As the Director of Regulatory Compliance, Wanda assists Sharps' customers in evaluating current federal and state-specific medical and pharmaceutical waste regulations, implementing compliant regulated medical and pharmaceutical waste management programs and processes, and developing training programs for both internal and external customers. 1800 Washington Blvd., Baltimore, MD 21230, Electronically Accepted Permit Applications, Permit Application Database Search (SB47), Click here to go directly to Title 26 Subtitles with links to their pertinent Chapters and Regulations.. All Rights Reserved. and 8-6A-08(f)(5), Annotated Code of Maryland .01 Exclusion from Regulations. Amount of Civil Money Penalties, Sec. (Family Day Care) or COMAR 07.04.02 (Child Care Center Licensing) except for those . The CCRCs, both operating and under construction, contains over 16,000 continuing care units, of which over 12,000 are independent living, over 2,000 are assisted living, and over 2,000 are nursing care. 201 W. Preston Street, Baltimore, MD 21201-2399, Maryland Laboratories Licensed to Perform COVID-19 Testing, of Maryland Regulations (COMAR) is the official compilation of all regulations issued by agencies of the State of Maryland. Reference is to the page number on which the regulation can be found. The Maryland Department of Aging provides a comprehensive consumer information packet for persons interested in learning more about Continuing Care Retirement Communities. The. The COMAR regulations are reviewed and updated frequently. This report is by the Appropriations Please review the website for the Office of Health Care Quality (OHCQ) Regulations provides the official online access to COMAR.The Office of Health Care Quality does not sell copies of COMAR regulations. Proposed actions are available for 30 days following their publication in the Maryland Register and emergency actions are available for 180 days following their effective date or until replaced by a proposed action, whichever is sooner. Maryland, like every state, has its own unique set of assisted living rules, regulations and statutes that each care home, employee, owner and administrator needs to understand, and uphold on a daily basis. Responsibility for implementation and enforcement of all provisions of the Patients Bill of Rights Regulations under COMAR 10.07.09. living, in a way that promotes optimum dignity and independence for the individuals. Compensation $12.50 - $20 per hour (based on experience and education) Investigation by Department, Sec. endstream endobj 460 0 obj <>stream The Maryland General Assemblys Office of Legislative Audits operates a toll-free fraud hotline to receive allegations of fraud and/or abuse of State government resources. 10.07.14.33. hmo6SE( 8[ ]P2baH 10.07.14.61. Maryland Manual Online State Department of Education, 200 West Baltimore Street, Baltimore, MD 21201-2595, 410-767-0100 You may be trying to access this site from a secured browser on the server. on proposed revisions to the assisted living regulations in COMAR 10.07.14. The above regulations are those most relevant to consider when evaluating a residential facility. Access available atall UM Libraries' locationsthrough the Database Finder (https://www.lib.umd.edu/dbfinder). All rights reserved. PA, Colorado The Department urges anyone who is considering moving into a CCRC to consult with an attorney and a. financial advisor familiar with these types of agreements before signing any documents. The Code of Maryland Residents, or COMAR, goes into depth on topics such as admission and discharge, resident's representative, special care units, pharmaceutical services, and relocation. Resident Agreement Financial Content, Sec. Springs, The Most Department Psychiatric Rehabilitation. The Maryland Register is COMAR's temporary supplement, printing all changes to regulations as soon as they occur. hVYo8+|L"^:Xub i+Y[,y%uu&[]pfH~.jp) #"C"58qF @-I P.jEF@x4!.! The Maryland Register is an official publication of the State of Maryland, The Register serves as the temporary supplement to the Code of Maryland Regulations (COMAR). %%EOF Volumes within COMAR are arranged by a title number marked on each volume. HUMo0W( *bEM{jlv-KUmbqHY"iEb==+XI'f?VZP Z,@C5J YNr ]. 3\3 a8S" c8KN+Le4l>*I)([oYDe. For additional information, please see the tabs below. Many of these are cataloged in the Library catalog. Vision Impaired, An Overview of Rhode Privacy Policy | Give Now | Website Feedback | Web Accessibility. 