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1995 No. 109 NATIONAL HEALTH REGULATIONS (AMENDMENT) - REG 3
3. New Schedule 7
3.1 Add at the end of the Regulations:
SCHEDULE 7 Regulation 49A
HOSPITAL CASEMIX PROTOCOL
Part 1-Explanatory Notes Hospital Casemix Protocol: object 1. The object of
the Hospital Casemix Protocol is to specify the financial, clinical and
demographic data that funds must give to the Department in respect of every
episode of hospital treatment for which a charge is billed to a fund. Hospital
Casemix Protocol: definitions 2. In this Protocol:
"blank filled" means that where blank filling is a valid entry, the field is
filled with blanks;
"CCU" means the Coronary Care Unit of a hospital;
"CMBS" means Commonwealth Medicare Benefits Schedule;
"contracted doctor" means a doctor who has entered into a medical
purchaser-provider agreement under section 73BDA of the National Health Act
1953 ;
"contracted hospital" means a hospital that has entered into a
purchaser-provider agreement under section 73BD of the National Health Act
1953 ;
"DRG" means Diagnosis Related Group;
"episode" means the period between admission and separation that a person
spends in one hospital, and includes leave periods not exceeding 7 days;
(NOTE: This definition of "episode" differs from the definition set out in the
NHDD.)
"fund" means a health benefits fund conducted by a registered organization;
"ICD-9-CM" means The International Classification of Diseases 9th Revision
Clinical Modification (Australian Version);
"MAA" means mandatory for all, and fields identified with this flag must
contain a valid entry regardless of whether the episode occurred in a
contracted hospital or a non contracted hospital;
"MAC" means mandatory for contracted hospitals, and fields identified with
this flag must contain a valid entry. Where the episode occurred in a non
contracted hospital, the field becomes optional;
"NHDD" means version 3 of the National Health Data Dictionary, published in
May 1994;
"OPA" means that fields identified with this flag are optional for all
hospitals;
"OPH" means optional for public hospitals, and fields identified with this
flag are optional for public hospitals, whether contracted or not, and
mandatory for private hospitals;
"OPO" means optional for public hospitals overnight, and fields identified
with this flag are optional for public hospitals, whether contracted or not,
where the patient stayed overnight;
"overnight-stay patient" means a person who is admitted to, and who separates
from, a hospital on different dates;
"sameday patient" means a person who is admitted to, and who separates from, a
hospital on the same date;
"valid arrangement" means an arrangement made under section 4C of the
National Health Act 1953.
(NOTE: "NHTP" (nursing home type patient) is defined in subsection 3 (1) of
the Health Insurance Act 1973.)
How to use the Protocol: the Parts of the Protocol 3. The medical record
supplied to the Department by a fund must comply with the specification set
out in the File Structure: Medical Record in Part 2, and with the contents set
out in Record Content: Medical Record in Part 4. 4. The hospital episode
record supplied to the Department by a fund must comply with the specification
set out in the File Structure: Hospital Episode Record in Part 3, and with the
contents set out in Record Content: Hospital Episode Record in Part 5. How to
use the Protocol: format specifications and how the details must be sent 5.
All fields are to be initialised to blanks. 6. Blanks are not a valid entry
for some fields. These fields are identified in Column 5. 7. Where identified
in Column 5, blanks are a valid entry under the following conditions:
(a) the data item is optional; or
(b) specific conditions apply and these are noted in Column 5. 8. A record
will be rejected by the Department if any of the following data items
is coded as blank:
(a) Fund identifier in either Part 4 or 5;
(b) Link Identifier in either Part 4 or 5;
(c) Provider (hospital) code in Part 5;
(d) Total charge in Part 5;
(e) Total benefit in Part 5;
(f) Date of birth in Part 5;
(g) Postcode in Part 5;
(h) Gender in Part 5;
(i) Date admitted in Part 5;
(j) Date separated in Part 5;
(k) Separation mode in Part 5;
(l) Principal Diagnosis Code in Part 5. 9. Records not containing valid
entries for items in item 8 will be rejected. 10. If 10% of records in
any transmission batch are rejected all records in that transmission
batch will be returned to the fund. The fund will resubmit the
rejected transmission within 4 weeks from the date of receipt of
rejected records. 11. Where a hospital is required to provide data to
a fund, the hospital episode record must comply with the
specifications set out in the File Structure: Hospital Episode Record
in Part 3. The hospital must reach an agreement with the fund as to
the medium on which the data must be sent. 12. Where a fund gives data
to the Department, the fund must give the data to the Department
using:
(a) DOS formatted floppy disks; or
(b) magnetic tapes; or
(c) MVS cartridges; or
(d) other electronic media as agreed with the Department in writing.
