# Forged certs



## bstone (May 26, 2010)

> More than 200 emergency medical technicians and paramedics in Massachusetts and New Hampshire have been practicing without legitimate certification, having paid certificate mills for fake credentials without taking any medical training, an investigation by Massachusetts public health officials has found.



http://www.boston.com/news/local/breaking_news/2010/05/sources_hundred.html


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## LucidResq (May 26, 2010)

Wow.... good job on the oversight NH and MA.


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## jjesusfreak01 (May 26, 2010)

I'm kinda confused. In NC there is an online registry of every individual who is certified at any level in EMS. Its called CIS (Credentialing Information System). Our instructor typed in his last name and it showed his EMT-P cert, his L2 instructor cert, as well as his father's EMT-B cert. Do other states just leave it to a paper system?


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## medicdan (May 26, 2010)

The falsified certs were ACLS and BCLS (CPR), which are paper. The last (unpublished) counts I heard were that 500-600 EMTs and Paramedics were affected. An entire FD had to shut down (Lexington), as well as several privates losing much of their (medic) staff. Now that the feds are getting involved, there is a question about whether some of the medicare billing can be revoked...

Serious stuff here.


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## Fox (May 26, 2010)

I don't understand why they are sending these people out to get legitimate certifications. I'd be firing them and hiring some people who were professional. I don't understand why you'd risk your whole career on something that petty and pointless. 

Guess if it's your whole department you wouldn't want to fire everyone. Business is money and all.


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## lightsandsirens5 (May 27, 2010)

Holy cow. What next? I say can 'em all and make them pay back all the wages they eared fraudulently. (Spelling???) h34r: Excellent job NH and MA. Absolutly outstanding. 10 points.



jjesusfreak01 said:


> I'm kinda confused. In NC there is an online registry of every individual who is certified at any level in EMS. Its called CIS (Credentialing Information System). Our instructor typed in his last name and it showed his EMT-P cert, his L2 instructor cert, as well as his father's EMT-B cert. Do other states just leave it to a paper system?


 
WA is the same way. But I like NCs name for it better. Out here it is the WADOHHCPCS (I guess?) Washington State Department of Health Healthcare Provider Credential System. 



emt.dan said:


> The falsified certs were ACLS and BCLS (CPR), which are paper.


 
That is sad. Even here in the changeaphobic state of WA all providers from MD down to Advanced First Aid/First Responder are computerized. To give you an example of how far behind in EMS WA is, we just became like the 45th or 46th state to accept the national registry. On the other hand, WA countys have more leeway to develop their own protocols than just about any other state. Maybe it all comes out even in the end. Ok, I stop hijacking thred now.


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## nemedic (May 27, 2010)

From what I have gathered, Trinity Ambulance is down to 12 medics to cover Lowell, parts of Lawrence, and a good part of southern NH


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## lightsandsirens5 (May 27, 2010)

nemedic said:


> From what I have gathered, Trinity Ambulance is down to 12 medics to cover Lowell, parts of Lawrence, and a good part of southern NH


 
Holy.........Are you serious? The action of a few and affect so many.

Do I smell job openings? Where is Linuss, errrmmmm Sally. Sally! Want to move to NH and get a job as a medic? You can probably walk on. (After a short credential check of course.....)


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## nemedic (May 27, 2010)

Hell, if you don't have the right papers, I'm sure there is someone that can "help" you out for a few bucks and your John Hancock on a few papers..............


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## nemedic (May 27, 2010)

just don't put the date/time on the papers for the same time you're in a meeting with your service's management/owners


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## mikeN (May 27, 2010)

I just read that article a bit ago.  200, even 600 EMT/paramedics is such an understatement.  In MA alone, so far about 2500 people falsified their recert.  

It was so widespread and widely accepted that even almost every private company and FD knew it was going on.  Honestly, something like this needed to happen.  Hopefully some good can come out of this and MA OEMS can get revamped and not having to keep moving to a smaller and smaller and smaller office.


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## nemedic (May 27, 2010)

haven't you heard, after recent events, they had to move into a broom closet at Florian Hall


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## medicRob (May 27, 2010)

WOW.

I am speechless.


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## EMSLaw (May 27, 2010)

I'm surprised.  OEMS here keeps a pretty tight leash on stuff.  I mean, sure, we've all gone to the "4 CEU" class that turned out to be 2 hours long, but not holding the class at all is just insane.

