKBOX IPV FORMCHECKBOX HepB FORMCHECKBOX Hib FORMCHECKBOX PCV FORMCHECKBOX Rota FORMCHECKBOX MCIR Checked/updated FORMCHECKBOX Acetaminophen FORMTEXT      mg. q.4 hoursPatient Unclothed FORMCHECKBOX Yes FORMCHECKBOX NoReview of SystemsPhysical ExamSystemsNANA FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX General Appearance FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Skin/nodes FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Head/Fontanel FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Eyes FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Ears FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Nose FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Oropharynx FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Gums/palate FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Neck FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Lungs FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Heart/pulses FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Abdomen FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Genitalia FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Spine FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Extremities/hips FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX  FORMCHECKBOX Neurological  FORMCHECKBOX Abnormal Findings and CommentsIf yes, see additional note area on next pageResults of visit discussed with parent FORMCHECKBOX Yes FORMCHECKBOX NoPlan FORMCHECKBOX History/Problem List/Meds Updated FORMCHECKBOX Referrals FORMCHECKBOX WIC FORMCHECKBOX Early On FORMCHECKBOX Transportation FORMCHECKBOX Maternal Infant Health Program (MIHP) FORMCHECKBOX Children Special Health Care Needs FORMCHECKBOX Other referral FORMTEXT       FORMCHECKBOX Other FORMTEXT      Anticipatory Guidance/Health Education(check if discussed)Safety FORMCHECKBOX Appropriate car seat placed in back seat FORMCHECKBOX Use safety belt and don t drive under the influence of alcohol or drugs FORMCHECKBOX Dont leave baby alone in tub or high places; always keep hand on baby FORMCHECKBOX Keep home and car smoke-free FORMCHECKBOX Water temp. <120 degrees/test with wrist FORMCHECKBOX Dont use baby walkers FORMCHECKBOX Check home for sources of leadNutrition FORMCHECKBOX Breastfeed or give iron-fortified formula FORMCHECKBOX Avoid foods that contribute to allergies FORMCHECKBOX Introduce solid foods at 4-6 months FORMCHECKBOX Wait one week or more to add new foodOral health FORMCHECKBOX Discuss teething FORMCHECKBOX Discuss good family oral health habits FORMCHECKBOX Dont share spoon or put pacifier in your mouth to clean.Infant Development FORMCHECKBOX Consoling a fussy baby FORMCHECKBOX Put baby to sleep on back/Safe Sleep FORMCHECKBOX Learn babys temperament FORMCHECKBOX Talk, sing, play music, and read to baby FORMCHECKBOX Establish daily and bedtime routinesFamily Adjustment FORMCHECKBOX Encourage partner to help care for infant FORMCHECKBOX Take time for self and spend time alone with your partner FORMCHECKBOX Keep in contact with friends, family FORMCHECKBOX Family Planning FORMCHECKBOX Choose responsible babysitters FORMCHECKBOX Discuss child care, returning to work FORMCHECKBOX Substance Abuse, Child Abuse, Domestic Violence Prevention, Depression FORMCHECKBOX Baby cannot be spoiled by holding, cuddling or rockingOther Anticipatory Guidance Discussed: FORMTEXT      Next Well Check: 6 months of ageDevelopmental Surveillance on Page 2 Page 3 required for Foster Care ChildrenMedical Provider Signature: PAGE 2  WELL CHILD EXAM  INFANCY: 4 Months  Developmental Surveillance (This page may be used if not utilizing a Validated Developmental Screener)DateChild s NameDOB FORMTEXT       FORMTEXT       FORMTEXT      Developmental Questions and ObservationsAsk the parent to respond to the following statements about the child:YesNo FORMCHECKBOX  FORMCHECKBOX Please tell me any concerns about the way your baby is behaving or developing FORMTEXT       FORMCHECKBOX  FORMCHECKBOX My baby cries when upset and seeks comfort. FORMCHECKBOX  FORMCHECKBOX My baby smiles and laughs. FORMCHECKBOX  FORMCHECKBOX My baby is sleeping well. FORMCHECKBOX  FORMCHECKBOX My baby is eating and growing well. FORMCHECKBOX  FORMCHECKBOX My baby can see and hear. FORMCHECKBOX  FORMCHECKBOX My baby likes to look at and be with me. FORMCHECKBOX  FORMCHECKBOX My baby reaches for objects and can hold them. FORMCHECKBOX  FORMCHECKBOX My baby rolls or tries to roll over from tummy to back. FORMCHECKBOX  FORMCHECKBOX My baby lets me know what it wants and needs.Ask the parent to respond to the following statements:YesNo FORMCHECKBOX  FORMCHECKBOX I am sad more often than I am happy. FORMCHECKBOX  FORMCHECKBOX I have more good days with my baby than bad days FORMCHECKBOX  FORMCHECKBOX I have people who help me when I get frustrated with my baby. FORMCHECKBOX  FORMCHECKBOX I am enjoying my baby more days than not.Provider to follow up as necessary.Developmental MilestonesAlways ask parents if they have concerns about development or behavior. (You may use the following screening list, or a standardized developmental instrument or screening tool).Infant DevelopmentParent DevelopmentYesNoYesNoHolds head upright in prone position FORMCHECKBOX  FORMCHECKBOX Looks at infant and shares babys smile FORMCHECKBOX  FORMCHECKBOX Laughs responsively FORMCHECKBOX  FORMCHECKBOX The parent comforts baby effectively FORMCHECKBOX  FORMCHECKBOX Follows past midline FORMCHECKBOX  FORMCHECKBOX Parent and baby are interested in and responsive to each other FORMCHECKBOX  FORMCHECKBOX No persistent fist clenching FORMCHECKBOX  FORMCHECKBOX Parent seems depressed, angry, tired, overwhelmed, or uncomfortable? FORMCHECKBOX  FORMCHECKBOX Raises body on hands FORMCHECKBOX  FORMCHECKBOX Seeks eye contact with parent FORMCHECKBOX  FORMCHECKBOX Please note: Formal developmental examinations are recommended when surveillance suggests a delay or abnormality, especially when the opportunity for continuing observation is not anticipated. (Bright Futures: Guidelines for health supervision of Infants, Children, and Adolescents)Additional Notes from pages 1 and 2 FORMTEXT      Medical Staff SignatureMedical Provider SignatureTHIS PAGE IS REQUIRED FOR FOSTER CARE CHILDREN PAGE 3  WELL CHILD EXAM  INFANCY: 4 MonthsDateChild s NameDOB FORMTEXT       FORMTEXT       FORMTEXT      Name of person who accompanied child to appointment FORMCHECKBOX Parent FORMTEXT       FORMCHECKBOX Foster ParentPhone number of person who accompanied child to appointment FORMCHECKBOX Relative Caregiver (specify relationship) FORMTEXT       FORMTEXT       FORMCHECKBOX CaseworkerPhysical completed utilizing all Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements FORMCHECKBOX YesPlease attach completed physical form utilized at this visit FORMCHECKBOX NoIf