0920-22AV Att 3b_Component 2_11-5-2021

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Comp 2_APR_Form_Year2_12-08-2021_Aug2022_clean

OMB: 0920-1353

Document [docx]
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Annual Performance Report—Component 2

Integrated Viral Hepatitis Surveillance and Prevention Funding for Health Departments

Component 2: Core Viral Hepatitis Prevention Activities


Reporting Agency

Reporting jurisdiction


Contact name (person completing form)


Contact phone number (xxx-xxx-xxxx)


Contact email address


Additional contact name(s) (if applicable)


Additional contact phone number(s)

(xxx-xxx-xxxx)


Additional contact email address(es)


Date of report submission (MM/DD/YYYY)


Reporting Period

(Complete this form with information from Reporting Period selected)

Select one

□ Year 1 (5/1/21-9/30/21)

□ Year 2 (10/1/21-9/30/22)

□ Year 3 (10/1/22-9/30/23)

□ Year 4 (10/1/23-9/30/24)

□ Year 5 (10/1/24-4/30/26)



2.1—Support viral hepatitis elimination planning and surveillance,

and maximize access to testing, treatment, and prevention


Measures 2.1.1.a – 2.1.1.b

  • Establishment and maintenance of a viral hepatitis elimination technical advisory committee (or coalition) with membership to support jurisdictional viral hepatitis elimination planning

  • Conduct at least two meetings per year of the viral hepatitis elimination technical advisory committee (or coalition)


Have you established a viral hepatitis elimination technical advisory committee (or coalition) to support viral hepatitis elimination planning?

Select one

□ Completed

□ In progress



□ Not started


Identify the stakeholder groups that are (or will be) represented on this committee (or coalition).

(select all that apply)

□ Public health

□ Corrections

□ Criminal justice, law enforcement

□ Medicaid

□ Injury prevention services

□ Substance use and mental health services

□ Healthcare providers

□ HIV care providers

□ Hospitals

□ Laboratories

□ Community-based organizations

□ Local harm reduction coalition members

□ Non-profit/advocacy groups

□ People with viral hepatitis lived experience

□ Other, specify:

>>

□ N/A (committee not established)

During this reporting period, when did the committee (or coalition) meet? (MM/DD/YYYY)

>

>

>

>

□ No meetings held during reporting period

□ N/A (committee not established)

If the committee (or coalition) met during this reporting period, please submit a copy of meeting agenda(s) with the APR.

Select one

□ Submitted □ Not submitted

□ N/A (committee not established)


Measure 2.1.1.c

  • Development and maintenance of a viral hepatitis elimination plan with support from the technical advisory committee (or coalition)



Have you developed a viral hepatitis elimination plan?

Select one

□ Completed

□ In progress



□ Not started


Does it contain plans for elimination of hepatitis C and/or hepatitis B?

(select all that apply)

□ Hepatitis C

□ Hepatitis B

□ N/A (plan not started)

If the viral hepatitis elimination plan is completed, please submit a copy with the APR.

Select one

□ Submitted □ Not submitted

□ N/A (plan not started)


Measures 2.1.2.c, 2.1.4.a

  • The jurisdictional viral hepatitis elimination plan addresses recommendations for increasing HCV RNA reflex testing

  • The jurisdictional viral hepatitis elimination plan addresses provider training in prescribing hepatitis C and hepatitis B treatment



Does your viral hepatitis elimination plan address recommendations for increasing HCV RNA reflex testing?

Select one

□ Yes

□ No



□ N/A (plan not started)

Does your viral hepatitis elimination plan address provider training in prescribing hepatitis C treatment?

Select one

□ Yes

□ No



□ N/A (plan not started)

Does your viral hepatitis elimination plan address provider training in prescribing hepatitis B treatment?

Select one

□ Yes

□ No

□ N/A (plan not started)


Measures 2.1.2.a – 2.1.2.b

  • CLIA-certified laboratories that conduct testing for at least 80% of all anti-HCV results identified in the jurisdiction

  • The proportion conducting HCV RNA reflex testing was assessed; feedback with recommendations conducted



Have you worked with your surveillance and/or epidemiology teams to identify the total number of CLIA-certified laboratories in your jurisdiction that report hepatitis C antibody testing results?

Select one

□ Yes

□ No

□ In progress


Of the CLIA-certified laboratories you have identified that report hepatitis C antibody testing results, have you selected the subset that reports at least 80% of the hepatitis C antibody testing results in your jurisdiction?

Select one

□ Yes

□ No



□ In progress

□ N/A (labs not identified)

Of this subset, have you performed a needs assessment to identify key barriers and challenges to increasing HCV RNA reflex testing?

Select one

□ Yes

□ No



□ In progress

□ N/A (labs not identified)

What proportion of the subset is conducting HCV RNA reflex testing?