2020 and 2021 Assisted Living State Regulatory Review Maryland Agency Department of Health, Office of Health Care Quality . The Code of Maryland Regulations, often referred to as COMAR, is the official compilation of all administrative regulations issued by agencies of the state of Maryland. Index- A keyword index toCOMAROnlineis available, though it only refers tobroad subjects at the end of each title. Abuse, Neglect, and Financial Exploitation, Sec. Copyright 2023 by eLaws. 2 Public Health Reports - 1990 Veterinary Technician - 2002-07 Journal of the American Medical Association - 1992-03 Adams Jobs Almanac 1998 - Bob Adams Publishers 1997-07 The Legislature enacts statutes. We're available on the following channels. 02 -Regulation 2022 University Libraries, University of Maryland. Assisted Living Programs, Code of Maryland Regulations (Last Updated: April 6, 2021), Sec. HUQO0~T7v'nbChhZ!I[Jh;88NO -hvZiib\dh,,`>8P(1.Pa:VhGv*.4T*NNz'X|;ILG2R |2Bc.Ly0>#.6'X+mW! Assisted Living Manager Training Basic Courses, Sec. Maryland OneStop OneStop is the central hub for Maryland State licenses, forms, certificates, permits, applications, and registrations. 10.07.14.24. F. The Department may require an individual who is exempt under the provisions of E of this regulation to complete a manager training course and examination if: (1) The Department finds that the assisted living manager repeatedly has violated State law or regulations on assisted living; and. Relocation and Discharge, Sec. As the regulatory authority for Continuing Care, the Maryland Department of Aging provides an information packet for a potential provider that describes the Development and Application Process. NM, Tucson, Make sure the facility is licensed in the state of Maryland, by the Office of Healthcare Quality. Available online 24 hours a day, 7 days a week. 10.07.14.52. (4) If the assisted living program is part of a continuing care retirement community and a separate, concurrent resident agreement is signed by a continuing care subscriber as defined at COMAR 32.02.01.01B(35), a statement indicating that if the resident's level of care, after admission to assisted living, exceeds the level of care for which . Resident-Specific Level of Care Waiver, Sec. Millersville, Maryland 21108 +Assisted Living Well On the Michelle Gray [III] (13) Magothy 410-212-8613 5127 Mountain Road 443-702-2929 Pasadena, Maryland 21122 . The fourth meeting will include comments. Preadmission Requirements, Sec. In the Quick Links section youll see a section for Assisted Living. The Nurse Practice Act and Annotated Code of Regulations (COMAR) for Nurses are both available on our website but can be difficult to locate and sort through; we are in the process of revising our website to make it more user-friendly. Specific sections of the regulation will be discussed at the first, second, and third meetings. The Homeless Education Liaison's duties are those mandated by Title VII, Subtitle B of the McKinney-Vento Homeless Assistance Act as amended by the No Child Left Behind Act of 2001 (Public Law 107-10), Education for Homeless Children and Youth, Title X, Part C, Subtitle B as implemented in Maryland under COMAR 13A.05.09.03.A(5) ("McKinney-Vento"). Assisted Living Programs. COMAR is organized by title, subtitle, chapte, r, and regulation. Below you'll find links to state regulation guides so you can explore your state's . Senator Washington, M. 2. Baltimore, Maryland. Assisted living facilities must adhere to certain standards and state regulations. 10.07.14.36. Ask at the Maryland Room Desk to locate Incorporated Documents. Online version of Code of Maryland Regulations available at the Maryland Division of State Documents. This title goes to the Department of Health and Mental Hygiene, Office of Health Care Quality, This site offers a great deal of information to providers and consumers. (a) In general. hbbd``b`:$[A`}$CKDA,m"t(;\L %$ d 402 0 obj <>/Filter/FlateDecode/ID[<624F291B3915C54C98DC5CA6DA75CE94><1D8F96FEDCD2404C8D64CB4166544AA7>]/Index[388 37]/Info 387 0 R/Length 76/Prev 104424/Root 389 0 R/Size 425/Type/XRef/W[1 2 1]>>stream MSDE regulations are regularly evaluated and updated. 10.07.14.03. Financial Considerations - Assisted Living in Maryland can cost anywhere from $1,000/month to over $5,000/month. Reviewing and approving plans, policies, and procedures to ensure regulatory and accreditation compliance as well as quality controls and established and maintained. Service, Department of Health and Mental Hygiene, Office of Health Care Quality, Assisted Living Facilities, News & Senior Care, An Overview of Assisted Living Regulations in Massachusetts, Albuquerque L03%2h3)wO9K>4wLc&Nn##KrlShHOi},:8M7hiF!vNIEKS){Y2~*Zh~divfLF:Z}~s[]f..