How to use the Protocol: data structure and specifications 13. A fund must
give data to the Department in ASCII format with a record length as stated in
Parts 2 and 3 of the Protocol. 14. For the purpose of the field size column
(Column 3 in Parts 4 and 5):
(a) D is a date field. Legal values are 0-9 and blanks. The format is
DDMMCCYY;
(b) N is a numeric field. N fields must be right justified and left
blank filled. Legal characters are 0-9 and blanks;
(c) C is a character field. C fields must be right justified and left
blank filled. Legal characters are alpha, 0-9 and blanks;
(d) I is for ICD-9-CM codes. I fields must be left justified and right
blank filled and should not include decimal points. 15. Data items
requiring rounding are noted in Column 5 in Parts 4 and 5. Rounding
takes fractions to the nearest whole number. If the fraction is 0.5
acceptable rounding is up for an odd number and down for an even
number. 16. All data items should reflect the completed discharge data
set. How to use the Protocol: how will the data transfer work 17. A
fund has the primary responsibility for giving the information set out
in Column 2-Data item of Parts 4 and 5. 18. Where the fund gives data
to the Department, the data must include all episodes, whether or not
the episodes took place in a contracted hospital. 19. Where the
hospital gives data to the fund:
(a) the data set out in items 27-56 in Part 5, Record Content: Hospital
Episode Record must be sent; and
(b) the data sent in accordance with paragraph (a) must be sent using the
structure set out in items 27-56 in Part 3, File Structure: Hospital
Episode Record. (NOTE: The NHDD is published by the Australian
Institute of Health and Welfare and aims to set out uniform
definitions and data items to be used in the collection of health and
welfare data. The definitions set out in the NHDD are endorsed by the
National Health Information Management Group through the National
Health Information Agreement.)
Part 2-File structure: medical record
Column 1 Column 2 Column 3 Column 4 Column 5
Item No. Data Item Start Position Field size Repetitions
1 Fund identifier 1 3 1
2 Link identifier 4 24 1
3 CMBS item 28 5 1
4 Medical charge 33 5 1
5 CMBS benefit 38 5 1
6 Fund Benefit 43 5 1
7 CMBS date of service 48 8 1
8 Contracted doctor 56 1 1
9 Total record length 56
Part 3-File structure: hospital episode record
Column 1 Column 2 Column 3 Column 4 Column 5
Item No. Data Item Start Position Field size Repetitions
1 Fund identifier 1 3 1
2 Link identifier 4 24 1
3 Provider (hospital) code 28 8 1
4 Product code 36 8 1
5 Hospital contract status 44 1 1
6 Total days paid 45 4 1
7 Accommodation charge 49 6 1
8 Accommodation benefit 55 6 1
9 Theatre charge 61 5 1
10 Theatre benefit 66 5 1
11 Labour ward charge 71 5 1
12 Labour ward benefit 76 5 1
13 Intensive Care Unit charge 81 5 1
14 Intensive Care Unit benefit 86 5 1
15 Prosthesis charge 91 5 1
16 Prosthesis benefit 96 5 1
17 Pharmacy charge 101 5 1
18 Pharmacy benefit 106 5 1
19 Total charge 111 6 1
20 Total benefit 117 6 1
21 Front End Deductible 123 5 1
22 Ancillary cover status 128 1 1
23 Ancillary charges 129 5 1
24 Ancillary benefits 134 5 1
25 Medical charges 139 6 1
26 Medical benefits 145 6 1
27 Date of birth 151 8 1
28 Postcode 159 4 1
29 Gender 163 1 1
30 Date admitted 164 8 1
31 Date separated 172 8 1
32 Hospital type 180 1 1
33 ICU days 181 3 1
34 DRG code 184 3 1
35 DRG version 187 2 1
36 Admission time 189 4 1
37 Admission transfer type 193 1 1
38 Age in years 194 3 1
39 Age in days 197 3 1
40 Neonatal admission weight 200 4 1
41 Hours of mechanical
ventilation 204 4 1
42 Separation mode 208 2 1
43 Separation time 210 4 1
44 Separation transfer type 214 1 1
45 Acute days of stay 215 4 1
46 Total leave days 219 4 1
47 Non-acute days of stay 223 4 1
48 Principal diagnosis code 227 5 1
49 Secondary diagnoses codes 232 5 14
50 Principal procedure code 302 4 1
51 Secondary procedure codes 306 4 14
52 Sameday status 362 1 1
53 Principal CMBS item number 363 5 1
54 Principal CMBS date 368 8 1
55 Time in operating theatre
(Principal CMBS) 376 4 1
56 Secondary CMBS item
numbers 380 5 14
57 Total record length 449
Part 4-Record content: medical record Column 1 Item No.
