医院质控科年终工作总结

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1、2014年医院质控科年终工作总结2014年医务科、质控科、病案室在院领导班子的正确领导和大力支持下，深入贯彻落实科学发展观，始终“以病人为中心，以质量为核心”，严格以“二级甲等医院”标准、“医疗质量万里行”活动要求强化科学管理，以“六讲两树一促”和“三好一满意”为准则，落实十五项核心制度和岗位责任制的、提高病历书写质量、加强继续医学教育力度等措施，提高医疗服务质量，确保医疗安全，保证了全院各项工作的正常运行，较好地完成了全年医疗工作任务，现将2014年医务科工作总结如下： 一、医疗质量管理1、住院业务工作指标完成状况：（1）全院9个病区，编制病床数220张，实际平均开放床位314张/天，收住院

2、病人11338人次，比上年同期（7824）增长3514人次，增长44.9%，出院11107人次，比上年同期（7444）增长3663人次，增长49.2%，病床周转率50.4/床，结转395人。（2）住院手术2752人次，住院急危重症抢救600人次，成功率95.4%，麻醉2752人次，病房药房调配处方143368人次。（3）完成临床路径16个病种，入径537人次，出径516人次。2、门急诊工作指标完成情况：全年门诊总人次124516人次，门诊手术1113人次，麻醉1113人次，急诊科抢救人206次，成功率91.74%。120接收病人957人次，转送病人117人次，门诊药房调配处方131720人次，

3、中药房调配处方13059人次。 3、医技科室工作指标完成情况：放射科摄片17441人次，检查阳性率52.5%，CT 检查17735人次，检查阳性率76.8%。检验138719人次，病理检查2700人份，细菌培养药敏试验2700人次，成份输血41.67L，成份输血率为100%；功能科超声检查17315人次，检查阳性率58.75%，内镜检查治疗3571人次，心电图、动太心电图检查14363人次； 二、严抓医疗质量管理，各项制度落实到实处2014年医务科继续加大十六项核心制度的执行和落实力度，特别是定期不定期参加临床科室查房工作，医务科深入到临床科室，定期参与科室交班、三级查房，对科室的实际情况有了

4、更全面的了解，这使我们在加强制度落实的基础上更加人性化的管理，在面对科室的危重症患者的重点督查方面，首先要求科室及时上报相关信息，医务科备案后及时到科室了解患者病情、查阅病历后，具体安排全院或科室内会诊，组织会诊人员和时间并参与会诊全程确保会诊质量，医务科组织全院专家会诊、病案讨论、死亡病例讨论、术前讨论34人次，这样就为科室节约了时间和精力集中于患者的治疗上，有效提高了科室救治危重患者的成功率，降低了医疗纠纷和医疗事故发生，提高了医疗质量。三、规范病历管理，提高病历书写质量医务科不定期到科室抽查环节病历，每月不定期到病案室抽查终末病历，。在环节病历方面重点督查病历书写及时性、三级查房的书写质

5、量、治疗计划的合理性、病情告知的有效性等方面，做到及时发现、及时反馈、及时更正；终末病例的抽查中，医务科重点强调病历书写的高质量和完整性，包括大中型手术的术前讨论、危重症患者讨论的书写质量，依法执业，医嘱执行记录，合理使用抗菌素等，为加强合理使用抗菌素的管理，医院以镇医发（2014）31号文件印发了抗菌药物临床应用整治实施方案下发临床科室贯彻落实。通过严抓病历质量，将各项规章制度落实到工作中的每个环节，在现场督查反馈的基础上追踪检查，对反馈后未及时更正的医师实行个人见面谈话、现场培训。 四、医疗安全管理切实把保障医疗安全作为我院医疗工作的出发点和落脚点。在日常工作中将核心制度贯穿于整个医疗过程

6、中，从源头和细节上消除不安全隐患，对危重患者及有纠纷苗头的患者实行跟踪式管理，即接到科室上报信息后，从过去单一的备案工作扩大到亲自到科室了解患者的情况，组织并参与会诊，并在终末病历中再次检查会诊和讨论的书写质量，杜绝因病历书写失误而产生的隐患。同时在总结出现过的医疗争议中，加强对病情告知的督察力度，严格要求临床人员在出入院、各种检查和手术时做到详细告知的同时必须将告知内容认真完整的填写在相应的知情告知书中，对填写不完整和空白告知书的医务人员严格按照“绩效考核办法”实行处罚。质控科坚持定期不定期深入科室进行质量检查，全年共查运行病历500份，归档病历409份，经评价统计如下入出院诊断符合率99.

7、50%治愈好转率97.45%甲级病案率96.57%术前术后诊断符合率100%无菌手术甲级愈合率99.00%无菌手术切口感染率0.00%手术分级管理100%临床与病理诊断符合率84.90%入院3日确诊率99.12%剖宫产率45.46%病案工作卓有成效：1、病案管理人员每周三主动下科室收集病历，确保病历及时归档和安全性，并能做到及时逐一登记，整理归档管理，无病历丢失现象。病案室收录病历9771份，录入率86.17%。2、严格执行卫生部医疗事故处理条例及医疗机构病历管理规定中的病历查阅、复印或复制病历资料申请及记录，严格规范病历查阅、复印或复制管理。全年共接受病人查阅、复印病历资料1602份。医务质