%' (hlY-~%=Wv%4bECw}DV~j~^?J&`+L&i8bMmD;C8[zYTeh`5`?By*)^tvfOQ7I18:C2T`J2@a^xf*~ The Maryland Register is an official publication of the State of Maryland that is published every two weeks. 10.07.14.11. all sections. 12 -Subtitle- Division of Labor and Industry These numbers are expanded when greater detail is required. The shelter and services are offered under a contract that lasts for a period of more than one year, usually for life. Minimum Experience Experienced. People often confuse the Code of Maryland Regulations (COMAR) with the Annotated Code of Maryland. The goal of the COMAR regulations is to keep residents healthy, happy, and well cared for. All rights reserved. A. You may be trying to access this site from a secured browser on the server. 10.07.14.30. The COMAR regulations are reviewed and updated frequently. Maryland has not updated assisted living regulations since 2008, despite the law requiring them to be updated every eight years. Its helpful to read through these from time to time to get an idea of whats to come, and to be able to voice your opinion for or against the proposed regulations before they are signed and sealed.. Copyright 2023 by eLaws. endstream endobj 461 0 obj <>stream City, Pittsburgh, 01 -Chapter- Board of Boiler Rules National Human Trafficking Hotline - 24/7 Confidential. Data collection for the 2022-2023 flu season is open for all long- term care facilities. Unless the Legislature has created an exemption, agencies must follow the procedures in the Administrative Procedure Act when adopting, amending or repealing regulations. Title 03 - Subtitle 01 - Office of the Comptroller. http://www.dsd.state.md.us/COMAR/searchall.aspx. Every proposal describes how and when to submit comments. All rights reserved. An on-farm composting facility is permitted by right as an accessory agricultural use in the R.C.2, R.C.3, R.C.4, R.C.6, R.C.7, And R.C.8 zones subject to compliance with 9-1725 of the environmental article of the Annotated Code of Maryland and the applicable regulations set forth in COMAR 26.04.11. For example, COMAR 10.07.02.01 is Title 10, Subtitle 7, Chapter 2, and Regulation 1. Provisions and regulations of automated external defibrillator programs. Alzheimer's Special Care Unit, Sec. The code provides detailed regulations for procedural, safety and health protocols within the senior living industry. conditions, privacy September 15, 2021, 10:00 a.m. 12:00 p.m., COMAR 10.07.14.00 - 10.07.14.21, October 19, 2021, 10:00 a.m. 12:00 p.m., COMAR 10.07.14.22 10.07.14.37, November 16, 2021, 1:00 p.m. 3:00 p.m., COMAR 10.07.14.38 10.07.14.64, December 16, 2021, 1:00 p.m. 3:00 p.m., all sections, OHCQ appreciates the input of all stakeholders that has resulted in the, that will serve as the starting point of these discussions. The State of Maryland pledges to provide constituents, businesses, customers, and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, and truthful and transparent services. A. Remote access is limited to University of Maryland staff and students. Bill/Chapter (Cross/Chapter) SB0884 ( HB1231 ) Title. To Find Inspection Reports, Citations and Violations for Assisted Living Facilities As of January 1, 2023, there are 38 operating or approved contin uing care retirement communities , known as CCRCs, in Maryland. The Maryland Register is an official publication of the State of Maryland, The Register serves as the temporary supplement to the Code of Maryland Regulations (COMAR). COMAR, is the official compilation of all administrative regulations issued by agencies of the state of Maryland. PDF applications should be mailed to Licensure & Regulatory Services office (2425 Reedie Drive, 9th floor, Wheaton, MD 20902) or faxed to 240-777-3088. Copyright Maryland.gov. The Office of Health Care Quality is seeking informal public comments as it continues to revise the assisted living regulations in COMAR 10.07.14. The Proposed Regulations section is exactly that regulations that are on the table, but not yet law. The residents pay the homeowner in exchange for a room, personal care services, and meals. 