Column 2
Data Item
Column 3
Field size
Column 4
Required
Column 5
Description of data item
1
Fund identifier
C(3)
MAA
See fund codes
2
Link identifier
C(24)
MAA
A unique identifier of an episode
that links data items from this
Part (Part 4) to the hospital
episode record (Part 5). The fund
may encrypt the membership
identifier for this purpose
3
CMBS item
C(5)
MAA
The CMBS item number Blank means
there was no CMBS item billed
4
Medical charge
N(5)
MAA
The amount that the patient was
billed by doctor An entry of 0
dollars means no amount was billed
5
CMBS benefit
N(5)
MAA
The amount paid to the patient as the
Medicare entitlement An entry of 0
dollars means no amount was paid
6
Fund benefit
N(5)
MAA
An amount additional to the Medicare
entitlement paid by the fund to the
patient An entry of 0 dollars means
no amount was paid
7
CMBS date of service
D(8)
MAA
DDMMCCYY Blank means there was no
CMBS date of service
8
Contracted doctor
C(1)
MAA
Y means the CMBS medical charge was
billed by a doctor with whom the fund
has a contract N means a doctor with
whom the fund has no contract Blank
means there was no CMBS item billed
Part 5-Record content: hospital episode record Column 1 Item No.
Column 2
Data Item
Column 3
Field size
Column 4
Required
Column 5
Coding Description
1
Fund identifier
C(3)
MAA
See fund codes
2
Link identifier
C(24)
MAA
A unique identifier of an episode
that links data items from this Part
(Part 5) to the medical record (Part
4). The fund may encrypt membership
identifier for this purpose
3
Provider (hospital) code
C(8)
MAA
The hospital provider number
4
Product code
C(8)
MAA
The product code for patient's
insurance cover at separation. The
fund must supply documentation of
cover field values
5
Hospital contract status
C(1)
MAA
Y means a hospital with which a fund
has a contract N means a hospital
with which the fund does not have a
contract
6
Total days paid
N(4)
MAA
The total number of days for which
benefits were paid by the fund,
including days for which benefits
were paid as an NHTP
7
Accommodation charge
N(6)
MAA
Accommodation charges rounded to the
nearest dollar. An entry of 0
dollars means that no accommodation
charges were billed Blanks are only
valid where an accommodation charge
was not separately identified but
was billed under another charge item
8
Accommodation benefit
N(6)
MAA
Accommodation benefit rounded to the
nearest dollar. An entry of 0
dollars means that no accommodation
benefits were paid Blanks are only
valid where an accommodation benefit
was not separately identified but
was paid under another benefit item
9
Theatre charge
N(5)
MAA
Theatre charges rounded to the
nearest dollar. An entry of 0
dollars means that no theatre
charges were billed Blanks are only
valid where a theatre charge was not
separately identified but was billed
under another charge item 10
Theatre benefit
N(5)
MAA
Theatre benefit rounded to the
nearest dollar. An entry of 0
dollars means that no theatre
benefits were paid
Blanks are only valid where a
theatre benefit was not separately
identified but was paid under
another benefit item 11
Labour ward charge
N(5)
MAA
Labour ward charges rounded to the
nearest dollar. An entry of 0
dollars means that no labour ward
charges were billed
Blanks are only valid where a labour
ward charge was not separately
identified but was billed under
another charge item 12
Labour ward benefit
N(5)
MAA
Labour ward benefit rounded to the
nearest dollar. An entry of 0
dollars means that no labour ward
benefits were paid
Blanks are only valid where a labour
ward benefit was not separately
identified but was paid under
another benefit item 13
Intensive Care Unit (ICU) charge
N(5)
MAA
ICU charge rounded to the nearest
dollar. An entry of 0 dollars means
that no ICU charges were billed.