no, please state reason physical exam was not completed FORMTEXT      Developmental, Social/Emotional and Behavioral Health Screenings (must use validated tool)Always ask parents or guardian if they have concerns about development or behavior. (You must use a standardized developmental instrument or screening tool as required by the Michigan Department of Community Health and Michigan Department of Human Services).Validated Standardized Developmental Screening completed: Date FORMTEXT      Screener Used: FORMCHECKBOX ASQ FORMCHECKBOX ASQSE FORMCHECKBOX PEDS FORMCHECKBOX PEDSDM FORMCHECKBOX Other tool: FORMTEXT      Score: FORMTEXT      Referral Needed: FORMCHECKBOX No FORMCHECKBOX YesReferral Made: FORMCHECKBOX No FORMCHECKBOX YesDate of Referral: FORMTEXT      Agency: FORMTEXT      Current or Past Mental Health Services Received: FORMCHECKBOX No FORMCHECKBOX Yes(if yes please provide name of provider)Name of Mental Health Provider: FORMTEXT      EPSDT Abnormal results: FORMTEXT      Special Needs for Child (e.g., DME, therapy, special diet, school accommodations, activity restrictions, etc.): FORMTEXT      Medical Staff Signature DateMedical Provider Name (Please print) FORMTEXT      AddressTelephone Number FORMTEXT       FORMTEXT      This form was developed by the Institute for Health Care Studies at Michigan State Univers8:T< & ( < > @ J L N P d f h r t v x  ˸˚˚˚y˚j hWNUjhWNUj8hWNUjhWNUmHnHujhWNU hWN5jhUjhWNUjhWNU h?V,hWNhr(hWNCJaJhbW.hWNhWNCJaJh>:h>:CJaJ/&8T< > y '$Ifgdm*ekd$$Ifl4Fv #,v  ,    4 lalf4ytm* G$Ifgdm* *$Ifgdm*gdk"  GekdB$$Ifl4F, ,    4 lalf4ytm* E$Ifgd G$Ifgdm*?kdr$$Ifl4,,,4 lalf4ytm* $ & N v }tttt E$Ifgdm*xkd$$Ifl4\n,h,4 lalf4ytm* G$Ifgdm*   }}*Rkd.$$Ifl40n,n2,4 lalf4ytm* G$Ifgdm*xkdv$$Ifl4\n,h,4 lalf4ytm*    * , . 0 D F H R T X Z n p r | ~     $ & j hWNUj* hWNUj hWNUjV hWNUjhWNUjJhWNUj hWNUjhWNUmHnHujhWNUhWNjhWNU7 . V X Z?kd$$Ifl4,,,4 lalf4ytm* G$Ifgdm*Rkdt$$Ifl40n,n2,4 lalf4ytm* E$Ifgdm*   $ 0 < V G$Ifgdm*Gd$If]gdm* Gd$Ifgdm*?kd$$Ifl4,,,4 lalf4ytm* V X kd$$Ifl4 jM 5)##(,jmvusu{},((((4 lalf4ytm*X ( P T | ,@dt 0$If^gdm* 0d$Ifgdm* G$Ifgdm*Ff E$If]^gdm* E$If^gdm* E$If]gdm* E$Ifgdm*& ( * > @ B L N T V j l n x z | ~ @B^`bdv#jPhhWNCJUaJhhWNCJaJjhhWNCJUaJhhWN5 hWN5j hWNUj< hWNUj hWNUjh hWNUjhWNUmHnHuj hWNUjhWNUhWN,dt .024HJLhjlntvxӽzhӽ#jhhWNCJUaJ#jDhhWNCJUaJjhWNUjhWNUmHnHujXhWNUjhWNU hWN5hWN#jhhWNCJUaJhhWNCJaJjhhWNCJUaJhhWN5hhWNCJaJ't G$If^gdm* Gd$Ifgdm* G$Ifgdm*:1(( E$Ifgdm* G$Ifgdm*kd<$$Ifl4ִ#(0*,^P8p,    4 lalf4ytV+ 4HJnt G$If^gdm* Gd$Ifgdm* G$Ifgdm* 0$If^gdm* 0d$Ifgdm*tvx:5) Gd$Ifgdm*gdWNkd0$$Ifl4ִ#(0*,^P8p,    4 lalf4ytV+ xVXlnpz|~󨚉}i}U}&jjhhWN5CJUaJ&jhhWN5CJUaJhhWN5CJaJ jhhWN5CJUaJhhWN56CJaJhWN56CJaJhhWNCJaJ"jhWNCJUaJmHnHujhWNCJUaJhWNCJaJjhWNCJUaJhWNhhWN5TV~]Q Ed$Ifgdm*Jkd$$Ifl t44 lalp ytbW. Gd$Ifgdm*Jkd>$$Ifl t44 lalp ytbW.~Gd$If^gdm* Gd$Ifgdm*Jkd$$Ifl0 t44 lalp ytbW.68:<VXlnpz|~˷נtXD&jhhWN5CJUaJ7jhjhWN5CJOJQJU^JaJmHnHu2jhjhWN5CJOJQJU^JaJ#hjhWN5CJOJQJ^JaJ,jhjhWN5CJOJQJU^JaJ&j^hhWN5CJUaJhhWN5CJaJhWN jhhWN5CJUaJ&jhhWN5CJUaJ<$ Gd$Ifgdm*kdR$$Ifl֞x8v x|D>*I t44 lalpFyt"<V~H< Gd$Ifgdm*kd<$$Ifl\02 0 t44 lalp(yt"Gd$If^gdm*Gd$If]^gdm* ,.@웗fJ>4hWNCJ^JaJhhWN5CJaJ7jhjhWN5CJOJQJU^JaJmHnHu2jhjhWN5CJOJQJU^JaJ,jhjhWN5CJOJQJU^JaJhWN#hjhWN5CJOJQJ^JaJ1jhWN5CJOJQJU^JaJmHnHu,jhWN5CJOJQJU^JaJhWN5CJOJQJ^JaJ&jhWN5CJOJQJU^JaJ*Gd$If^gdm**,.B<0 Gd$If^gdm* Gd$Ifgdm*kdd$$Iflֈ0 0 I t44 lalp<yt"@BD`bdfnpⷳ֟ⳋ|eL1jhWN5CJOJQJU^JaJmHnHu,j^ hWN5CJOJQJU^JaJhWN5CJOJQJ^JaJ&jhWN5CJOJQJU^JaJ&jhhWN5CJUaJhWNhhWNCJaJ&jhhWN5CJUaJhhWN5CJaJ jhhWN5CJUaJh lhWNCJ^JaJBfnGd$If^gdm*G$d$Ifa$gdm*<,Gd$If^gdm*Gd$If]gdm*kdj$$Iflֈ0 0Fk t44 lalp<yt">T||Gd$If]^gdm* Gd$Ifgdm*bkd $$Ifl0F  t44 lalpyt"8:<>VdfϷˬ{plXlJhhWN56CJaJ&j|#hhbW.5CJUaJhbW.hhbW.CJaJ&j#hhbW.5CJUaJhhbW.5CJaJ jhhbW.5CJUaJhbW.hbW.CJaJ&j!hhWN5CJUaJhWNhhWN5CJaJ jhhWN5CJUaJ&j\!hhWN5CJUaJTVdl`QAQAGd$If^gdbW.G$d$Ifa$gdbW. Gd$Ifgdm*kdD"$$Ifl\0o0?[E t44 lalp(yt"TD8(Gd$If^gdm* Gd$Ifgdm*Gd$If]gdm*kd#$$Iflr F t44 lalp2yt"&'(678ABEFNO]^_`̞̆̆r̞^&jp)hhWN5CJUaJ&j'hhWN5CJUaJhbW.&jH'hhWN5CJUaJhhWN56CJaJ&j@%hhWN5CJUaJhhWN5CJaJhWNhhWNCJaJ jhhWN5CJUaJ&j$hhWN5CJUaJ#%&/kd%$$Iflr ,n  t 44 lalp2ytGd$If^gdm* Gd$Ifgdm*&'9N`iwgGd$If^gdm*Gd$If^gdbW. Gd$Ifgdm*kkd&$$Ifl0oo  t 44 lalpyt"ijl` Gd$Ifgdm*kd0($$Ifl\0( 0w t44 lalp(yt"Gd$If^gdm* Gd$Ifgdm*Jkd)$$Ifl t44 lalp ytbW.  '()789:lm{۠۠ׄsgSsgOsghy&j-hhy5CJUaJhhy5CJaJ jhhy5CJUaJhhWN5&j:,hhWN5CJUaJhfu#hWN5CJaJ&j+hhWN5CJUaJhhWN5CJaJhWN56CJaJhWN jhhWN5CJUaJ&j)hhWN5CJUaJK;Gd$If^gdm*kdX*$$Iflro oOn  t 44 lalp2yt"  Gd$If^gdm* Gd$Ifgdm*SkdF+$$Ifl  t 44 lalp ytbW. 'l` Gd$Ifgdm*kd,$$Ifl\0'0~V t44 lalp(yt"'(:kl~5bkdT.$$Ifl000 t44 lalpyt"Gd$If^gdm* Gd$IfgdbW.Jkdr-$$Ifl t44 lalp ytbW.{|}~ !"#89Gp^RJhWNCJaJjhWNCJUaJ#j&2hhWNCJUaJ#j0hhWNCJUaJ#j0hhWNCJUaJhhWNCJaJjhhWNCJUaJhWNhhWN56CJaJhWN56CJaJhyhhy5CJaJ jhhy5CJUaJ&j.hhy5CJUaJ G$Ifgdm* Gd$Ifgdm*bkd\/$$Ifl000 t44 lalpyt"wwGd$If^gdm* Gd$Ifgdm*kkd/$$Ifl0H H   t 44 lalpytbW.#8JTl`P`PGd$If^gdm* Gd$Ifgdm*kdp1$$Ifl\0P 0P t44 lalp(yt"GHIJUyz{ո٦ոٔոقոpbWhbW.56CJaJhhbW.56CJaJ#j$7hhWNCJUaJ#j6hhWNCJUaJ#j4hhWNCJUaJ#jl4hhWNCJUaJjhhWNCJUaJhhWN56CJaJhWNhhWNCJaJjhWNCJUaJj2hWNCJUaJ"TUxyl`` Gd$Ifgdm*kd3$$Ifl\0P 0P t44 lalp(yt"yzwwwGd$If^gdm* Gd$Ifgdm*kkd3$$Ifl0  K  t 44 lalpytbW.l`PGd$If^gdm* Gd$Ifgdm*kdT5$$Ifl\00& t44 lalp(yt"wwwGd$If^gdm* Gd$Ifgdm*kkd6$$Ifl01  t 44 lalpytbW.l`T Gd$Ifgdm* Gd$IfgdbW.kd7$$Ifl\00. t44 lalp(yt"'(  02468TVXZo]UUC#jr;hhbW.CJUaJhhbW.5#hjhbW.5CJOJQJ^JaJ1jhbW.5CJOJQJU^JaJmHnHu,jh9hbW.5CJOJQJU^JaJhbW.5CJOJQJ^JaJ&jhbW.5CJOJQJU^JaJ#j8hhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhbW.hhbW.56CJaJ{k{Gd$If^gdbW. Gd$Ifgdm* Gd$IfgdbW.kkd\8$$Ifl01  t 44 lalpyt[0l` Gd$Ifgdm*kd9$$Ifl \0E 0|: t44 lalp(yt"0246Z]MGd$If^gdm*Jkd;$$Ifl t44 lalp ytbW. Gd$Ifgdm*Jkd:$$Ifl t44 lalp ytbW.0|Gd($If^gdm*Gd($Ifgdm*bkd;$$Ifl000 t44 lalpyt"24PRTV`b~  4|j#j@hhbW.CJUaJhyhbW.CJaJ#jx?hhbW.CJUaJ#j?hhbW.CJUaJ#j=hhbW.CJUaJ#jf=hhbW.CJUaJhbW.#jl<hhbW.CJUaJhhbW.CJaJjhhbW.CJUaJ%02V`Gd$If^gdy Gd$Ifgdm*bkd<$$Ifl000 t44 lalpyt"l`PPPGd$If^gdy Gd$Ifgdm*kdN>$$Ifl\0o0?M? t44 lalp(yt":Dl`PPPGd$If^gdy Gd$Ifgdm*kd?$$Ifl\0o0?M? t44 lalp(yt"468:FHdfhjDFbӽӫϗqXF#hmhbW.5CJOJQJ^JaJ1jhbW.5CJOJQJU^JaJmHnHu,jChbW.5CJOJQJU^JaJhbW.5CJOJQJ^JaJ&jhbW.5CJOJQJU^JaJ#j:ChhbW.CJUaJ#j@BhhbW.CJUaJhbW.hhbW.CJaJjhhbW.CJUaJ#jAhhbW.CJUaJDFjl`PGd$If^gdy Gd$Ifgdm*kdA$$Ifl\0o0?M? t44 lalp(yt"pGd$If^gdaGd$If^gdy Gd$Ifgdm*bkdB$$Ifl000 t44 lalpyt"l` Gd$Ifgdm*kdD$$Ifl\0FY 0 t44 lalp(yt" DhpGd$If^gdm* Gd$Ifgdm*JkdD$$Ifl t44 lalp ytbdfhpr  -./01?@ABCQRSTjkyӽϵϵӣޚӈޚvޚdޚ#j@LhhbW.CJUaJ#jKhhbW.CJUaJ#jXKhhbW.CJUaJhhbW.CJ#jJhhbW.CJUaJhhbW.5#jEhhbW.CJUaJhbW.hhbW.CJaJjhhbW.CJUaJ#jJEhhbW.CJUaJ%TH111G$d$If]^a$gdm* Gd$Ifgdm*kd2F$$Iflr2 @  t44 lalp2yt"8kdG$$Ifl4r-8  A         x   _  t44 lalp2yt" Gd$Ifgdm*G$d$Ifa$gdm*G88G$d$Ifa$gdm*kdH$$Ifl4r-8  A         x  _  t44 lalp2yt" Gd$Ifgdm*   Gd$Ifgdm*G$d$Ifa$gdm*   $ Gd$Ifgdm*kd"I$$Ifl֞Z-8  n      u      x   _  t44 lalpFyt" 0BTgh Gd$Ifgdm*Gd$If^gdm*G$d$Ifa$gdm*hij$ Gd$Ifgdm*kdL$$Ifl֞Z-8  n    u    x   _  t44 lalpFyt"yz{|}ʸʦʔՐ~lZ#jHRhhbW.CJUaJ#jQhhbW.CJUaJ#j`QhhbW.CJUaJhbW.