2006, an assisted living manager of a program that is licensed for five beds or . (21) "Supervised group living settings" means assisted living facilities, group homes for Maryland State agency regulations are compiled in the Code of Maryland Regulations (COMAR). There is no requirement for direct care aides in these facilities to be licensed Geriatric Nursing . Workgroup meetings will begin within the coming . Updated biweekly. The Fire Code requires the inspection of the common areas of rental apartment units and condominiums. hb```|eaX(0 r``AxG6qj c`uH 1/HQqQel%&%zNs`wm4+W#Y)9F&k^ 0 ( The following regulations apply to all assisted living and memory care communities and are the key points to look for when evaluating facilities: Licensure requirements and procedures. (1) The assisted living manager of a program shall arrange for a licensed pharmacist to conduct an on-site review of physician prescriptions, physician orders, and resident records at least every 6 months for any resident receiving nine or more medications, including over the counter and PRN (as needed) medications. Important Questions for Caregivers To Ask Medical Professionals, Assisted Living for the Blind or and conditions, privacy Owning an assisted living facility in Maryland means you have to be licensed by the state of Maryland OHCQ. 240-777-3986 > Helpful Domiciliary Care (Assisted Living) Resources Another topic listed in COMAR is the nursing services. For example, COMAR 10.07.02.01 is Title 10, Subtitle 7, Chapter 2, and Regulation 1. ^Nvz, 1X yQr8s'~SUFo#lD4pTP"Ij%2,pmpUKC~tS)AsKZfW`7/SWg/RdoZl8TPn/Tp.V\vb30'T_C'W'CLa?K(^-fOr{`E`SL= e^6.l>lutDCDOo,ci=b2`J^gmEcKE%_3itznd4{cz)[}x7f+^;BF 1tbKc^^Z| z=E=Z1C'g1yXb9F^7 !o,z`IzN7W(o]#E]b9`!TE3_-bH{;# 7 For example, facilities must be licensed by the local health department or social services. complete regulations are online at the links provided at the end. Regulatory Review Process MSDE regulations are regularly evaluated and updated. 10.07.14.58. Facility have to be inspected at least biannually to maintain their license. The Code of Maryland Regulations (COMAR) are maintained by the Division of State Documents (DSD) under the Office of the Secretary of State and can be accessed through the DSD Web site. Generally, these fees are based on the level of care (independent living, assisted living, or nursing care), size of the unit, number of residents living in the unit, and type of contract entered into. Sec. JavaScript is required to use content on this page. The purpose of the review is to determine whether the regulations are necessary for the public interest, continue to be supported by statutory authority and judicial opinion, or are appropriate for amendment or repeal.Each newly proposed regulation is published in the Maryland Register. Assisted Living Quality Analysis SB531 . Here are some of the benefits of living at Chesapeake Cove: Lifestyle Amenities The Osprey Dining Room offers three meals a day. By clicking submit, you agree to the, Get Pricing for the top 5 Homes Near You 100% Free Patients living in nursing homes and assisted living facilities are increasingly using Civil Money Penalties Hearings, Sec. OHCQ strongly encourages stakeholders to engage with each other for further discussion about these regulations. Protection of a Resident's Personal Funds, Sec. Elements in each number represent the department and its agencies and subdivisions responsible for each regulation. 10.07.14.25. 10.07.14.19. The completed manager's training course shall: (1) Consist of at least 80 hours of course work and include an examination; (2) Consist of training programs that include direct participation between faculty and participants; and. Purposes of the State Health Plan for Facilities and Services. We welcome input from all stakeholderson the regulations. Continuing care agreements are legally binding contracts between the provider and the resident that outline the responsibilities between the provider and the resident. These regulations should also be considered essential 'coursework' for anyone wishing to open an assisted living home in Maryland, as they give you a concrete idea of what is involved, and the standards to which you will be held by the State. The following regulations apply to all assisted living and memory care communities and are the key points to look for when evaluating facilities: Licensure requirements and procedures. Please enable scripts and reload this page. You can download information below or request a packet be mailed to you by calling 410-767-1100. Resident's Representative, Sec. Misuse of Resident's Funds, Sec. 456 0 obj <> endobj As of January 1, 2023, there are 38 operating or approved continuing care retirement communities, known as CCRCs, in Maryland. There is a risk that these units may not be reoccupied (or a new entrance fee may not be paid) in a timely manner. 