Blanks are only valid where an ICU
charge was not separately identified
but was billed under another charge
item 14
Intensive care unit (ICU) benefit
N(5)
MAA
ICU benefit rounded to the nearest
dollar. An entry of 0 dollars means
that no ICU benefits were paid
Blanks are only valid where an ICU
benefit was not separately
identified but was paid under
another benefit item 15
Prosthesis charge
N(5)
MAA
Prosthesis charge rounded to the
nearest dollar. An entry of 0
dollars means that no prosthesis
charge was billed
Blanks are only valid where a
prosthesis charge was not separately
identified but was billed under
another charge item 16
Prosthesis benefit
N(5)
MAA
Prosthesis benefit rounded to the
nearest dollar. An entry of 0
dollars means that no prosthesis
benefit was paid
Blanks are only valid where a
prothesis benefit was not separately
identified but was paid under
another benefit item 17
Pharmacy charge
N(5)
MAA
Pharmacy charge rounded to the
nearest dollar. An entry of 0
dollars means that no pharmacy
charges were billed
Blanks are only valid where a
pharmacy charge was not separately
identified but was billed under
another charge item 18
Pharmacy benefit
N(5)
MAA
Pharmacy benefit rounded to the
nearest dollar. An entry of 0
dollars means that no pharmacy
benefits were paid
Blanks are only valid where a
pharmacy benefit was not separately
identified but was paid under another
benefit item 19
Total charge
N(6)
MAA
The total charge field must contain
the actual total charge billed by the
hospital
Total charges rounded to the nearest
dollar. An entry of 0 dollars means
that no charges were billed
A blank entry is not valid in this
field 20
Total benefit
N(6)
MAA
The total benefits field should
contain the actual total benefits
paid to the hospital by the fund
Total benefits rounded to the nearest
dollar. An entry of 0 dollars means
that no benefits were paid
A blank entry is not valid in this
field 21
Front end deductible
N(5)
MAA
The amount of FED deducted from the
benefit otherwise payable by the fund
to the patient
Blank means there is an FED but the
amount is unknown
0 means there was no FED applicable 22
Ancillary cover status
C(1)
MAA
Y means that the patient has
ancillary cover
N means that the patient does not
have ancillary cover 23
Ancillary charges
N(5)
OPA
The ancillary charges incurred during
the episode and billed against an
ancillary table 24
Ancillary benefits
N(5)
OPA
The ancillary benefits paid for
charges billed as occurring during
the episode 25
Medical charges
N(6)
MAA
The total Medical charges as set out
in Part 4 26
Medical benefits
N(6)
MAA
The total CMBS and Fund benefits as
set out in Part 4 27
Date of birth
D(8)
MAA
DDMMCCYY 28
Postcode
C(4)
MAA
The patient's residential postcode 29
Gender
C(1)
MAA
1 = Male;
2 = Female;
0 = Unknown 30
Date admitted
D(8)
MAA
DDMMCCYY 31
Date separated
D(8)
MAA
DDMMCCYY 32
Hospital type
C(1)
MAA
1 = public;
2 = private;
3 = private day facility;
4 = public day facility;
9 = other 33
ICU days
N(3)
OPH
The number of days spent by the
patient in:
ICU; and/or
CCU; and/or
Neonatal intensive care; and/or
paediatric intensive care.