I smell lawsuits, and people spending a lot of time and money explaining that the people they used improper CPR and ACLS algorhythms on would have died anyway.


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## medicdan (May 27, 2010)

OEMS has completely and totally dropped the ball... and this is just one in a series of failures recently. AHA has dropped the ball, and Employers have dropped the ball. 

The fact that OEMS did not approve one Con-Ed class from Nov 2009 to March 2010 (because they were busy processing every recert on paper) just invited instructors to falsify training records (they tell us we cannot advertise or hold a class until we receive the approval number, then told us to hold the classes anyway). OEMS doesn't even read Con-Ed outlines, only the Region office does, so the holdup wasn't substantive, only administrative, as they needed to stamp the approval number on the form. 

There simply aren't any checks on the system. It's embarrassing.


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## nemedic (May 27, 2010)

emt.dan said:


> There simply aren't any checks on the system.



Sure there are. But that's if you add the eventual investigative news story, and ensuing storm of lawsuits


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## mikeN (May 27, 2010)

OEMS has been doing that con-ed thing for years.  

I know people that haven't been to a recert class in years.  If you needed a CPR card by TOMORROW, you knew who to go to.  If you didn't want to take the 24 hour BLS refresher or the 48 hour ALS refresher, you also knew who to go to.  If you were in EMS, this was common knowledge.


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## bstone (May 27, 2010)

I live in MA but did my Intermediate training (and EMT-I license) in NH.

It's shameful that so many of our fellow EMTs give us a bad name. This is not just a civil issue- it's criminal. 

The people who allowed it to happen need to be punished the most, possibly even jail time. Those who got fake certs need to be banned from EMS.


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## medicRob (May 27, 2010)

This question is for someone who is VERY familiar with the laws as they apply to EMS. 

If these individuals had fake ACLS certificates and say came across a situation that required them to utilize advanced procedures, could the provider be held liable for assault, given that when the patient or their family consents (either complied or explicit), they are under the assumption that the individual is properly trained to carry out such procedures, when in fact the individual is not properly certified to carry out ACLS interventions? 

Wouldn't this be the same as a contract being nullified because it contained something criminal in nature or untrue?


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## Veneficus (May 27, 2010)

*Not a legal mind, but I have to point this out.*

the AHA is not a credentialing body. Having an ACLS or any other card they pass out does not certify you to perform any procedure or intervention. For example, if you are not permitted to place an advanced airway or administer IV meds in your scope of practice, having an ACLS card does not permit you to or increase your scope.

Some states require various levels of providers to have specific credentials, like a CPR or ACLS card, using paramedics as an example: 

My home state requires paramedics to have a valid ACLS card. That means if you do not have one you cannot be certified or recertified as a paramedic. If your certification lapses and you do provie care, I would be more worried about being charged with practicing medicine without a license, than I would be assault.

If you recertified under false records or statements, you maybe looking at fraud or some other related charges. 

No matter what, you would be standing before the EMS board, with a lawyer if you were smart, trying to not get banned from holding certification in the state.

Some agencies may require employees to hold specific AHA cards. I am involved with a facility that requires various AHA cards for all of its physicians. Their state license for the unrestricted practice of medicine certainly trumps an ACLS card. 

I guess I should probably comment on the OP now that I am involved.

I don't think would advocate or support punishing of street providers based on some of the comments here. Since the practices were so wide spread it seems like a system failure. If I was going to start firing people, I would start with the state level employees for letting this become so common.


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## medicRob (May 27, 2010)

Veneficus said:


> the AHA is not a credentialing body. Having an ACLS or any other card they pass out does not certify you to perform any procedure or intervention. For example, if you are not permitted to place an advanced airway or administer IV meds in your scope of practice, having an ACLS card does not permit you to or increase your scope.
> 
> Some states require various levels of providers to have specific credentials, like a CPR or ACLS card, using paramedics as an example:
> 
> ...



Thank you for your answer. My state requires Paramedics to hold BLS, ACLS, and PALS.


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## mikeN (May 27, 2010)

Veneficus said:


> If I was going to start firing people, I would start with the state level employees for letting this become so common.


You realize MA OEMS only has about 4-5 full-time employees to take care of everything OEMS related.  The office is probably going to use this to their advantage, so they can get more funding so they can ACTUALLY oversee things.  