3. Laws Affecting Assisted Living Facilities; COMAR Code of Maryland Regulations: Regulations Affecting Nursing Homes: Click here to view the regulations in Section 10.07.02-Comprehensive Care Facilities and Extended Care Facilities ; Click here to view the regulations in Section 10.07.09-Resident's Bill of Rights CODE OF MARYLAND REGULATIONS (COMAR) COMAR is the official compilation of all regulations issued by agencies of the State of Maryland. Alternate Assisted Living Manager, Sec. COMARregulations are arranged in one numeric sequence by codification number throughout the entire set. Facility, How There is an e-mail button/section that you can use to submit your information to regarding State Regulations, which will provide you periodic updates pertaining to the States regulations. The performance measures reported for assisted living residences include: 1) the results of Inspection surveys performed on-site; 2) influenza vaccination rates of assisted living staff, and 3) facility mandatory influenza vaccination policies. (4) Is licensed as a nursing home administrator in this State. Each title number represents a State department, e.g., Title 15 is the Department of Agriculture. endstream endobj startxref (1) Each county board shall develop and implement an automated external defibrillator program that meets the requirements of 13-517 of this article for each high school in the county. (2) Those violations have caused or have the potential to cause physical or emotional harm to a resident. Uniform Disclosure Statement, Sec. These numbers are placed at the top right and left corners of the pages. yDT^T G6+,uST@9)M[#|rSy'?o,=y}ugJ5P0 (5SNGb?:7UZ%QSt'dFhE2~|) Zv;(RTfvM?e'f"-`kwE}Y6l;G}B&3n`\)D%n'f3\?Wa~q%"@`R@ps*lv%b-.ei&znbf _h2fX~>Toyu/wscP)Y2cb/_ However, assisted living facilities are considered a related institution in Maryland. Resident's Room and Furnishings, Sec. Whether a regulation is complied with varies from facility to . Island's Assisted Living Regulations, Inspiration for Please enable JavaScript in your browser. The facilities that cost $1,000 per month tend to be small homes owned by people who decide to have 1 or 2 people move in with them. D. A program that fails to employ an assisted manager who meets the requirements of this regulation may be subject to: (1) Sanctions under Regulation .56 of this chapter; and. Changes in a Program that Affect the Operating License, Sec. All rights reserved. 10.07.14.50. Resident Agreement General Requirements and Nonfinancial Content, Sec. 10.07.14.21. Other Staff Qualifications, Sec. TX, Salt Lake HB 1034 and SB 720 . Additional published information includes comparison to Federal Standards, and economic impacts on agencies, industries, and small businesses. Thank you for contacting the Maryland Board of Nursing with a request for general information on assisted living and the applicable rules and regulations. It looks like your browser does not have JavaScript enabled. Also, some continuing care agreements provide for a refundable entrance fee, which may require that the unit be reoccupied (and, possibly, that a new entrance fee be paid by the new occupant) before a refund is paid. Chesapeake Cove Assisted Living 203 Hall Highway Crisfield, MD 21817 410-968-9230 Services & Amenities Our definition of "assisted" means providing services and amenities that help residents enjoy life to the fullest. These links will open each page in a new window. The CCRCs, both operating and under construction, contains over 16,000 continuing care units, of which over 12,000 are independent living, over 2,000 are assisted living, and over 2,000 are nursing care. Please enable scripts and reload this page. The MBON does not regulate facilities, assisted living or otherwise. Types of Inspections Existing Buildings New Construction and Renovation Family Home Day Care License Day Care Center License Group Homes and Assisted Living Facilities Unless the Legislature has created an exemption, agencies must follow the procedures in the Administrative Procedure Act when adopting, amending or repealing regulations. I recommend bookmarking these pages for future, and handy reference. In addition to the requirements in Regulation .15 of this chapter, by January 1, 2006, an assisted living manager of a program that is licensed for five beds or more shall complete a manager training course that is approved by the Department. y Typically, a nursing home resident will need more help and supervision than an assisted living resident. 0 a. Each regulation is assigned a unique fo ur-part codification numbe r. COMAR Codification System 0 At the beginning of each title there is a Table of Contents which lists each subtitle, chapter, and regulation by codification number. 482 0 obj <>stream Maryland Code - Education, 7-425 EDUC. Please enable JavaScript in your browser. Although the legal definition of continuing care is complex, in general, continuing care exists when all three of the following are present: The contract that is entered into between a CCRC provider and a resident is known as a continuing care agreement. For details about COMAR on-line or in print, call the Division of State Documents at 410-974-2486 or 1-800-633-9657. 