8、控科共处理医疗争议7 起，经市医学会鉴定 1起，协商解决5 起，分析原因为医患沟通不到位，缺少相应临床检查是发生争议的主要原因。五、临床路径管理：按照省、市、县卫生行政部门的要求，我院从六月份开始启动了临床路径管理，成立了以院长为组长的临床路径管理管理领导小组，举办临床路径管理培训二期，培训了卫生部临床路径管理指导原则和省、市有关临床路径管理实施方案，培训临床医护人员241人次，按照卫生部临床路径管理指导原则结合本院实际，制定了临床路径管理实施方案，遴选临床路径管理病种151种，编写了临床路径管理病种流程及临床路径管理表，启动16种，进入临床路径管理总病人数537人次，完成临床路径管理516人

9、次，发生变异11人次，医务科每月进行检查考核，上报信息，从检查分析得出开展临床路径管理工作，缩短了病人住院时间，减少医疗费用，提高了医疗质量，完成了上级下达的任务。六、三基培训、人才培养、继续医学教育工作医院要发展，人才是关键，随着医院规模的不断扩大，医务科协助院领导制定适合医院的短期和中长期人才培训计划，为医院储备人才。1、加强三基培训，提高基本技能根据“人才兴院，管理强院”的建院精神，进一步提高医护人员的基本技能，突出基本理论、基本技能、基本操作。今年医院集体“三基”培训3次，共参加254人次。操作考核254人次，合格率100%，达到了预期的目的，取得了较好的效果。今年共组织两次院外急救演

10、练，培训了2013版心肺复苏技术。树立“严格管理、严密组织、严谨态度”的管理理念，“三基三严”训练从每一份病历，每一张处方抓起，落实质量检查，突出重点，抓住难点，做到环节质量与终末质量检查相结合，质量检查与考核评价相结合，通过一系列的学习和考核，加强了医护人员的自身技能、信心，提高了医护人员对危、急、重症患者抢救的应变能力。2、2014年在去年的基础上，全院医护人员参加北京大学华医网继续医学教育学习251人，人均取得继续医学教育学分25.4分，医务科组织全院医务人员举办“三基”培训班三期四班，参训考核239人，培训考核合格率为98.5%。参加3个月短期培训学习16人，半年以上进修8人，3、20

11、14年免费接收基层医疗机构进修人员14人，接收大学实习生17人，代县卫生局举办妇产科医师培训班一期培训13人。4、三基读本编写：院领导安排医务科负责组织编写三基读本，除编写本科三基读本6万字草稿外，还负责了临床、医技、总务、信息19个科室三基读本初稿修改审定工作，现基本定稿出书。七、医改及医疗质量考核管理工作：1、考察学习，3月份由李书记带队赴子长、镇安县医院学习医改先进经验到四川绵阳参观学习电子病历。4月份两人参加了卫生部在杭州市举办的电子病历临床路径管理培训班学。医院从9月份开始装电子病历软件，医务负责电子病历模板编写和审定工作，编写和审定了入院记录、病程记录、知情同意书等电子文件700件

12、，现在正式运行。2、医院绩效考核工作，医务科负责了临床、医技科室的岗位人员职责和科室医疗质量考核细节编写工作并下科室全部征求意见，经研究确定了医疗质量考核细节，八月份开始试运行，第四季度正式执行，考核兑现。八、对口支援乡镇卫生院工作：完成了2013年对口支援的3个卫生院任务，实施支援项目9个，已完成任务9个，培训进修4人。九月份接受了新的对口支援渔渡中心卫生院、盐场镇卫生院和托管大池卫生院任务，十月份由院长带领工作组人员深入3个卫生院现场考察调研，十一月初医院组织3个卫生院院长和医院相关人员召开了对口支援和托管座谈会，研究对口支援和托管方案，制定了对口支援和托管实施方案，现在正在实施之中。九、

13、存在困难：1、医务、质控科专业人员少，缺乏专业管理人员，深入科室调研督查少，很多管理工作不到位，需配专业人员1人。2、临床科室病人增多，执业医师较少，达不到基本标准，现在紧缺执业住院医师12人（内科8人，儿科2人，外科6人），由于人员紧缺，诊疗工作不到位，存在很多医疗安全隐患、医疗纠纷时有发生。经过一年的坚心工作，基本完成了各项工作任务，2015年初将制定较为周密的工作计划和管理方案并认真落实。内部资料仅供参考9JWKffwvG#tYM*Jg&6a*CZ7H$dq8KqqfHVZFedswSyXTy#&QA9wkxFyeQ!djs#XuyUP2kNXp6X4NGpP$vSTT#UE9wEwZ#

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23、xGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Am

24、YWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXR

25、m6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9Cpb

26、K!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U

27、*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv

28、$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4N

29、GpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqvadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#

30、KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#

31、KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWR

32、rWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89A

33、mYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89A

34、mYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%MadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz

35、849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*adNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9

36、wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YW

37、RrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84

38、9GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA

39、5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA

40、5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR

41、9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#

42、&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGj

43、qv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD

44、6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NG

45、pP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%MzadNu#KN&MuWFA5uxY7J

46、nD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz84

47、9GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89

48、AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE

49、%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9C

50、pbK!zn%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv

51、*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpaz

52、adNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X

53、4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!z

54、n%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqvUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWp

55、azadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYp

56、Eh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!z

57、n%Mz84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnG

58、K8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#

59、KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNuGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP

60、$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz8

61、49GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv84!z89Amv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpa

62、zadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$U*3tnGK8!z89AmYWpa

63、zadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3adNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!z89AmYWpazadNu#KN&MuWFA5uxY7JnD6YWRrWwcvR9CpbK!zn%Mz849GxGjqv$UE9wEwZ#QcUE%&qYpEh5pDx2zVkum&gTXRm6X4NGpP$vSTT#&ksv*3tnGK8!