#jOhhbW.CJUaJ#j&OhhbW.CJUaJ#jNhhbW.CJUaJhhbW.CJaJhhbW.CJjhhbW.CJUaJ#j>NhhbW.CJUaJ#j| Gd$Ifgdm*Gd$If^gdm*G$d$Ifa$gdm*$ Gd$Ifgdm*kdP$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt" Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*()*+,:;<=>LMNOP^_`aijxyz{|m[#jXhhbW.CJUaJ#jWhhbW.CJUaJ#jUhhbW.CJUaJ#jjUhhbW.CJUaJ#jThhbW.CJUaJ#jThhbW.CJUaJhbW.hhbW.CJjhhbW.CJUaJ#jRhhbW.CJUaJhhbW.CJaJ#$ Gd$Ifgdm*kd0S$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"+=Oafg Gd$Ifgdm*G$d$Ifa$gdm*ghi$ Gd$Ifgdm*kdRV$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"i{ Gd$Ifgdm*G$d$Ifa$gdm*  ݹݣݑm#j"\hhbW.CJUaJ#j[hhbW.CJUaJ#j:[hhbW.CJUaJ#jZhhbW.CJUaJhbW.#jYhhbW.CJUaJ#jXhhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhhbW.CJ#$ Gd$Ifgdm*kdtY$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt" Gd$Ifgdm*G$d$Ifa$gdm* $ Gd$Ifgdm*kd\$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"*+,-.<=>?@NOPQ_`nopqrʸʦʔՐ~lZ#jahhbW.CJUaJ#j~ahhbW.CJUaJ#j ahhbW.CJUaJhbW.#jD_hhbW.CJUaJ#j^hhbW.CJUaJ#j\^hhbW.CJUaJhhbW.CJaJhhbW.CJjhhbW.CJUaJ#j]hhbW.CJUaJ# -?Q\] Gd$Ifgdm*G$d$Ifa$gdm*]^_$ Gd$Ifgdm*kd_$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"_q Gd$Ifgdm*G$d$Ifa$gdm*'()m[#jghhbW.CJUaJ#jNghhbW.CJUaJ#jehhbW.CJUaJ#jehhbW.CJUaJ#jdhhbW.CJUaJ#j,dhhbW.CJUaJhbW.hhbW.CJjhhbW.CJUaJ#jfbhhbW.CJUaJhhbW.CJaJ#$ Gd$Ifgdm*kdb$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt" Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*$ Gd$Ifgdm*kde$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"*<NTU Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*)*+9:;<=KLMNWXfghijxyz{|ݹݣݑm#jkhhbW.CJUaJ#jXkhhbW.CJUaJ#jjhhbW.CJUaJ#jpjhhbW.CJUaJhbW.#jhhhbW.CJUaJ#j6hhhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhhbW.CJ#UVW$ Gd$Ifgdm*kdi$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"Wi{ Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*$ Gd$Ifgdm*kd@l$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"       # $ % & ' 5 6 7 8 9 ʸʦʔՐ~lZ#jqhhbW.CJUaJ#j(qhhbW.CJUaJ#jphhbW.CJUaJhbW.#jnhhbW.CJUaJ#jznhhbW.CJUaJ#jnhhbW.CJUaJhhbW.CJaJhhbW.CJjhhbW.CJUaJ#jmhhbW.CJUaJ# Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*   $ Gd$Ifgdm*kdbo$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"  & 8 J T U Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*9 G H I J W X f g h i j x y z { | m[#jlwhhbW.CJUaJ#jvhhbW.CJUaJ#j2uhhbW.CJUaJ#jthhbW.CJUaJ#jJthhbW.CJUaJ#jshhbW.CJUaJhbW.hhbW.CJjhhbW.CJUaJ#jrhhbW.CJUaJhhbW.CJaJ#U V W $ Gd$Ifgdm*kdr$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"W i { Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm* $ Gd$Ifgdm*kdu$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt" !! Gd$Ifgdm*Gd$If^gdaG$d$Ifa$gdm* !!!!!!!%!&!'!(!)!7!8!9!:!;!I!J!K!L!^!_!m!ݹݣݑm#jv{hhbW.CJUaJ#j{hhbW.CJUaJ#jzhhbW.CJUaJ#jzhhbW.CJUaJhbW.#jTxhhbW.CJUaJ#jwhhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhhbW.CJ#!!!$ Gd$Ifgdm*kdx$$Ifl֞Z-8  n  u  x  _  t44 lalpFyt"!!(!:!L!Z![! Gd$Ifgdm* Gd$IfgdaG$d$Ifa$gdm*[!\!]!$ Gd$Ifgdm*kd{$$Ifl֞Z-8  n    u    x   _  t44 lalpFyt"]!^!p!!!!!5bkdJ~$$Ifl000 t44 lalpyt"Gd$If^gdm* Gd$Ifgdm*Jkdt}$$Ifl t44 lalp ytbW.m!n!o!p!!!!!!!""""""""""-"."/"0"S"T"b"c"d"e"q"r""""""""ӽӫϣӑm#jbhhbW.CJUaJ#jthhbW.CJUaJ#jxhhbW.CJUaJhhbW.5#jhhbW.CJUaJ#jhhbW.CJUaJhbW.hhbW.CJaJjhhbW.CJUaJ#j}hhbW.CJUaJ&!!!!!EJkdV$$Ifl t44 lalp ytbW. Gd$Ifgdm*bkd~$$Ifl000 t44 lalpyt"!!!"""Gd$If^gdm* Gd$Ifgdm*Jkd$$Ifl t44 lalp ytbW."""l` Gd$Ifgdm*kd$$Ifl\0x0H-V t44 lalp(yt"""""0"R"]MGd$If^gdm*Jkd$$Ifl t44 lalp ytbW. Gd$Ifgdm*Jkd$$Ifl t44 lalp ytbW.R"S"e"o"Gd$If^gdm* Gd$Ifgdm*bkd$$Ifl000 t44 lalpyt"o"p"q"""""Gd$If^gdm* Gd$Ifgdm*bkd$$Ifl000 t44 lalpyt"""""""""""""""""######9#:#H#I#J#K#Z#[#e#ӽϱӈvbShbW.5CJOJQJ^JaJ&jhbW.5CJOJQJU^JaJ#j.hhbW.CJUaJ#j(hhbW.CJUaJj"hbW.CJUaJhbW.CJaJjhbW.CJUaJ#jhhbW.CJUaJhbW.hhbW.CJaJjhhbW.CJUaJ#j؄hhbW.CJUaJ"""""TH88Gd$If^gdm* Gd$Ifgdm*kdN$$Iflr0- 0' t44 lalp2yt"""""#xhhGd$If^gdm* Gd$Ifgdm*zkd$$IflF0-0 t    44 lalpyt"####7#xhhGd$If^gdm* Gd$Ifgdm*zkd$$IflF0-0 t    44 lalpyt"7#8#9#K#Z#$$xhhhhGd$If^gdm* Gd$Ifgdm*zkd$$IflF0-0 t    44 lalpyt"e#f#$ $ $$$$0$2$4$6$B$D$X$Z$\$f$h$l$n$p$r$$$ռժzkTռժLLhhbW.5,j`hbW.5CJOJQJU^JaJhbW.5CJOJQJ^JaJ#jhhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhbW.#hhbW.5CJOJQJ^JaJ1jhbW.5CJOJQJU^JaJmHnHu&jhbW.5CJOJQJU^JaJ,jhbW.5CJOJQJU^JaJ$$6$B$j$l$TH888Gd$If^gdm* Gd$Ifgdm*kd$$Iflr0- 0mK t44 lalp2yt"l$n$p$l]G$d$Ifa$gdm*kdʋ$$Ifl\0x 0H8 K t44 lalp(yt"p$r$$$$ZJkd$$Ifl t44 lalp ytbW.G$d$Ifa$gdm*Jkd$$Ifl t44 lalp yt{J$$$$%$%<kkd؍$$Ifl088   t 44 lalpyt" Gd$Ifgdm*Jkdj$$Ifl t44 lalp ytbW.$$%%% %"%$%x%z%%%%%&&&&)&*&+&,&t&u&w&x&&&&&&&ԀqfTqfPhoI#jhhoICJUaJhhoICJaJjhhoICJUaJ#jhhbW.CJUaJh"#jlhh"CJUaJhh"CJaJjhh"CJUaJ#jphhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhbW.hhbW.56CJaJ$%v%x%%&pGd$If^gdoI Gd$Ifgdm*bkd$$Ifl(000  t44 lalpytGd$If^gdF&&&&Gd$If^gdF Gd$Ifgdm*dkd$$Ifl4(000`  t44 lalpyt&&,&s&}Gd$If^gdoI Gd$Ifgdm*dkdp$$Ifl4(000  t44 lalpyts&t&u&v&Gd$If^gdm* Gd$Ifgdm*dkdt$$Ifl4(000`  t44 lalpytv&w&&&Gd$If^gdm* Gd$Ifgdm*dkd$$Ifl4(000  t44 lalpyt&&&&Gd$If^gdm* Gd$Ifgdm*bkd$$Ifl(000  t44 lalpyt&&&&&&&&&&& ''''''='?'I'K'L'Z'['\']'k'o''''''''ЀnjX#jhhbW.CJUaJh%#jhh"CJUaJhhbW.56CJaJ#jhhbW.CJUaJh"#jhh"CJUaJhh"CJaJjhh"CJUaJhbW.jhhbW.CJUaJ#jhhbW.CJUaJhhbW.CJaJ"&&& 'Gd$If^gdm* Gd$Ifgdm*bkd$$Ifl(000  t44 lalpyt ' ''>'Gd$If^gdm* Gd$Ifgdm*bkd$$Ifl(000  t44 lalpyt>'?'I'J'K'$kkd$$Ifl0   t 44 lalpyt" Gd$Ifgdm*bkd$$Ifl(000  t44 lalpytK']'''''pGd$If^gdm*bkd$$Ifl(000  t44 lalpytGd$If^gd% Gd$Ifgdm*''''Gd$If^gdm* Gd$Ifgdm*bkd$$Ifl(000  t44 lalpyt''''''''''' ( ( ( (4(?(@(B(C(Q(R(S(T(f(g(u(v(w(x((̶̎n̶\#jhh"CJUaJ#jhh"CJUaJhh"56CJaJh"56CJaJ#j hh"CJUaJhh"CJaJjhh"CJUaJ hFhbW.h"#jhhbW.CJUaJhhbW.CJaJjhhbW.CJUaJhbW.'' (3(Gd$If^gdm* Gd$Ifgd"bkd$$Ifl(000  t44 lalpyt3(4(@(A(Gd$If^gd" Gd$Ifgd"bkd$$Ifl(000  t44 lalpytA(B(T(e(wGd$If^gd" Gd$Ifgd"kkd$$Ifl0  '  t 44 lalpyt"e(f(x((Gd$If^gd" Gd$Ifgd"bkd$$Ifl(000  t44 lalpyt((((Gd$If^gd" Gd$IfgdoIbkd$$Ifl(000  t44 lalpyt(((((((((())))))))/)0)>)?)@)A)g)h)v)w)x)y))))))))))Ͻyg#jhhoICJUaJ#jhhoICJUaJ#jhhoICJUaJ#jŸhhoICJUaJhhoI56CJaJhoI56CJaJ hFhoIhoI#jhhoICJUaJhhoICJaJjhhoICJUaJ&((((Gd$If^gdm* Gd$Ifgdm*dkd$$Ifl4(000  t44 lalpyt(())Gd$If^gd" Gd$Ifgd"dkd$$Ifl4(000  t44 lalpyt))).)wGd$If^gd" Gd$Ifgd"kkd*$$Ifl0  '  t 44 lalpytbW..)