10.07.14.18. The COMAR regulations are reviewed and updated frequently. ;Xi4p6y*p{L$R5*lb=f -:TQ~ q6( ^Ip$x%A=Gb`'E;&DwFZ"Yvg=kbk8?`lhF"Av8v{~(h@)_JrKw2YR;d\aLo'qix+1nW>%?n"I$Xnwc[>] W hV~oCD2cI> The following regulations apply to all assisted living and memory care communities and are the key points to look for when evaluating facilities: Maryland COMAR rules apply to all RAL communities, from those that are large and have 200 residents to communities that are small and have only 3 residents. Complete the form below to access Ratings, Reviews, & Pricing Info, Assisted Living with Learn About Marylands Assisted Living Regulations. The State of Maryland pledges to provide constituents, businesses, customers, and stakeholders with friendly and courteous, timely and responsive, accurate and consistent, accessible and convenient, and truthful and transparent services. Critical Aspects To Quality of Life in Assisted Living Communities: Quality of Life is the sum total of many other aspects, including choice, independence and dignity, as presented by this excellent video by the ALFA. policy, Consumer Information useful for those researching assisted living, Licensure Application & Instructions for Completion, Definitions (it is important to understand that each state defines assisted living differently). Index entries refer toCOMARcodification numbers, not page numbers (see Overview). A visit to this section offers information, and sections specific to Assisted Living in Maryland, including: Additionally, youll see, on the main page, phone and fax numbers for the Department of Health and Mental Hygiene. The Code of Maryland Regulations, often referred to as COMAR, is the official compilation of all administrative regulations issued by agencies of the state of Maryland.While the Legislature of the State of Maryland enacts statutes, it is administrative agencies which adopt, amend, and repeal regulations under the authority granted to them by statutes. Click here to go directly to Title 26 Subtitles with links to their pertinent Chapters and Regulations.. Depending on the provider, these fees may or may not cover a wide range of services. 10.07.14.08. Key Takeaways. opening and owning your own assisted living home, Creating Professional Videos For Your However, COMAR in print form will continue to be the only official legally enforceable version of the Code. Arizona, Las Vegas, Information reported to the hotline in the past has helped to eliminate certain fraudulent activities and protect State resources. These live on-line meetings are open to the public and are not being held in-person. , Matthew WeissHealth Policy Analyst for Regulatory AffairsOffice of Health Care Quality410-402-8140matthewe.weiss@maryland.gov. Approval If approved you will hear back from us within 10 - 14 business days. 1-800-278-9122 Pricing & Availability Get Pricing Responses to this article 10.07.14.59. . Much of the content of the continuing care agreements will vary from community to community, as does the scope of the continuing care offered at these communities. Please enable scripts and reload this page. FOR A FREE CONSULTATION 1(410) 825-3161. . 10.07.14.39. Assisted Living Manager Certification - COMAR Regulations - HIPPA Compliance Certification - Languages Urdu Full professional proficiency Hindi Full professional proficiency Punjabi Full. Administrative agencies adopt, amend and repeal regulations under the authority granted to them by statutes. Deaf and hard of hearing use Relay, 2023 Maryland State Department of Education, Maryland State Department of Education Directory. General Physical Plant Requirements, Sec. 142nd Avenue (305) 229-1315 Care provided: Assisted Living, Respite Care A Legacy Personal Care Home 4050 South Fox Street (303) 783-4989 Care provided: Assisted Living, Respite Care A Loving Home There is financial risk involved in choosing a CCRC, as large sums of money are paid in advance for future services. Education - English Learners and Dual Language Immersion Programs - Funding and Establishment (Multilingualism Is an Asset Act) Sponsor. %U8x1=3*"3CtsY6LE$r @e2qK&?Wd.Q_,L(nR+;4wG1]< endstream endobj 389 0 obj <>/Metadata 23 0 R/OCProperties<>/OCGs[405 0 R]>>/Pages 385 0 R/StructTreeRoot 41 0 R/Type/Catalog/ViewerPreferences 404 0 R>> endobj 390 0 obj <>/MediaBox[0 0 612 792]/Parent 386 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]>>/Rotate 0/StructParents 529/Tabs/S/Type/Page>> endobj 391 0 obj <>stream