One of my BLS co-workers got his  NH medic a few months back and has been waiting months for his MA reciprocity.  Now that this happened he is probably going to wait many more months.


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## zmedic (May 27, 2010)

I think it depends on what the people who got the cert thought they were doing. If it were a situation where they (and I'm making this up off the top of my head) needed to recert their EMT and found some online course that wasn't approved but they thought it was that's one thing, if they just paid to get a cert that they knew was fake that is another. 

Though to murky the waters is the fact that people sometimes have the right training, but not the right cert. For example, if I have a EMT from Colorado (before they went national) and wanted to move to NYC, New York wouldn't grant reciprocity. If I found an online course that claimed to be qualifying me for reciprocity I would be in a situation where I didn't have a valid New York certification, even though I had been trained properly. 

All of which may have no bearing on the actual situation in the article. Just saying to look at what they people involved thought they were signing up for before starting to fire people.


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## mikeN (May 27, 2010)

^ Everyone that signed up for the "recert" classes that never happened knew what they were doing.


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## Veneficus (May 27, 2010)

mikeN said:


> You realize MA OEMS only has about 4-5 full-time employees to take care of everything OEMS related.  The office is probably going to use this to their advantage, so they can get more funding so they can ACTUALLY oversee things.



Had no idea.

Still doesn't matter to me. If so many providers knew this was happening, I find it difficult to believe that the state authorities didn't have any idea. It simply got exposed.

If they were just sitting in an office pushing paper because they were so "overwhelmed" then they were out of touch, not exactly leadership material in my book.


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## medicdan (May 27, 2010)

Ok, I'll throw in a personal note here. Two paramedics likely holding forged ACLS cards coded a close family member of mine a few weeks ago. I read their run sheet, and know that they did everything correctly. That likely wasn't despite the training they never received in their ACLS recert class, but because they were good providers to start with. 

Who should be punished? The Instructor? The Students? The Employer who saw both employees pass preemployment testing, saw a valid card and didn't investigate further? The state office (OEMS) who saw a valid paper card, and because they are understaffed, never examined further. 

Let me get this clear: The cards provided are legitimate, the class was just not. The error seems, to me, to fall with the AHA, or regional office, for not monitoring instructors appropriately. 
Embarrassing, really. The real question is whether we can link this to errors in patient care, or whether it is merely fraud.


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## bstone (May 27, 2010)

mikeN said:


> You realize MA OEMS only has about 4-5 full-time employees to take care of everything OEMS related.  The office is probably going to use this to their advantage, so they can get more funding so they can ACTUALLY oversee things.
> 
> One of my BLS co-workers got his  NH medic a few months back and has been waiting months for his MA reciprocity.  Now that this happened he is probably going to wait many more months.



You're in Cambridge? So am I. I have a NH card. I won't be paying $300 for my card in MA.


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## mikeN (May 28, 2010)

bstone said:


> You're in Cambridge? So am I. I have a NH card. I won't be paying $300 for my card in MA.


I live in east cambridge.   It is worth getting your MA ticket.  To my understanding the pay is far better in the Boston area than it is in NH.


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## got_shoes (May 28, 2010)

it is much better in mass then in NH trust me I know this for a fact. in my opinion the providers that cheated the system knew what they were doing. there is no doubt about that. this in reality is a awful PR nightmare for all of EMS and the fire departments that have been affected, but it will also call into question every other provider that did it the right way.


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## bstone (May 28, 2010)

I guess I just can't imagine forging a cert. ConEd is so easy. They say it's a 4 hour class and let us go after 2.5, yet we still get 4 hours. I mean, come on!


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## Aidey (May 29, 2010)

I know where I am you have to have a valid ACLS and CPR cert for your paramedic cert to be valid. The state requires you to have them, and if you don't you don't meet the requirements to hold your cert, and thus your cert is not valid. 

I to find it hard to believe that people's managers and the state officers were totally clueless. Hopefully better oversight and accountability will come out of this. 

As far as punishment, I'm of mixed thoughts. Permanently decerting possibly thousands of people seems a little excessive, but I do think the individuals involved should be punished. Whether it's a temporary ban, a fine or something else I'm not sure. The people who were actually signing off on the falsified training logs should be permanently decerted, and should have to repay any money they were paid for providing the certifications.


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## rescue99 (May 29, 2010)

mikeN said:


> ^ Everyone that signed up for the "recert" classes that never happened knew what they were doing.