/)A)f)Gd$If^gdoI Gd$Ifgdm*bkd8$$Ifl(000  t44 lalpytf)g)y))Gd$If^gdm* Gd$Ifgdm*bkd4$$Ifl(000  t44 lalpyt))))Gd$If^gdm* Gd$Ifgdm*bkd0$$Ifl(000  t44 lalpyt)))*Gd$If^gdF Gd$Ifgdm*bkd,$$Ifl(000  t44 lalpyt))))*******+*,*-*X*Y*g*h*i*j*************++++ĶϪϪϪuϪfϪWjDhoICJUaJjHhoICJUaJjLhoICJUaJjPhoICJUaJjThoICJUaJhoICJaJjhoICJUaJhhoI56CJaJhoI56CJaJhoIhhoICJaJjhhoICJUaJ#jhhoICJUaJ"*****$kkd$$Ifl088  t 44 lalpyt" Gd$Ifgdm*bkd($$Ifl(000  t44 lalpyt*-*W*X*j**tbGd$If^gdm* Gd$IfgdoIbkdʥ$$Ifl(000  t44 lalpytGd$If^gdoI Gd$IfgdY****Gd$If^gdY Gd$IfgdYbkdƦ$$IflP000  t44 lalpyt****Gd$If^gdm* Gd$Ifgdm*bkd§$$Ifl(000  t44 lalpyt*++1+Gd$If^gdm* Gd$IfgdoIbkd$$Ifl(000  t44 lalpyt+++2+3+A+B+C+D+k+l+z+{+|+}+++++++++, ,$,&,t,v,z,|,,,,ܾܯ䓄m,jήh5CJOJQJU^JaJh5CJOJQJ^JaJ&jh5CJOJQJU^JaJh{JhjάhoICJUaJj<hoICJUaJj@hoICJUaJhoICJaJhoIhhoICJaJjhoICJUaJ!1+2+D+j+Gd$If^gdm* Gd$IfgdoIbkd$$Ifl(000  t44 lalpytj+k+}++Gd$If^gdoI Gd$IfgdoIbkd$$Ifl(000  t44 lalpyt++++Gd$If^gdoI Gd$IfgdoIdkd$$Ifl4(000  t44 lalpyt+++",Gd$If^gdoI Gd$IfgdoIdkd@$$Ifl4(000  t44 lalpyt",$,&,(,Gd$If^gdoI Gd$IfgdoIdkdD$$Ifl4(000`  t44 lalpyt(,*,x,z,,DJkd`$$Ifl( t44 lalp yt Gd$Ifgdm*dkdҭ$$Ifl4p000  t44 lalpytoI,,,,-..\.`....(/*/,/@/B/D/N/P/R/T/h/j/l/v/x/z/|/////////xme^ hWN5>*hJrhWN>*jhWNUjhWNUjhWNUmHnHujhWNUjhWNU hWN5hWN5CJOJQJhhWNhoI#hhoI5CJOJQJ^JaJ&jh5CJOJQJU^JaJ1jh5CJOJQJU^JaJmHnHu$,,,,2--M::G$d$If^a$gdm*Skd$$Ifl(  t 44 lalp ytG$d$If^a$gdoIJkdB$$Ifl t44 lalp ytoI-----TDGd$If^gdm*Jkd$$Ifl t44 lalp ytm* Gd$Ifgdm*Skd*$$Ifl  t 44 lalp ytoI---Z.\..f] ($Ifgdm*?kd$$Ifl4,,4 lalf4yt. ($IfgdgdWNJkd$$Ifl% t44 lalp yt{J..../ /(/vmmm G$Ifgdm*?kd>$$Ifl4,,4 lalf4yt. ($Ifgdm*?kd$$Ifl4,,4 lalf4yt.(/*/R/z// E$Ifgdm*ekd$$Ifl4F(H',( "{    4 lalf4yt./////PG G$Ifgdm*?kdش$$Ifl4,,4 lalf4yt. !$Ifgdm*ekdX$$Ifl4F(H',( "{    4 lalf4yt.//00000vjja G$Ifgdm* !$$Ifa$gdm*?kd$$Ifl4,,4 lalf4yt. $Ifgdm*?kd<$$Ifl4,,4 lalf4yt.//000000000000001111111111111111111㳤tfXjdhhWNUjhhWNU1jhWN5CJOJQJU^JaJmHnHu,jhWN5CJOJQJU^JaJhWN5CJOJQJ^JaJ&jhWN5CJOJQJU^JaJjhhWNUjhhWNU hhWNjhhWNUhWN he%ehWN"000011 $Ifgdm* E$$Ifa$gdm*ekd$$Ifl4F*T,**o&    4 lalf4yt.11111zzq $Ifgdm* E$$Ifa$gdm*xkdl$$Ifl4\*TU$,**n4 lalf4yt.1111*2 $Ifgd} E$$Ifa$gdm*ekdj$$Ifl4F*T,**o&    4 lalf4yt.1112(2*2+2,2:2;2<2=2>2L2M2N2O2W2h2j2k2l2z2{2|2}2~2222222222222222222222223jhhWNUj:hhWNUj@hhWNUj̻hhWNUjҺhhWNUj^hhWNU he%ehWNh} hWN hhWNjhhWNU2*2+2=2O2j2 $Ifgd} E$$Ifa$gdm*ekdع$$Ifl4F*T,**o&    4 lalf4yt.j2k2}222 $Ifgdm* E$$Ifa$gdm*ekdF$$Ifl4F*T,**o&    4 lalf4yt.22222 $Ifgd} E$$Ifa$gdm*ekd$$Ifl4F*T,**o&    4 lalf4yt.223313 $Ifgd} E$$Ifa$gdm*ekd"$$Ifl4F*T,**o&    4 lalf4yt.333333333303132333A3B3C3D3E3S3T3U3V3^3}33333333333333333ߴߦ›xq he%eh} jhh} Ujhh} U hh} jhh} UjhhWNUjhhWNU he%ehWNh} hWNjhhWNU hhWNjhhWNUjhhWNU(1323D3V33 $Ifgd} E$$Ifa$gdm*ekd$$Ifl4F*T,**o&    4 lalf4yt.33333 $Ifgd} E$$Ifa$gd} ekd$$Ifl4F*T,**o&    4 lalf4yt.333304 $Ifgd} E$$Ifa$gd} ekdl$$Ifl4F*T,**o&    4 lalf4yt.333333333041424@4A4B4C4D4R4S4T4U4444444444444444444555߸ߪƣxjjhhWNUjhhWNU hhWNjhhWNUhWN he%ehWN hWN5>*jhh} Uj`hh} U he%eh} h} jfhh} U hh} jhh} Ujhh} U)0414C4U44 $Ifgd} E$$Ifa$gd} ekd$$Ifl4F*T,**o&    4 lalf4yt.44444PG $Ifgdm*?kd$$Ifl4,,4 lalf4yt. G$Ifgdm*ekdH$$Ifl4F*T,**o&    4 lalf4yt.4444444D8 E$$Ifa$gdm*ekd$$Ifl4F*T,**o&    4 lalf4yt. G$Ifgdm* !$$Ifa$gdm*?kd2$$Ifl4,,4 lalf4yt.44555$565g5h5qxkd$$Ifl4\*TU$,**n4 lalf4yt. $Ifgdm* E$$Ifa$gdm*5!5"5#5$5%535455565h5i5j5x5y5z5{5|555555555555555556666@6B6C6D6Ǡ}yrk hWN5>* he%eh} h} jhh} Uj|hh} U hh} jhh} UjhhWNUjhhWNU he%ehWNhWNjhhWNUjhhWNUjhhWNU hhWN)h5i5{555zzq $Ifgdm* E$$Ifa$gdm*xkdz$$Ifl4\*TU$,**n4 lalf4yt.55556 $Ifgdm* E$$Ifa$gd} ekd$$Ifl4F*T,**o&    4 lalf4yt.6666A6PG $Ifgdm*?kd$$Ifl4,,4 lalf4yt. G$Ifgdm*ekdd$$Ifl4F*T,**o&    4 lalf4yt.A6B6C6D6]6^67v6?kd$$Ifl4,,4 lalf4yt.?kd$$Ifl4,,4 lalf4yt. $Ifgdm*?kdN$$Ifl4,,4 lalf4yt.D6\6]6^67777#7$7677787H7I7m7n7o7}7~7777777777777777777777777778ĽĽĽĽĽĽĽĽĽjhhWNUjJhhWNUjhhWNUjbhhWNU hhWNjhhWNUh} h/hWN5 hY5 h chWNhWN he%ehWNh chWN5 hWN5.77$7778797=7@7A7E7H7`WWWWWW $Ifgdm*Rkd$$Ifl40],]f4 lalf4yt. $$Ifa$gdm*?kdz$$Ifl4,,4 lalf4yt. H7I7n777777`WKKWKK E$$Ifa$gdm* $Ifgdm*kdP$$Ifl4 ֈ ](^*,SIe4 lalf4yt.77788<8N8`8`WKKBKK $Ifgdm* E$$Ifa$gdm* $Ifgd} kd2$$Ifl4 ֈ ](^*,SIe4 lalf4yt.888888888;8<8=8K8L8M8N8O8]8^8_8`8a8i8m8v8w888888888888888888888߻߭ߦߘߊ|jJhhWNUjhhWNUjbhhWNU he%ehWNj>hhWNUjhhWNUhWNh} jVhhWNU hhWNjhhWNUjhhWNU-`8a8v888888`WKKWKK E$$Ifa$gdm* $Ifgd} kd$$Ifl4 ֈ ](^*,SIe4 lalf4yt.88888999*9+9,9-9.9<9=9>9?9K99999999999999999999999999::ߴ߰ߢߔߌ~pjhhWNUjbhhWNUhe%ehWN5j>hhWNUjhhWNUhn{jVhhWNUjhhWNUhWNh} he%ehWN hhWNjhhWNUjhhWNU,889-9?9999`WKKWKK E$$Ifa$gdm* $Ifgdm*kd2$$Ifl4 ֈ ](^*,SIe4 lalf4yt.999999`WKKK E$$Ifa$gdm* $Ifgdm*kd$$Ifl4 ֈ ](^*,SIe4 lalf4yt.99::&:':}qqq E$$Ifa$gdm* $Ifgdm*xkdJ$$Ifl4 \ ],Sf4 lalf4yt.:::::::#:$:%:':(::B;C;D;E;F;k;l;m;w;x;< < <<<<<z<|<<<<<<<0=2=B=D=p=r=ŨŨŨŨŨŨ~sŜ~~hWN5CJOJQJ hWN5jh} UmHnHujh} Uh} jh} Uhe%ehWNCJ he%ehWNh/hWN6 hWN6hWNhe%ehWN5jRhhWNUjhhWNU hhWNjhhWNU+':(:C;D;E;}=}?kdZ$$Ifl4,,4 lalf4yt. G$Ifgdm*xkd$$Ifl4 \ ],Sf4 lalf4yt.E;F;j;k;l;<TK E$Ifgdm*bkd"$$Ifl40 ,    4 lalf4p yt. G$Ifgdm*?kd$$Ifl4,,4 lalf4yt.<<<<D<z<v?kd$$Ifl4,,4 lalf4yt. G$Ifgdm*?kd9$$Ifl4,,4 lalf4yt} z<|<~<<<<PG ($Ifgdm*Rkds$$Ifl4h0],]f4 lalf4yt. G$Ifgdm*Rkd$$Ifl40],]f4 lalf4yt.<<<<B=D=vm-?kd$$Ifl4,,4 lalf4yt. ($Ifgd} ?kdA$$Ifl4,,4 lalf4yt. ($Ifgdm*?kd$$Ifl4,,4 lalf4yt.D=N=h=p=r==== E$Ifgdm*ekd$$Ifl4F(H',( "{    4 lalf4yt. G$Ifgdm*r=t====================T>V>r>t>v>>>>>>>>>>>>>h?j?l????????h !0hWN@ hWN>*jhWNU hUShWNjhWNUjqhWNUjKhWNUjahWNUjhWNUjhWNUmHnHujyhWNUhWNjhWNU/==T>x>>z $If^gdm* E$Ifgdm* G$Ifgdm*ekd$$Ifl4F(H',( "{    4 lalf4yt.>>>>> $If^gdm* E$Ifgdm*ekd$$Ifl4F(,h    4 lalf4yt.>>j??? @vi E$If^gdm*$If]^gdm* E$Ifgdm* G$Ifgdm*ekdQ$$Ifl4F(,h    4 lalf4yt.???@@ @ @@"@$@&@0@2@4@6@R@T@V@X@l@n@t@NAPARATApArAtAAABBBBBBBBBBBCCDDEEEӶӱӞӓӈӱӁ hshWNjhWNUjhWNUjhWNUhshWN5 hWN5jhWNU hc'hWNjhWNUhWN hUShWNjhWNUmHnHujhWNUjihWNU0 @ @4@X@n@}}p $If^gdm* E$Ifgdm*xkd$$Ifl4\(X ,h0 k 4 lalf4yt.n@p@r@t@PALC 0$Ifgdm*?kd$$Ifl4,,4 lalf4yt. $If^gdm*ekdc$$Ifl4F(,h    4 lalf4yt.PARAvA~AAAB$BCekdC$$Ifl4Fh,h?)    4 lalf4yt. $If^gdm* E$Ifgdm*?kdw$$Ifl4,,4 lalf4yt.$BBBBBB0Rkd$$Ifl40,?)4 lalf4yt. E$Ifgdm*ekd1$$Ifl4Fh,h?)    4 lalf4yt. $If^gdm*BBBCCDi] 0$$Ifa$gdm*?kd$$Ifl4,,4 lalf4yt. 0$Ifgdm*?kd}$$Ifl4,,4 lalf4yt. $If^gdm*DDDDEFFrfYY E$If^gdm* 0$$Ifa$gdA?kd$$Ifl4,,4 lalf4yt. $If^gdm*?kd)$$Ifl4,,4 lalf4yt.EEF F FF4F6FRFTFVF`FbF~FFFFFFFFFFFFFFFFFGGG0G2GFGHGJGTGVGhGjG~GGָ֢֭֝֒ևynjhAUjhAUmHnHuj5hAUjhAU hA5j}hAUjhAUjhAUjhAUjhAUhAhWNjhWNUmHnHujhWNUjhWNU+FFFF4FXFPD7 E$If^gdm* 0$$Ifa$gdm*?kd$$Ifl4,,4 lalf4yt. 0$Ifgdm*ekd?$$Ifl4F ,     4 lalf4ytAXF`FFFFFFF 0$Ifgdm* E$If^gdm* E$If^gdA0$$If^a$gdm*FFF' 0$$Ifa$gdm*kd$$Ifl4 :Hf !,  _ $$$$4 lalf4ytAFG0GXGZGhGGG E$If^gdm*0$$If]^a$gdm*E$If]^gdm*GGGGGGGGGGGGGHHHHH6H8HTHVHXH`HbH~HHHHHHHHHHHHHII IIxIzIIIIIIIIIfJhJjhAUj!hAUjohAUjhAUjhAUjhAUjhAUj+hAU hA5hAjhAUmHnHujhAU5GGG:1 0$Ifgdm*kd $$Ifl4ִ $, D ,    4 lalf4yt.GGGGGHHH E$If^gdm*0$$If^a$gdm*E$If]^gdm*0$$If]a$gdm*?kd$$Ifl4,,4 lalf4yt.HHH`W 0$Ifgdm*kd$$Ifl4ֈD L ,,4 lalf4yt.HH6HZH`HHHHHHIzmzm E$If^gdm*0$$If]^a$gdm*0$$If^a$gdm*E$If]^gdm*0$$If]a$gdm*?kd$$Ifl4,,4 lalf4yt. III' 0$Ifgdm*kd$$Ifl4 D L @,,(H;$$$$4 lalf4yt.IIxIIIII JE$If]^gdm* 0$$Ifa$gdm*?kd$$Ifl4,,4 lalf4yt. J"J$J`W 0$Ifgdm*kd $$Ifl4ֈ,L ,, \,L4 lalf4yt.