This data item does not include days
spent in High Dependency Units. 34
DRG code
C(3)
OPA
Blank filled if not known 35
DRG version
C(2)
OPA
10 = version 1;
20 = version 2;
21 = version 2.1;
30 = version 3 36
Admission time
N(4)
MAA (sameday patients only)
The admission hour is based on a
24-hour clock. For example, 6:35AM
is entered as 0635. 37
Admission transfer type (to this hospital)
C(1)
MAC
If the patient transferred in from
another hospital, the data item must
indicate whether the care in the
admitting hospital was more or less
resource intensive per day than the
care provided in the hospital from
which the patient was transferred.
The data item must be entered using
the following codes:
Blank means there was no transfer.
U means Up Transfer: this hospital
stay was more resource intensive per
day.
D means Down Transfer: this hospital
stay was less resource intensive per
day.
L means Lateral Transfer: this
hospital stay was of similar resource
intensity per day.
X means transfer type unknown. 38
Age in years
N(3)
MAA
The age of the patient at admission.
The data item must be entered using a
valid range of 0 - 124. If the
patient's age was 365 days or less,
then enter zeros. 39
Age in days
N(3)
MAC
The age of the patient at admission
if less than 1 year of age. The data
item must be entered using a valid
range of 0 - 365. 40
Neonatal admission weight
N(4)
MAC
The admission weight rounded to the
nearest gram for Neonates (patient
age less than 29 days old). 41
Hours of mechanical ventilation
N(4)
MAC
The number of hours (rounded) for
which the patient received mechanical
ventilation during the episode. 42
Separation mode
C(2)
MAC
01 means separation or transfer of
the patient to an acute hospital
02 means separation or transfer of
the patient to a nursing home
03 means separation or transfer of
the patient to a psychiatric hospital
04 means separation or transfer of
the patient to another health
facility
05 means statistical separation-type
change
06 means the patient left the
hospital against medical advice
07 means a statistical separation
from leave
08 means the patient died
09 means the patient went home/other 43
Separation time
N(4)
MAA (sameday patients only)
This separation time is based on a
24-hour clock. For example, 10:35PM
is entered as 2235. 44
Separation transfer type (Separation from this hospital)
C(1)
MAC
If the patient was transferred to
another hospital, the data item must
indicate whether the care in the
separating hospital was more or less
resource intensive per day than the
care expected to be required by the
patient in the hospital to which the
patient was transferred. The data
item must be entered using the
following codes:
Blank means there was no separation
transfer
U means Up Transfer: this hospital
stay expected to be less resource
intensive per day
D means Down Transfer: this hospital
stay expected to be more resource
intensive per day
L means Lateral Transfer: this
hospital stay expected to be of
similar resource intensity per day
X means transfer type unknown 45
Acute days of stay
N(4)
MAA
Acute days of stay are calculated:
as 1 for sameday patients; or
by subtracting the date of admission
from the date of separation, and
excluding any leave days. 46
Total leave days
N(4)
MAA
This data item is calculated as the
sum of leave days for all leave
periods during the episode.
If there are no leave days, enter 0.
Leave days exclude one-day leave
periods for acute and private
psychiatric hospital patients, and
are subject to the following
conditions:
Patients in acute hospitals and
private psychiatric hospitals who do
not require treatment over a weekend
or other short period may leave the
hospital temporarily with the
approval of the hospital or treating
medical practitioner. If there is a
decision that the patient will return
to the same hospital within a short
time to resume treatment, this
absence is defined as "leave".
A patient of a public psychiatric
hospital who leaves the hospital for
a short period without a formal
discharge is defined as being on
leave from the hospital. (NOTE: See
NHDD P27a and P4-62.) 47
Non-acute days of stay
N(4)
MAA
This data item refers to the number
of days in the hospital that exceeded
35 days without certification. 48
Principal diagnosis code
I(5)
MAC
The ICD-9-CM code for the diagnosis
or condition chiefly responsible for
occasioning the hospital admission.
A blank entry is not valid for this
field. 49
Secondary diagnosis codes
I(5) 14 times
MAC
Additional ICD-9-CM diagnosis codes
for conditions other than the
principal diagnosis:
that arose during the patient's stay
in hospital;
that affected the patient's
treatment and/or length of stay in
hospital by greater than one day;
that existed at the time of the
patient's admission to hospital and
for which treatment was given.