What is the state policy concerning fraud and license applications? Did these folks renew or attempt to renew their license by presenting an ill gotten cert as part of their continuing education? Whatever the disciplinary steps; it is what it is. My opinion...fraud is fraud. Follow the state policy and follow through with each and every one of them. There can be no exceptions so that everyone is treated equally.


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## Medic_Forever (May 29, 2010)

emt.dan said:


> An entire FD had to shut down (Lexington), as well as several privates losing much of their (medic) staff. Now that the feds are getting involved, there is a question about whether some of the medicare billing can be revoked...
> 
> Serious stuff here.



Not Sure where you got all this info.  Lexington FD has not shut down.  A medic in that department has been flagged as one of those giving out bogus cards though.  From what i hear from OEMS, the most anyone was temporarily suspended for was 3-5 days until they completed "Emergency retraining"  As far as i am hearing this is still being handled at the State levels in Both MA and NH..nothing reported about Feds yet, but who knows.


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## Medic_Forever (May 29, 2010)

EMSLaw said:


> I mean, sure, we've all gone to the "4 CEU" class that turned out to be 2 hours long, but not holding the class at all is just insane.



This exact statement above is a topic that has been discussed for years at training meetings with regions and OEMS.  FYI as far as OEMS is concerned your 4 hour CEU class that you only need to spend 2 hours in is considered a fraudulent class unless the instructor advises OEMS to reduce the hours.  The system is a joke. Think about it.  Say most of your classes in con-ed are like this (and we all know that most are)  you probably sit for 15 hours of instruction out of 28 hours of CEU's your required to attend.  Now whos going to complain about that right? I never complain..it is what it is.  Your recert is as fraudulent as someone who takes none.  There is no differentiating between completing all 28 hours, 16 hours or 0 hours.  OEMS knows this and have noever done anything to fix it.


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## Medic_Forever (May 29, 2010)

emt.dan said:


> The fact that OEMS did not approve one Con-Ed class from Nov 2009 to March 2010 (because they were busy processing every recert on paper) just invited instructors to falsify training records (they tell us we cannot advertise or hold a class until we receive the approval number, then told us to hold the classes anyway).



Same thing happened to me.  When i called OEMS and asked them about my poending approval numbers they told me to just hold the classes using a blank roster.  When the number arrives (4 months later) just fill out the top and send it in.  No problem according to OEMS.  They constantly break the rules themselves.  The website is usually 6 months behind as far as posting CEU's taken


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## Medic_Forever (May 29, 2010)

emt.dan said:


> Let me get this clear: The cards provided are legitimate, the class was just not. The error seems, to me, to fall with the AHA, or regional office, for not monitoring instructors appropriately.
> Embarrassing, really. The real question is whether we can link this to errors in patient care, or whether it is merely fraud.



Take it a step further.  We all know there is a different level of comptence between say a street medic in a busy city sytem, vs a part time medic in a rural system, vs a volunteer service that doesnt have a ton of responses.  So the full time city medic that has been doing this as a career for 15-20 years has a ton of practical experience.  He skips his ACLS refresher or Medic Refresher this year, ie short class or bogus class (we all know that the majority of refresher classes are 80% war stories and socializing)  The volunteer Medic with not a whole lot of calls under his belt faithfully takes his refresher and requirements year after year without fail.  You come up on a person with a serious trauma, or in cardiac arrest.  Knowing all the facts of who took what class and who didnt, choose which medic you want working on this patient if it is your family member.  

No i do not condone paying for a class you had no intention of taking.  THe fault equally lies with the guy taking the money as well as the guy paying it.  WHat needs to be brought into the light is the value of what they require for refreshers/con-ed etc.  When you can hop online and take 90% of everything required including a refresher at all levels now in MA the system is not providing anything of value.  Yes i have taken some great classes that kept my interest for the duration.  I have taken many many more that didn't provide much more than fulfilling requirements.  100% revamp needs to be done at OEMS.


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## Aidey (May 29, 2010)

Time spent in class is a tough one because sometimes you legitimately end early. Half arseing it and sending everyone home early is unacceptable, but if the class gets out 30 minutes early because there were only 2 people in the class that really isn't fraudulent to me.


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## Medic_Forever (May 29, 2010)

rescue99 said:


> My opinion...fraud is fraud. Follow the state policy and follow through with each and every one of them. There can be no exceptions so that everyone is treated equally.