$J&JfJJJJWN 0$Ifgdm*Rkd{$$Ifl400 ,0  4 lalf4yt. E$Ifgdm* 0$$Ifa$gdm*?kd$$Ifl4,,4 lalf4yt.hJ|J~JJJJJJJJJJJKKKKKKLLLLLLLLLLLLLLLLL MMMMMM M4M6M8MBMDMFMHMNDmDDDF hJhAUjhAUjGhAUjhAUhe%ehACJ hA5jehAUjhAUjhAUmHnHujhAUjhAUhA7JJJJJJTK E$Ifgdm*bkdI$$Ifl40 , "  4 lalf4p yt. 0$Ifgdm*?kd$$Ifl4,,4 lalf4yt.JJJJKKv?kd$$Ifl4,,4 lalf4yt. 0$Ifgdm*?kd6$$Ifl4P,,4 lalf4yt.KKLLLT?kd$$Ifl4,,4 lalf4yt. E$Ifgdm*bkd$$Ifl40&,&  4 lalf4p yt.LLJLLLLLcZ E$Ifgdm*Rkd$$Ifl40],]f4 lalf4yt. G$Ifgdm*?kd1$$Ifl4,,4 lalf4yt.LLLLLMFMPGG E$Ifgdm*Rkd$$Ifl40!,!9 4 lalf4yt. G$Ifgdm*Rkdc$$Ifl4h0],]f4 lalf4yt.FMHMJMLMDcZ G$Ifgdm*?kd$$Ifl4(,,4 lalf4yt. 0$Ifgdm*Rkd$$Ifl40!,!9 4 lalf4yt.ity in collaboration with the Michigan Medicaid managed care plans, Michigan Department of Community Health, Michigan Department of Human Services, Michigan Association of Health Plans, and Michigan Association of Local Public Health.Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.FOSTER PARENT/CAREGIVER HANDOUT SHEET Your Childs Health at 4 Months Milestones Ways your child is developing between 4 and 6 months. Babbles using single consonants such as dada or baba Smiles, laughs, and squeals responsively Rolls over from front to back Shows interest in toys Tries to pass toys from one hand to the other May get upset when separated from familiar person(s) Sits with support Enjoys a daily routine For Help or More Information: Breast feeding, food and health information: Women, Infant, and Children (WIC) Program, call 1-800-26-BIRTH The National Womens Health Information Center Breastfeeding Helpline. Call 1-800-994-9662, or visit the website at:  HYPERLINK "http://www.4woman.gov/breastfeeding" www.4woman.gov/breastfeeding LA LECHE League 1-800-LALECHE (525-3243). Visit the website at  HYPERLINK "http://www.lalecheleague.org" www.lalecheleague.org Text4Baby for health and development information  HYPERLINK "http://www.text4baby.org" http://www.text4baby.org For families of children with special health care needs: Children Special Health Care Services, MDCH Family phone line at 1-800-359-3722. Car seat safety: Contact the Auto Safety Hotline at 1-888-327-4236. Visit the website at HYPERLINK "\\\\HCS084VSNBPF008\\DHS2\\Lansing\\Shared\\OSD\\Mrbig2\\Forms\\DHS Forms\\0500-0599\\www.nhtsa.dot.gov"www.nhtsa.dot.gov To locate a Child Safety Seat Inspection Station, call 1-866-SEATCHECK (866-732-8243) or online at  HYPERLINK "http://www.seatcheck.org" www.seatcheck.org If youre concerned about your childs development: Contact Early On Michigan at 1-800-327-5966 or Project Find at  HYPERLINK "http://www.projectfindmichigan.org/" http://www.projectfindmichigan.org/ or call 1-800-252-0052. For information about childhood immunizations: Call the National Immunization Program Hotlines at 1 (800) 232-4636 or online at http:/www.cdc.gov/vaccines. For help finding childcare: Child Care Licensing Agency, Michigan Department of consumer & Industry Services, 1-866685-0006 or online at  HYPERLINK "http://www.michigan.gov/michildcare" http://www.michigan.gov/michildcare Domestic Violence hotline: National Domestic Violence Hotline (800) 799-SAFE (7233) or online at  HYPERLINK "http://www.ndvh.org" http://www.ndvh.org Safety Tips Always keep one hand on your baby when he is on a bed, sofa, or changing table so he does not roll off. Safety Tips: Never leave your baby alone in your home, car or community. Use a rear-facing car seat for you baby on every ride. Buckle her up in the back seat, away from the air bag. Keep the Poison Control Center phone number by your phone: 1-800-222-1222 Health Tips: Check-ups are a good time to ask the doctor or nurse questions about your baby. Make a list of questions before you go. Keep your babys immunization (shot) card in a safe place and bring it to every doctor or clinic visit. Babies can get shots even when they have a slight cold. Your baby is still getting all the nutrition he needs from breast milk or formula. Try to keep breast-feeding until your baby is at least 12 months old. Talk to your doctor about when to start your baby on cereal or other solid foods. This usually happens when your baby is 5 or 6 months old. Check how your baby sees and hears. Watch to see if her eyes follow moving objects. Watch to see if she turns toward a loud or sudden sound Keep putting your baby to sleep on his back. Keep soft bedding and stuffed toys out of the crib. Make sure your baby sleeps by himself in a crib or portable crib. Call your babys doctor or nurse before your next visit if you have any questions or concerns about your babys health, growth, or development. Parenting Tips: Sing, talk, read to and play with your baby every day. Look at your baby and repeat the sounds she makes. Put your baby on his tummy to play on the floor. Put toys close to him so he can reach for them. Try to make a daily routine for you and your baby. When you are a parent, you will be happy, mad, sad, frustrated, angry and afraid, at times. This is normal. If you feel very mad or frustrated: Make sure your child is in a safe place (like a crib) and walk away. Call a good friend to talk about what you are feeling. Call the free Parent Helpline at 1-800-942-4357 (in Michigan). They will not ask your name and can offer helpful support and guidance. The helpline is open 24 hours a day. Calling does not make you weak; it makes you a good parent. Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual orientation, gender identity or expression, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area.From the Institute for Health Care Studies at Michigan State University.     DHS-581 (7-11) MS Word  PAGE 1 See Next Page DHS-581 (7-11) MS Word  PAGE 4 DDDDFvi G<<$Ifgdm*?kd9$$Ifl4,,4 lalf4yt. 0$Ifgdm*?kd$$Ifl4,,4 lalf4yt.FFFFF)GbGGGGG#H5HLHq & F hd8$If^hgdm* & F hd8($If^hgdm*d8($Ifgdm*d8$Ifgdm*?kd$$Ifl4,,4 lalf4yt. FFFFFFFFFFFFG'G)GaGbGGGGG4H5HKHLHjHHHHKILI}I~IIIIIJ JJJ J!JTJUJ{J|JJJJJJJJ K!K0K1K2KýýýýýýýýhZ hA0J9CJhBhA0J9CJjhACJUhL0hACJ hACJh:hACJhACJfHq !h!uGhACJfHq h:hA5CJ hA5CJhA:LHjHHHI!JJJ!K2KLLLMy & Fd8$Ifgdm* & Fd8$Ifgdm*d8$Ifgdm* & F hd8$If^hgdm* & F hd8($If^hgdm*d8x$Ifgdm*d8($Ifgdm* 2KzK{KKKKLLLfLgLzLLLLLLLLLLMMGMHMkMlMMMM!N:hA5& Z!Z"Z#Z%Z&Z(Z)Z+Z,Z.Z/Z_Z`ZaZZZZZ$$ !,d8gd'gdk"gdWN?kd$$Ifl4,, 4 lalf4yt.ZZZZZ&(*>@BLNPRfhvxzƀȀʀހ(Ҽ֮ңҘҍ҂wj hYUj hYUjM hYUj hYUjhYUjhYUmHnHuj/hYUjVhYUhYjhYUh;CJaJh<hn{!hwRhn{B*CJRHsaJph+ZZ(PxȀ:^ց Hj܂(P%$#"! gdk"6&P/R :p/ =!"#$% @ 00&P/R :pnj/ =!"#$% P 90&P/R :pY/ =!"#$% p$$Ifl!vh#vv #v#v :V l4,5v 55 4alf4ytm*Z$$Ifl!vh#v,:V l4,,5,4alf4ytm*tDText1$$Ifl!vh#v#v #v:V l4,55 5/ / / / / / / 4alf4ytm*$$Ifl!vh#v#v#vh#v:V l4,555h5/  /  / / 4alf4ytm*jD!jDjDjD!