Select one

%:




□ In progress

□ N/A (labs not identified)

Have you provided recommendations to increase HCV RNA reflex testing?

Select one

□ Yes

□ No

□ In progress

□ N/A (labs not assessed)



Measures 2.1.3.a – 2.1.3.b

  • The top 5 highest volume health systems in the jurisdiction identified

  • The proportion of health systems promoting routine HCV and HBV testing assessed; feedback with recommendations was conducted




What are the top 5 highest volume health systems in your jurisdiction?

1.

2.

3.

4.

5.

□ In progress

□ Not started

Have you assessed how many of these health systems are promoting routine HCV testing?

Select one

Completed

In progress

Not started

□ N/A (health systems not assessed)

If so, what percent of health systems are promoting routine HCV testing?

%:


In progress

N/A (health systems not assessed)

Have you assessed how many of these health systems are promoting routine HBV testing?

Select one

Completed

In progress



Not started

□ N/A (health systems not assessed)

If so, what percent of health systems are promoting routine HBV testing?

%:


□ In progress

N/A (health systems not assessed)

Have you provided feedback to the top 5 highest volume health systems with recommendations on promoting routine HCV and/ or HBV testing?

Select one

Yes, to all 5

No, have not provided feedback to any of them



Yes, to some but not all

□ N/A (health systems not assessed)



Please use this space

to provide information about challenges and successes experienced when implementing Strategy 2.1 activities. Include additional contextual information that would help us interpret your annual performance data.



















Was Section 2.2 funded?

Select one

□ No NOTE: Stop here if not funded


□ Yes

-----------------------------------------------------------------------------------------------------------------------------------------------------


2.2—Increase access to hepatitis C and/or hepatitis B testing and referral to care

in high-impact settings


Measures 2.2.2.a – 2.2.2.b

  • Jurisdiction established relationship with partners in high-impact settings to identify high priority facilities for expansion of testing for HCV and/or HBV in high-impact settings, by setting type (syringe services programs, substance use disorder treatment programs, correctional facilities, emergency departments, hospital-based programs, sexually transmitted disease clinics, homeless services, health centers, other)

  • Number of clients seen, by setting



During the reporting period, were component 2 activities conducted at one or more syringe services programs (SSPs)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more substance use disorder (SUD) treatment programs (non-hospital based)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more hospital-based substance use disorder (SUD) treatment programs?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more hospital-based programs (excluding SUD treatment programs which are included separately above)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more health centers (non-hospital based)?

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more sexually transmitted infections (STI) clinics? 

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more mobile clinics? 

□ Yes

□ No

During the reporting period, were component 2 activities conducted at one or more emergency departments? 

□ Yes

□ No

During the reporting period were component 2 activities conducted at one or more correctional facilities? 

□ Yes

□ No

During the reporting period were component 2 activities conducted at one or more homeless services? 

□ Yes

□ No

During the reporting period, were component 2 activities conducted at another type of setting? 

□ Yes, specify: __________________

□ No

Note: If more than one other type of setting, list the first other type here and describe the additional other type(s) individually in the following questions. 

During the reporting period, were component 2 activities conducted at a second other type of setting? 

□ Yes, specify: __________________

□ No

Note: If more than two other types of settings, list the second other type here and describe the additional other type(s) individually in the following questions. 

During the reporting period, were component 2 activities conducted at a third other type of setting?

□ Yes, specify: __________________

□ No





Setting type

Was relationship established to expand HCV testing?

Was relationship established to expand HBV testing?

Number of clients seen at this setting during reporting period





SSPs

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






SUD treatment programs, non-hospital based

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






SUD treatment programs, hospital-based

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown


Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown


Health centers (non-hospital based)

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






STI clinics

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






Mobile clinics

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






Emergency departments

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown


Correctional facilities

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown


Homeless services

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






Other type of setting described above, first

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown






Other type of setting described above, second

questions will be skipped if not applicable


Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown


Other type of setting described above, third

questions will be skipped if not applicable

Select one

□ Yes

□ No

□ In progress

Select one

□ Yes

□ No

□ In progress

>

□ Unknown




Measures 2.2.2.c – 2.2.2.f, 2.2.3.a

  • Number of clients screened for hepatitis C (anti-HCV), by setting

  • Number of clients positive for anti-HCV, by setting

  • Number of clients tested for HCV RNA, by setting

  • Number of clients positive for HCV RNA, by setting

  • Number of clients positive for HCV RNA linked to treatment, by setting



During this reporting period, number of:

Setting type

Clients screened for hepatitis C (anti-HCV)