As long as you throw in everyone who has taken a 3 hour class that was finished in 2 hours yet still got 3 hours credit.  Same thing.  Your saying no exceptions right?  These people that have gotten more credits than they sat for (myself included,and none of it intentional it is what it is) are no different in the end.  Yes i signed for 24 hours of continuing education but only sat for 15 hours of instruction, is no different than my 48 hour refresher was done in 30 hours, is no different than 0 hours.  Look at the admin requirements for conducting con-ed from OEMS.  You are required to notify OEMS of any class that does not run for the full approved time to have the credit hours reduced.  So what we now sit thru is "sorry guys we were able to complete all the material in 3 hours because we have been doing this forever, so i need you to all sit here in this room and do nothing for the next hour to make sure we are here for the full 4 hours"  This is the current system....it is a joke.


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## Medic_Forever (May 29, 2010)

Aidey said:


> Time spent in class is a tough one because sometimes you legitimately end early. Half arseing it and sending everyone home early is unacceptable, but if the class gets out 30 minutes early because there were only 2 people in the class that really isn't fraudulent to me.


  Unfort OEMS doesn't see it the same way we do.  This incident happened in MA 4 or 5 months ago regarding a paramedic refresher.  The instructor was well known, very popular, knowledgable and more than qualified to teach.  All material was adequately covered and tested.  So over the course of this 48 hour refresher they had completed everything including the exam and were let out the final day at like 1300 or 1330.  Basically 43 or 44 hours of a 48 refresher.  Someone posted a "Thank you" to the instructor for great refresher and the early out on that last friday of class on Facebook.  Someone with a grudge or as a joke somehow made OEMS aware of this post.  They came in and investigated.  They made everybody come back in and re-do the final 2 days of the paramedic refresher class.


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## rescue99 (May 29, 2010)

Medic_Forever said:


> As long as you throw in everyone who has taken a 3 hour class that was finished in 2 hours yet still got 3 hours credit.  Same thing.  Your saying no exceptions right?  These people that have gotten more credits than they sat for (myself included,and none of it intentional it is what it is) are no different in the end.  Yes i signed for 24 hours of continuing education but only sat for 15 hours of instruction, is no different than my 48 hour refresher was done in 30 hours, is no different than 0 hours.  Look at the admin requirements for conducting con-ed from OEMS.  You are required to notify OEMS of any class that does not run for the full approved time to have the credit hours reduced.  So what we now sit thru is "sorry guys we were able to complete all the material in 3 hours because we have been doing this forever, so i need you to all sit here in this room and do nothing for the next hour to make sure we are here for the full 4 hours"  This is the current system....it is a joke.



The suggested amount of times is 4 hours. 4 hours is not mandated. Not going to class, not participating in class and not taking the required tests is fraud. A class of 3 recert candidates lasting less than 4 hours is to be expected. Class time estimations are based on at least 6 participants per ACLS instructor. When I do an ACLS recert for 2-4 people it does take a less than 4 hours to get through everything. If I add another 2 it goes almost 4.


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## Medic_Forever (May 30, 2010)

rescue99 said:


> The suggested amount of times is 4 hours. 4 hours is not mandated. Not going to class, not participating in class and not taking the required tests is fraud. A class of 3 recert candidates lasting less than 4 hours is to be expected. Class time estimations are based on at least 6 participants per ACLS instructor. When I do an ACLS recert for 2-4 people it does take a less than 4 hours to get through everything. If I add another 2 it goes almost 4.



I fully agree with you that there are many many factors regarding how long it takes to teach the material outlined for a class.  As i said before i was not and do not condone "no show" classes.  I will assume you are a more than competent ACLS instructor, who after years of teaching the same material (with a few changes in protocols obviously thru the years) you have probably gotten to the poiint where you can teach it in your sleep.  You also need to factor in the skill level and competency of your students as well.  If your teaching a brand new class of Paramedics in ACLS you can assume it will take a substantial amount of time longer than it would to be teaching a group of Paramedics with 10-20 years of experience.  Unfortunately in MA, far to much emphasis is placed on "time approved" for a class than the quality of the class.  If OEMS stamps 4 approval on your class you had better be there for 4 hours according to OEMS. We have had these discussions in MA for a long long time.  WHy not just test everyone Written and/or practical for your recert instead of allowing all these less than stellar continuing education classes?


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