$$Ifl!vh#v#v#vh#v:V l4,555h5/ / / / 4alf4ytm*p$$Ifl!vh#vn#v2:V l4,5n52/  4alf4ytm*jD-jD-p$$Ifl!vh#vn#v2:V l4,5n52/ 4alf4ytm*b$$Ifl!vh#v,:V l4,5,/  4alf4ytm*jD]b$$Ifl!vh#v,:V l4,5,/ 4alf4ytm*$$Ifl!v h#vj#vm#vv#vu#vs#vu#v#v {#v }:V l4,5j5m5v5u5s5u55 {5 }/ 4alf4ytm*jDjDjDjDjDjDjDjDjDjD$$Ifl!v h#vj#v1#v<#vv#vW#v#vs#vH#v -#v #v {#v }:V l4,5j515<5v5W55s5H5 -5 5 {5 }/ / / / / / / / / / / / / / / /  / /  /  4alf4ytm*Dkd $$Ifl4" jM 5})##(,j1<vWsH-{},44444 lalf4ytm*vDeCheck28vDeCheck28$$Ifl!vh#v#v#v#v^#v#vP#v8#vp:V l4,++,5555^55P585p/ / / /  / / 4alf4ytV+ vDText12vDText13vDeCheck29vDeCheck28 $$Ifl!vh#v#v#v#v^#v#vP#v8#vp:V l4,++,5555^55P585p/ / / /  / 4alf4ytV+ l$$Ifl!vh#v:V l t,5/ alp ytbW.l$$Ifl!vh#v:V l t,5/ alp ytbW.tDcText5f$$Ifl!vh#v:V l0 t5/ alp ytbW.tDeCheck6tDeCheck6tDeCheck6 $$Ifl!vh#vx#v|#vD#v>#v*#v#vI:V l t,5x5|5D5>5*55I/ / alpFyt"tDeCheck6jD$$Ifl!vh#v0#v#v#v:V l t,50555/ / / / alp(yt"tDeCheck6jDjD$$Ifl!vh#v0#v#v#v #v#vI:V l t,50555 55I/ / / / / alp<yt"tDeCheck6tDeCheck6$$Ifl!vh#v0#v#vF#v#vk#v:V l t,5055F55k5/ / alp<yt"jD$$Ifl!vh#v#vF :V l t,55F / / alpyt"tDeCheck6tDeCheck6$$Ifl!vh#v0#v?#v[#vE:V l t,505?5[5E/ / alp(yt"tDeCheck6tDeCheck6$$Ifl!vh#v#vF#v#v#v:V l t,55F555/ / alp2yt"tDeCheck6tDeCheck6$$Ifl!vh#v#v,#v#vn#v:V l  t ,55,55n5/ / alp2yt$$Ifl!vh#vo#v :V l  t ,5o5 / / alpyt"tDeCheck6tDeCheck6$$Ifl!vh#v0#v#vw#v:V l t,5055w5/ / / alp(yt"l$$Ifl!vh#v:V l t,5/ alp ytbW.tDeCheck6tDeCheck6$$Ifl!vh#vo#vO#v#vn#v:V l  t ,5o5O55n5/ / alp2yt"~$$Ifl!vh#v:V l  t ,5/ alp ytbW.tDeCheck6tDeCheck6$$Ifl!vh#v0#v#v~#vV :V l t,5055~5V / / alp(yt"l$$Ifl!vh#v:V l t,5/ alp ytbW.tDeCheck6$$Ifl!vh#v0#v :V l t,505 / / alpyt"tDeCheck6$$Ifl!vh#v0#v :V l t,505 / / alpyt"$$Ifl!vh#vH #v:V l  t ,5H 5/ alpytbW.tDeCheck7tDeCheck7$$Ifl!vh#v0#v#vP#v:V l t,5055P5/ alp(yt"tDeCheck7vDeCheck30$$Ifl!vh#v0#v#vP#v:V l t,5055P5/ alp(yt"$$Ifl!vh#v #vK:V l  t ,5 5K/ / alpytbW.tDeCheck7tDeCheck7$$Ifl!vh#v0#v#v&#v :V l t,5055&5 / / alp(yt"$$Ifl!vh#v#v1:V l  t ,551/ alpytbW.tDeCheck7tDeCheck7$$Ifl!vh#v0#v#v.#v :V l t,5055.5 / / alp(yt"$$Ifl!vh#v#v1:V l  t ,551/ alpyt[tDeCheck7jD$$Ifl!vh#v0#v#v|#v::V l t,5055|5:/ / alp(yt"l$$Ifl!vh#v:V l t,5/ alp ytbW.l$$Ifl!vh#v:V l t,5/ alp ytbW.tDeCheck7$$Ifl!vh#v0#v :V l t,505 / alpyt"tDeCheck7$$Ifl!vh#v0#v :V l t,505 / alpyt"tDeCheck7tDeCheck7$$Ifl!vh#v0#v?#vM#v?:V l t,505?5M5?/ alp(yt"tDeCheck7tDeCheck7$$Ifl!vh#v0#v?#vM#v?:V l t,505?5M5?/ alp(yt"tDeCheck7tDeCheck7$$Ifl!vh#v0#v?#vM#v?:V l t,505?5M5?/ alp(yt"tDeCheck7$$Ifl!vh#v0#v :V l t,505 / alpyt"tDeCheck7jD$$Ifl!vh#v0#v#v#v:V l t,50555/ / alp(yt"l$$Ifl!vh#v:V l t,5/ alp yttDeCheck9tDeCheck9$$Ifl!vh#v#v#v#v#v:V l t,55555/ / alp2yt"$$Ifl!vh#v#vA#v #vx#v_:V l4 t+++,55A5 5x5_/  /  /  /  alp2yt"$$Ifl!vh#v#vA#v #vx#v_:V l4 t+++,55A5 5x5_/  /  /  /  alp2yt"$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  /  /  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9P$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  alpFyt"tDeCheck9tDeCheck9tDeCheck9tDeCheck9$$Ifl!vh#v#vn#v#vu#v#vx#v_:V l t,55n55u55x5_/  /  /  /  /  /  /  /  /  /  /  alpFyt"^$$Ifl!vh#v:V l t,5alp ytbW.vDeCheck10$$Ifl!vh#v0#v :V l t,505 / alpyt"$$Ifl!vh#v0#v :V l t,505 / alpyt"^$$Ifl!vh#v:V l t,5alp ytbW.^$$Ifl!vh#v:V l t,5alp ytbW.vDeCheck10vDeCheck10$$Ifl!vh#v0#vH#v-#vV :V l t,505H5-5V / alp(yt"^$$Ifl!vh#v:V l t,5alp ytbW.^$$Ifl!vh#v:V l t,5alp ytbW.vDeCheck10$$Ifl!vh#v0#v :V l t,505 / alpyt"vDeCheck10v$$Ifl!vh#v0#v :V l t,505 alpyt"vDeCheck10vDeCheck10$$Ifl!vh#v0#v#v#v'#v:V l t,50555'5/ alp2yt"vDeCheck10$$Ifl!vh#v0#v#v :V l t,5055 alpyt"vDeCheck31$$Ifl!vh#v0#v#v :V l t,5055 alpyt"vDeCheck10$$Ifl!vh#v0#v#v :V l t,5055 alpyt"vDeCheck10jD$$Ifl!vh#v0#v#vm#v#vK:V l t,5055m55K/ / alp2yt"vDeCheck10jD$$Ifl!vh#v0#vH#v8 #vK:V l t,505H58 5K/ / alp(yt"l$$Ifl!vh#v:V l t,5/ alp yt{Jl$$Ifl!vh#v:V l t,5/  alp ytbW.l$$Ifl!vh#v:V l t,5/ alp ytbW.$$Ifl!vh#v8#v :V l  t ,585 / alpyt"vDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l4( t+,505 / alpyt$$Ifl!vh#v0#v :V l4( t+,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l4( t+,505 / alpyt$$Ifl!vh#v0#v :V l4( t+,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpyt$$Ifl!vh#v#v :V l  t ,55 / alpyt"vDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpyt$$Ifl!vh#v #v':V l  t ,5 5'/ alpyt"vDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l4( t+,505 / alpyt$$Ifl!vh#v0#v :V l4( t+,505 / alpyt$$Ifl!vh#v #v':V l  t ,5 5'/ alpytbW.vDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck10$$Ifl!vh#v0#v :V l( t,505 / alpyt$$Ifl!vh#v8#v:V l  t ,585/ / alpyt"vDeCheck34$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck35$$Ifl!vh#v0#v :V lP t,505 / alpytvDeCheck35$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck36$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck36$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck36$$Ifl!vh#v0#v :V l( t,505 / alpytvDeCheck36$$Ifl!vh#v0#v :V l4( t+,505 / alpyt$$Ifl!vh#v0#v :V l4( t+,505 / alpytvDeCheck36$$Ifl!vh#v0#v :V l4( t+,505 / alpyt$$Ifl!vh#v0#v :V l4p t+,505 / alpytoIl$$Ifl!vh#v:V l( t,5/ alp yttDBText4f$$Ifl!vh#v:V l t5/ alp ytoI~$$Ifl!vh#v:V l(  t ,5/ alp yt~$$Ifl!vh#v:V l  t ,5/ alp ytoIl$$Ifl!vh#v:V l t,5/ alp ytm*l$$Ifl!vh#v:V l% t,5/  alp yt{JZ$$Ifl!vh#v,:V l4,5,4alf4yt.Z$$Ifl!vh#v,:V l4,5,4alf4yt.Z$$Ifl!vh#v,:V l4,5,4alf4yt.~$$Ifl!vh#v(#v "#v~:V l45(5 "5{/  4alf4yt.jDjDjD~$$Ifl!vh#v(#v "#v~:V l45(5 "5{/ 4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.~$$Ifl!vh#v*#vr&:V l45*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#v#vq:V l4,5*55n/ / 4alf4yt.jD$$Ifl!vh#v*#vr&:V l4,5*5o&/ /  4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.~$$Ifl!vh#v*#vr&:V l45*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#v#vq:V l4,5*55n/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#v#vq:V l4,5*55n/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v*#vr&:V l4,5*5o&/ / 4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/ 4alf4yt.p$$Ifl!vh#v]#vi:V l45]5f/ 4alf4yt.$$Ifl!vh#v#v#vS#v#vI#vh:V l4 ,555S55I5e/ / / / / /  / / 4alf4yt.tDeCheck7tDeCheck7tDeCheck7tDeCheck7$$Ifl!vh#v#v#vS#v#vI#vh:V l4 ,555S55I5e/ 4alf4yt.tDeCheck7tDeCheck7tDeCheck7tDeCheck7$$Ifl!vh#v#v#vS#v#vI#vh:V l4 ,555S55I5e/ 4alf4yt.tDeCheck7tDeCheck7tDeCheck7tDeCheck7$$Ifl!vh#v#v#vS#v#vI#vh:V l4 ,555S55I5e/ 4alf4yt.tDeCheck7tDeCheck7tDeCheck7tDeCheck7$$Ifl!vh#v#v#vS#v#vI#vh:V l4 ,555S55I5e/ 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v#v#vS#vi:V l4 ,555S5f/ 4alf4yt.tDeCheck7tDeCheck7$$Ifl!vh#v#v#vS#vi:V l4 ,555S5f/ 4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.b$$Ifl!vh#v,:V l45,/  4alf4yt.$$Ifl!vh#v #v :V l4  5 5 / / /  4alf4p yt.jDb$$Ifl!vh#v,:V l45,/ 4alf4yt} b$$Ifl!vh#v,:V l45,/ 4alf4yt.p$$Ifl!vh#v]#vi:V l45]5f/  4alf4yt.p$$Ifl!vh#v]#vi:V l4h5]5f/ 4alf4yt.Z$$Ifl!vh#v,:V l4,5,4alf4yt.Z$$Ifl!vh#v,:V l4,5,4alf4yt.Z$$Ifl!vh#v,:V l4,5,4alf4yt.