Clients positive for anti-HCV

Clients tested for HCV RNA

Clients positive for HCV RNA

Clients positive for HCV RNA linked to hepatitis C treatment

SSPs

questions will be skipped if not applicable

>

□ Unknown

>

□ Unknown

>

□ Unknown

>

□ Unknown

>

□ Unknown

SUD treatment programs, non-hospital based

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


SUD treatment programs, hospital based

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Health centers (non -hospital based)

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


STI clinics

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mobile clinics

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Emergency departments

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Correctional facilities

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Homeless services

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Other type of setting described above, first

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Other type of setting described above, second

questions will be skipped if not applicable


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


Other type of setting described above, third

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown





Measures 2.2.2.g – 2.2.2.h, 2.2.3.b

  • Number of clients screened for hepatitis B, by setting

  • Number of clients positive for HBsAg, by setting

  • Number of clients positive for HBsAg linked to care, by setting



During this reporting period, number of:

Setting type

Clients screened for hepatitis B

Clients positive for HBsAg

Clients positive for HBsAg linked to hepatitis B care

SSPs

questions will be skipped if not applicable

>

□ Unknown

>

□ Unknown

>

□ Unknown

SUD treatment programs, non-hospital based

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


SUD treatment programs, hospital-based

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Health centers (non- hospital based)

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


STI clinics

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mobile clinics

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Emergency departments

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Correctional facilities

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Homeless services

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Other type of setting described above, first

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


Other type of setting described above, second

questions will be skipped if not applicable


>

□ Unknown


>

□ Unknown


>

□ Unknown


Other type of setting described above, third

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown





Please use this space

to provide information about challenges and successes experienced when implementing Strategy 2.2 activities. Include additional contextual information that would help us interpret your annual performance data.








Was Section 2.3 funded?

Select one

□ No NOTE: Stop here if not funded

□ Yes


-----------------------------------------------------------------------------------------------------------------------------------------------------


2.3—Improve access to services preventing viral hepatitis

and other bloodborne infections among people who inject drugs (PWID)


Measures 2.3.3.a – 2.3.3.d

  • Number of hepatitis A vaccination doses administered to clients in the high-impact settings, by setting

  • Number of clients in the high-impact settings who completed hepatitis A vaccination series, by setting

  • Number of hepatitis B vaccination doses administered to clients in the high-impact settings, by setting

  • Number of clients in the high-impact settings who completed hepatitis B vaccination series, by setting




During this reporting period, number of:

Setting type

Hepatitis A vaccination doses administered

Clients who completed hepatitis A vaccination series

Hepatitis B vaccination doses administered

Clients who completed hepatitis B vaccination series

SSPs

questions will be skipped if not applicable

>

□ Unknown

>

□ Unknown

>

□ Unknown

>

□ Unknown

SUD treatment programs, non-hospital based

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

SUD treatment programs, hospital-based

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Hospital-based programs (excluding SUD treatment programs which are included separately above)

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Health centers (non- hospital based)

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

STI clinics

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Mobile clinics

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Emergency departments

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Correctional facilities

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Homeless services

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Other type of setting described above, first

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Other type of setting described above, second

questions will be skipped if not applicable


>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown

Other type of setting described above, third

questions will be skipped if not applicable

>

□ Unknown


>

□ Unknown


>

□ Unknown


>

□ Unknown






Measures 2.3.1.a – 2.3.1.d, 2.3.2.a

  • Number of syringe services programs (SSPs) in the jurisdiction

  • Number of visits in the jurisdiction, by SSP

  • Number of unduplicated SSP clients in the jurisdiction, by SSP

  • Mean (median) syringe coverage rates, by SSP

  • Number of clients linked to substance use disorder treatment by SSPs in the jurisdiction, by SSP



During this reporting period, number of:


Syringe services programs (SSPs) in jurisdiction

Total client visits

Unduplicated SSP clients

Clients linked to substance use disorder treatment

Mean syringe coverage rates during this reporting period

SSP 1

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 2

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 3

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 4

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 5

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 6

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 7

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 8

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 9

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 10

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 11

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 12

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 13

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 14

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 15

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 16

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 17

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 18

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 19

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 20

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 21

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 22

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 23

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 24

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 25

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 26

Name:

>

>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 27

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 28

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 29

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 30

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 31

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 32

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 33

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 34

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 35

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 36

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 37

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 38

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 39

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 40

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 41

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 42

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 43

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 44

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 45

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 46

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 47

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 48

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 49

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=


SSP 50

Name:

>


>

□ Unknown


>

□ Unknown


>

□ Unknown


Mean=





Please use this space

to provide information about challenges and successes experienced when implementing Strategy 2.3 activities. Include additional contextual information that would help us interpret your annual performance data.









23


File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorCooley, Laura A. (CDC/DDID/NCHHSTP/DVH)
File Modified0000-00-00
File Created2023-08-31

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