~$$Ifl!vh#v(#v "#v~:V l45(5 "5{/  4alf4yt.tDText6tDFText7jD~$$Ifl!vh#v(#v "#v~:V l45(5 "5{/ 4alf4yt.vDeCheck11$$Ifl!vh#v#vh#v:V l4,55h5/  / / /  4alf4yt.jD&vDeCheck11$$Ifl!vh#v#vh#v:V l4,55h5/ / / 4alf4yt.vDeCheck11jD$$Ifl!vh#v#vh#v0 #vn :V l4,55h50 5k /  / / 4alf4yt.jD&vDeCheck11$$Ifl!vh#v#vh#v:V l4,55h5/ / / /  4alf4yt.b$$Ifl!vh#v,:V l45,/ 4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.vDeCheck11v$$Ifl!vh#vh#v#vB):V l4,5h55?)4alf4yt.vDeCheck11v$$Ifl!vh#vh#v#vB):V l4,5h55?)4alf4yt.jDh$$Ifl!vh#v#vB):V l4,55?)4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.jD$$Ifl!vh#v#v#v :V l4,555 / 4alf4ytAT$$Ifl!vh#v,:V l45,4alf4yt.vDeCheck14vDeCheck14vDeCheck17vDeCheck18$$Ifl!v h#v#v #v #v#v#vb#v#v#v  :V l4, 55 5 555_555  4alf4ytAvDeCheck19jDjD$$Ifl!vh#v#v #vD#v #v,#v#v#v:V l4,55 5D5 5,555/ 4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.vDeCheck24vDeCheck25$$Ifl!vh#v#v,#v#v#v#v:V l4,55,55554alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.vDeCheck24vDeCheck25tDText8tDText9$$Ifl!v h#v#v,#v#v#v#v#v(#vH#v >:V l4, 55,55555(5H5 ;/ /  4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.vDeCheck26vDeCheck27$$Ifl!vh#v,#v #v\#v,#vL#v:V l4,5,5 5\5,5L54alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.vDCText10v$$Ifl!vh#v0 #v :V l4,50 5 / 4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.$$Ifl!vh#v #v":V l4  5 5"4alf4p yt.jD.T$$Ifl!vh#v,:V l4P5,4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.$$Ifl!vh#v&#v:V l4  5&54alf4p yt.vDText11T$$Ifl!vh#v,:V l45,4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.p$$Ifl!vh#v]#vi:V l45]5f/  4alf4yt.jD-p$$Ifl!vh#v]#vi:V l4h5]5f/ 4alf4yt.p$$Ifl!vh#v!#v< :V l45!59 /  4alf4yt.jDEjDp$$Ifl!vh#v!#v< :V l45!59 / 4alf4yt.T$$Ifl!vh#v,:V l4(5,4alf4yt.T$$Ifl!vh#v,:V l45,4alf4yt.b$$Ifl!vh#v,:V l45,/ 4alf4yt.b$$Ifl!vh#v,:V l45,/ 4alf4yt.DyK ]\\HCS084VSNBPF008\DHS2\Lansing\Shared\OSD\Mrbig2\Forms\DHS Forms\0500-0599\www.nhtsa.dot.govp$$Ifl!vh#v]#v\:V l4. 5]5\/ 4alf4yt.b$$Ifl!vh#v,:V l4 5,/ 4alf4yt.b$$Ifl!vh#v,:V l4 5,/ 4alf4yt.DAddress1 UppercasedEnter the Addressee's mail address (street address, PO Box, etc., wh^I 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH 8`8 USNormal_HmH sH tH B@B  Heading 3 $<5CJDA`D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List POP BLANKLINEdx5CJOJQJkHTOT Captions 6ptd(CJ OJQJkHDOD Captions 6pt bold5`O"` Captions 6pt boxd<5CJ OJQJkHD2D Captions 6pt Nbox<DOBD Captions 7pt dtCJDOARD Captions 7pt Bold5BOqbB Captions 7pt box5^Or^ Captions 7pt NBoxdt<CJOJQJkHdOd @Captions 8pt Char Char d`CJOJQJkH^O^ Captions 8pt Bold d`5CJOJQJkHFF Captions 8pt box <DD Captions 8pt NboxPPOP Captions 9pt dLCJOJQJkHJOJ ACaptions 9pt BolddLCJFOF Captions 9pt Box dDOD Captions 9pt Nbox5POP C Captions 10pt d`( OJQJkH^O^ Captions 10pt Bold!d`(5OJQJkHXO"X Captions 10pt box"d`P OJQJkHHO2H Captions 10pt Nbox#P5J @BJ Footer$dt !CJOJQJkHRORR Form Title 10pt%$d8a$ OJQJkH^Ob^ Form Title 10pt Bld&$d8a$5OJQJkHVOrV Form Title 11pt'$d$a$CJOJQJkHLOaL Form Title 11pt Bld(d$CJVOV Form Title 12pt)$da$CJOJQJkHbOb =Form Title 12pt Bld*$da$5CJOJQJkH44 Header + !HOH Small Blank Line ,CJbOb DUser Input 10pt Char-d8(5OJQJkHTOT User Input 11pt.d$5CJOJQJkH\O\ User input 12pt/d((5CJOJQJkHTOT >Letter Text 10pt0$d$a$ OJQJkHFOF ?Letter Text 11pt1dCJXO"X Letter Text 12pt2$da$CJOJQJkHL2L Captions 10pt 2 line 3<FOBF Date 08pt45CJOJQJkH6OAR6 Date 09pt5CJ6OAb6 Date 10pt6CJ2Oar2 Date 11pt7CJ.. Memo Body80U`0 Hyperlink>*B*@V`@ FollowedHyperlink>*B* H@H _C Balloon Text;CJOJQJ^JaJ.)@. wR Page Numberhoh *!Form Title 12pt Bld Char5CJOJQJ_HmH sH tH ZoZ 0}Letter Text 10pt CharOJQJ_HmH sH tH ^o^ 1\Letter Text 11pt CharCJOJQJ_HmH sH tH lol xCaptions 8pt Char Char CharCJOJQJ_HmH sH tH fof xCaptions 9pt Bold Char5CJOJQJ_HmH sH tH j#j Cl Table Grid7:VB0BTo1T MCaptions 10pt CharOJQJ_HmH sH tH foAf -xSyUser Input 10pt Char Char5OJQJ_HmH sH tH LORL sUser Input 10ptEd8 5OJQJVObV H;Captions 8pt Char Fd` CJOJQJLOrL ; Captions 8pt Gd` CJOJQJdod F;Captions 8pt Char Char1CJOJQJ_HmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] sEv8vzv >>>>>>>>>>>>bbbe%'39;GMO[a,8>@LRVbhjv| 0HX`lrt+7=FV\lq !17G[gmp'7N^(8l|!8Hz  ( . D T n ~    . 4 D L \ t 5 E G W Y i k {   / B R T d f v x     ( 2 B D T V f h x %/?AQSceu +;=MO_aq-=?OQacs#)9GW|+;br L\7Gs(Td0@#3_o5Em} Xh%179EKMY_Uagjz|  :JL\ "2dtvWgiy  \ l n ~ !"" "J"Z"\"l"""""""""###(#i#y#{######$$$&$6$N$^$`$p$$$$$%&&&&&&&&&&&3'C'M'Y'_'a'q''''( (((!(#(3((())X)d)j)++"+7+G+M+]+e+u+|+++++++++++ ,,,8,H,M,],u,,,,,,,,,,P-\-b---- ...i.u.{.......h4444%5;5q5556 7777728d8899::::EFFFFFFFFFFFFFFFFFFG$G$FFG$G$FG$G$G$G$FG$FFG$G$FG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FG$G$G$G$G$G$G$G$G$G$FG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FTG$FG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FFFFG$G$FG$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$G$FFFFG$FG$G$FFG$G$G$FFG$G$G$G$G$FFG$G$G$G$FFG$G$FFFFFFXXXXXXXX#*,U\^e!!@ @H 0(  0(  B S  ? Check28Text12Text13Check29Check31Check34Check35Check36Text4!`tnE2s~E4<5Z9:<::?E@EBECEEEFEHEIEKELEcEmEEEEE pprr##4<59:::@@@@@IA?E@E@EBECECEEEFEHEIEKELEcEmEEEEE pprr##4<59:::@@@@@IA?E@EBECECEEEFEHEIEKELEcEmEEEEE|܉}~tzHz j PpRcXH@0N7  8Bh%qU4 8VlQPy[E~cAYxD``m|Ll{^`.^`.88^8`.^`. ^`OJQJo( ^`OJQJo( 88^8`OJQJo( ^`OJQJo(hh^h`. hh^h`OJQJo(h ^`hH.h ^`hH.h pL^p`LhH.h @ ^@ `hH.h ^`hH.h L^`LhH.h ^`hH.h ^`hH.h PL^P`LhH.h^`OJQJo(hHh^`OJQJ^Jo(hHohpp^p`OJQJo(hHh@ @ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohPP^P`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHhh^h`OJQJo(hHh8^8`OJQJ^Jo(hHoh^`OJQJo(hHh ^ `OJQJo(hHh ^ `OJQJ^Jo(hHohx^x`OJQJo(hHhH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHhh^h`OJQJo(hHh8^8`OJQJ^Jo(hHoh^`OJQJo(hHh ^ `OJQJo(hHh ^ `OJQJ^Jo(hHohx^x`OJQJo(hHhH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohp^p`OJQJo(hHh@ ^@ `OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hHh^`OJQJo(hHh^`OJQJ^Jo(hHohP^P`OJQJo(hHhh^h`OJQJo(hHh8^8`OJQJ^Jo(hHoh^`OJQJo(hHh ^ `OJQJo(hHh ^ `OJQJ^Jo(hHohx^x`OJQJo(hHhH^H`OJQJo(hHh^`OJQJ^Jo(hHoh^`OJQJo(hH8~}|AYx0N7 %qUPy[m|8V                                                                @ @GSCgu! ;CE5] >:n(f7A cq|\q= N^ 5l V+ rx u0 s u } ##Ng? ym*WAZ+Wpl +XHoIO]a?,etW j7C wP OZ!j"k"Yi#P $$0$"j$t$0%3'c'_](v )4)b*d*%h*wT,e,L--.&..bW./p!/ !0k1?23.3jZ31_34>46w 7yb768&9=:M:[:d:U ;;#;,=j =$y=!>Z>Aq7B>BEB`BLjCsEF1#F*F*G(kG nG!uGJK{L("M\TMN#Ng4OX^PR-ASjS%:TVTUbVvVcaWXXhX+ZP]#^/^\_`Ea`a Vbe{cWee%eXneY]frffgwgfhmh iEi|iFuj=lClkp0r|rs"s~s5u!vYvwxWHxlaxy>$yxSy_y z2jzn{-|9c},~e\3KG89Gjd5OU[d8oGyJYk"v"2D6[?x [|D i 8A[y%_CZyn>%s'&w\zys D:yoS7 ^6B|uEz<IMPk Fz(p"!wRzGTz /q{JUSaM\>WQYo1uq1"WA&p/::b3L0e#8HFbT[B@FHJL@UnknownG* Times New Roman5Symbol3. * Arial?= * Courier NewI" Arial (W1)Arial5. *aTahoma;WingdingsA$BCambria Math"hEFEFMbFI :#}I :#}r c#4DD9U0 2QXZ 88o*!xx *DHS-581, Well Child Exam Infancy: 4 Months*DHS-581, Well Child Exam Infancy: 4 MonthsForms and Mail Managementbushd2P            ^@ Oh+'0,8DX ht    ,DHS-581, Well Child Exam Infancy: 4 Months,DHS-581, Well Child Exam Infancy: 4 MonthsForms and Mail Management 0581.dotbushd22Microsoft Office Word@F#@hl@@FD5F@FD5FI :՜.+,D՜.+,|8 hp  (Michigan Department of Human Services}#D +DHS-581, Well Child Exam Infancy: 4 Months TitleP 8@ _PID_HLINKSA0T@`http://www.ndvh.org/+?]$http://www.michigan.gov/michildcarey(Z$http://www.projectfindmichigan.org/\Whttp://www.seatcheck.org/oT]\\HCS084VSNBPF008\DHS2\Lansing\Shared\OSD\Mrbig2\Forms\DHS Forms\0500-0599\www.nhtsa.dot.govQhttp://www.text4baby.org/BNhttp://www.lalecheleague.org/+wK$http://www.4woman.gov/breastfeeding  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~      !"#$%&'()*+,-./0123456789:;=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~/?    !"#$%&'()*+,-.0123456789:;<=>@ABCDEFGHIJKLMNOPQRSTUVWXYZ[\]^_`aRoot Entry F6F "Data <&1TableӨWordDocument .SummaryInformation(DocumentSummaryInformation8MsoDataStore6FV6FGCOOVCZ5U==26FV6FItem  PropertiesUMacrosV6FV6FVBA V6FV6F  !"#$%&'()*+,-./023456789:;<=>@ABCDEFGHIJKLMNPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{}~ J0* pHdTemplateProjectQH@  = | DreK0 J< 9stdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\WINDOWS\system32\e2.tlb#OLE Automation0EOfficEOficEE2DF8D04C-5BFA-101B-BDE5EAAC42Egram Files\@CommonMicrosoft Shared\OFFICE14\MSO.DLL#M 10.0 Ob LibraryK׈dir NModule1 UpdateField1]ThisDocument?-ThisDocumentGTisDcum7n]* 2  HB1Bx%B,! q"EB+B UpdFieldHGp}aA!eFi$l 2 O#P#H!E#@Module1GEdE12Ob@I\-xME(<0<< <h , .X%"  .@Pp &x  (((P X h]@'If document is protected, Unprotect it. $!2 4cladd878 $B@6kPerform Spelling/Grammar check.2 :(< . $!>8 .!@(BF .!@B@Dn . ReProtect the document. $!2 4cladd878J Ll $B@HkoAttribute VB_Name = "Module1" Sub FormsSpellCheck2() Dim x As wdNo Then  9ZPassword:="c@ladd87E nd If'P(erf ing/Gramma8r clK.Op2tBs.vWi thFalse EachIn JsZx.Range.iof>$;;5AlwaysSuggest :=Tru; Next: 'Re the=&EW, n orese&, o:=wdAllowOnlyAbAAe\c-xMEH "8"( $!&B@(o`XXAttribute VB_Name = "UpdateField" Sub D () ActiveDocu ment.Zs.P End p - q#xME (SLSS<N0{00020906-0000-0000-C000-000000000046}8(%HxAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |GlobalSpacFalse dCreatablPredeclaIdTru BExposeTemplateDerivBustomizD2a  *\G{000204EF-0_VBA_PROJECTO PROJECT |PROJECTwmeCompObjr000-0000-C000-000000000046}#4.1#9#C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA7\VBE7.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.5#0#C:\Program Files\Microsoft Office\Office14\MSWORD.OLB#Microsoft Word 14.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINDOWS\system32\stdole2.tlb#OLE Automation(*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.5#0#C:\Program Files\Common Files\Microsoft Shared\OFFICE14\MSO.DLL#Microsoft Office 10.0 Object Library DreK0-ThisDocument054f7c0426ThisDocument q%UpdateField064f7c0426"UpdateFieldModule1074f7c0426*Module10bP0/:EJc[G#zxKeO6DetgWL(#0'$)WordkVBAWin16~Win32Win64xMacVBA6#VBA7#TemplateProjectEstdole`Officeu ThisDocument< _Evaluate UpdateFieldKActiveDocument\Fields7UpdateModule1bFormsSpellCheck2gzxo FormFieldProtectionTypewdNoProtection Unprotect?PasswordOptionsCheckGrammarWithSpelling FormFields-|Range  NoProofing] CheckSpellingW AlwaysSuggestProtectfnoresetgwdAllowOnlyFormFields!Documentj`# +6ID="{F3D2E693-E167-422E-B5CE-A99054437EB4}" Document=ThisDocument/&H00000000 Module=UpdateField Module=Module1 Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="DEDC381CC824A228A228A228A228" DPB="BCBE5A7AE659E759E759" GC="9A987CA05BA15BA1A4" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C UpdateField=0, 0, 0, 0, C Module1=0, 0, 0, 0, C ThisDocumentThisDocumentUpdateFieldUpdateFieldModule1Module1  F Microsoft Word 97-2003 Document MSWordDocWord.Document.89qg Bbjbj٘ .bxbxʆ`(( ʆ-d .:!Ө-   V6F0-ӨӨӨ$-Ө\y |:  FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTE(*8:<PRTZ\^`tvāƁԁց؁ "68FHJ^`b~qjghY5U hY5jhY5UjhYUjhYUjhYUjhYUjChYUj hYUjhYUmHnHuj hYUhYjhYUj? hYU,bfhjlЂ҂Ԃ؂ڂ܂ނ$&(*>@NPRfhvxzڶڶڶڶjhYUj"hYUjhYUj:hYUjhYUjhYUmHnHujhYUjhYUjhYUhYjhY5UjhY5UmHnHu0Pxȃ@hڌ*Lp ,PxȎ=<;:9876543210/.-,+*)('&ƃȃʃރ .0>@BVXfhj~Ȍʌ،ڌ܌jfhYUjhYUjhYUj~hYUjhYUjhYUmHnHujhYUUjshYUjhYUhYjhYUjhYU1XT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       (*,@BDHJLNbdflnpr֍؍   "$(*,j!hYUjN!hYUj hYUj hYUjihYUjhYUjhYUmHnHujhYUjphYUhYjhYUjhYU3,.BDFLNPRfhvxzƎȎʎގ.02<>@Bh"YYjr&hYUj%hYUj$hYUj_$hYUj#hYUj^#hYUjhYUmHnHuj"hYUhYjhYU*@B?>,1h/ =!"#$% ere the mail will be delivered). ClientCityDBureau#Enter your Bureau/Office/Unit name.DCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite or Apartment Number, C/O)Address1D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)D ClientCity UppercaseEnter the Addressee's City. ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD ClientZip UppercaseKEnter the Addressee's Zip Code (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond8(OJQJ_HmH sH tH \O\ WorkerTitle?d8(5OJQJ_HmH sH tH PK![Content_Types].xmlN0EH-J@%ǎǢ|ș$زULTB l,3;rØJB+$G]7O٭V$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! I_TS 1?E??ZBΪmU/?~xY'y5g&΋/ɋ>GMGeD3Vq%'#q$8K)fw9:ĵ x}rxwr:\TZaG*y8IjbRc|XŻǿI u3KGnD1NIBs RuK>V.EL+M2#'fi ~V vl{u8zH *:(W☕ ~JTe\O*tHGHY}KNP*ݾ˦TѼ9/#A7qZ$*c?qUnwN%Oi4 =3N)cbJ uV4(Tn 7_?m-ٛ{UBwznʜ"Z xJZp; {/<P;,)''KQk5qpN8KGbe Sd̛\17 pa>SR! 3K4'+rzQ TTIIvt]Kc⫲K#v5+|D~O@%\w_nN[L9KqgVhn R!y+Un;*&/HrT >>\ t=.Tġ S; Z~!P9giCڧ!# B,;X=ۻ,I2UWV9$lk=Aj;{AP79|s*Y;̠[MCۿhf]o{oY=1kyVV5E8Vk+֜\80X4D)!!?*|fv u"xA@T_q64)kڬuV7 t '%;i9s9x,ڎ-45xd8?ǘd/Y|t &LILJ`& -Gt/PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-![Content_Types].xmlPK-!֧6 0_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!0C)theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] 0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber CoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictEmailFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2 OtherID!Section" SuperAreaCode#SuperExtension$SuperPhoneNumber%SupervisorName&Unit'Worker(WorkerAreaCode)WorkerExtension* WorkerFax+ WorkerName, WorkerName2- WorkerPhone. WorkerTitle/0 Address11BureauCareOf1 CaseNumber1 ClientCity1 ClientState1 ClientZip1 CoAddress1 CoAreaCode1CoCity1 CoExtension1CoPhoneNumber1CoState1CoSuppaddress1 CountyName1 CountyNumber1CoZip1Date11 District2EmailFaxAC FirstName1 FirstName21GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstName2GranteeLastName1 GranteeState GranteeZip LastName1 LastName21OtherID1Section2SuperAreaCode1SuperExtension1SuperPhoneNumber1SupervisorName1Unit2Worker2WorkerAreaCode1WorkerExtension1 WorkerFax WorkerName1 WorkerName2 WorkerPhone1 WorkerTitle1(<Pdu$5I]n  4EYm(<Pdx & dx@{G4by)9 m!"e#$&'()+,/1335D688:r=?EGhJF2KN"XZ(b,B',127:=@DGLQU[`diquz~ 02479BCEHI  V X tt~<*BT&i 'Ty00D  hjgi ]_UW  U W !![!]!!!""R"o"""#7#$l$p$$$%&&s&v&&& '>'K'''3(A(e(((().)f)))*****1+j+++",(,,--.(///011*2j222133304444h556A67H77`8899':E;<z<<D==>> @n@PA$BBDFXFFFGGHHII J$JJJKLLFMDFLHM;R"X ZZPB()*+-./0345689;<>?ABCEFHIJKMNOPRSTVWXYZ\]^_abcefghjklmnoprstvwxy{|}     !./13568:DJ  &(4:<HNP\bdpsu"$035AGIU[]ilnz   ,24@CEQWYekmy"&(4:<HNP\bdpvxFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipdate1DistrictEmailFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitle)=Qev%6J^o !5FZn)=Qey  !"#$%&'()*+,-./';Oct#4H\m 3DXl';OcwY"YYC(UnknownG* Times New Roman5Symbol3. * Arial?= * Courier NewI" Arial (W1)Arial5. *aTahoma;WingdingsA$BCambria Math"1h0HP?C2!xx