(NOTE: See NHDD P36 and ICD-9-CM
under the entry Additional
Diagnoses.) 50
Principal procedure code
I(4)
MAC
The ICD-9-CM procedure code for the
procedure which consumed the
greatest amount of hospital
resources.
Blank means no ICD-9-CM procedure
code was applicable (NOTE: See NHDD
P37 and ICD-9-CM.) 51
Secondary procedure codes
I(4) 14 times
MAC
Additional ICD-9-CM procedure codes
for other procedures performed
during the episode. (NOTE: See NHDD
P38 and ICD-9-CM.) 52
Sameday status
C(1)
MAC
0 means patient with a valid
arrangement allowing overnight stay
for procedure normally performed on a
sameday basis.
1 means sameday patient.
2 means overnight patient (other than
type 0 above). 53
Principal CMBS item number
C(5)
OPH
Principal CMBS item related to the
Principal Procedure Code referred to
in Item 50 in this Part.
Blank means there was no applicable
CMBS item. 54
Principal CMBS date
D(8)
OPH
The date on which the principal CMBS
procedure was carried out.
(DDMMCCYY)
Blank means there was no Principal
CMBS date. 55
Time in operating theatre (Principal CMBS)
N(4)
MAA (sameday patients only)
The time in minutes that the patient
spent in the operating theatre, from
the time the patient entered the
operating theatre until the time the
patient left the operating theatre.
Zero means no time was spent in the
operating theatre.
Blank means there was no applicable
CMBS item. 56
Secondary CMBS item numbers
C(5) 14 times
OPH
Additional CMBS item numbers related
to the Secondary Procedure Codes
referred to in item 51 in this Part.
Blank means there was no applicable
CMBS item.
Part 6-Registered Health Benefits Organizations
Column 1 Column 2 Column 3
Item No. Name Identifier
1 A.C.A. Health Benefits Fund ACA
2 A.M.A Health Fund Limited AMA
3 Army Health Benefits Society AHB
4 Australian Health Management Pty Ltd AHM
5 Australian Unity Friendly Society** AUF
6 C.D.H. Benefits Fund CDH
7 Commonwealth Bank Health Society (Friendly Society) CBH
8 C.P.S. Health Benefits Society CPS
9 CUA Members' Benefits Friendly Society CUA
10 FAI Health Benefits Limited FAI
11 Geelong Medical and Hospital Benefits
Association Limited GMH
12 Goldfields Medical Fund (Inc.) GMF
13 Government Employees Health Fund Limited GEH
14 Grand United Friendly Society GUF
15 Health Care Insurance Ltd HCI
16 Healthguard Health Benefits Fund Limited HHB
17 Health Insurance Fund of WA HIF
18 Hospital Benefits Association Limited* HBA
19 Hospital Benefits Fund of Western Australia (Inc.),
The HBF
20 Hospitals Contribution Fund of Australia, Limited,
The HCF
21 Independent Order of Odd Fellows of Victoria IOF
22 I.O.R. Australia Pty Ltd IOR
23 Latrobe Health Services, Inc. LHS
24 Lysaght Hospital and Medical Club, The LHM
25 Manchester Unity Independent Order of Oddfellows
Friendly Society in New South Wales MUI
26 Medibank Private
(Health Insurance Commission) MBP
27 Medical Benefits Fund of Australia Ltd MBF
28 Mildura District Hospital Fund MDH
29 MIM Employees Health Fund MIM
30 Mutual Community Ltd* MCL
31 National Mutual Health Insurance Pty Ltd* NMH
32 Naval Health Benefits Society NHB
33 New South Wales Teacher's Federation Health Society NTF
34 N.I.B. Health Funds Limited NIB
35 Over 50's Friendly Society, The OFF
36 Phoenix Welfare Association Limited, The PWA
37 Queensland Teachers Union Health Society QTU
38 Queenstown Medical Union Health Benefits QMU
39 Railway & Transport Employees' Friendly Society
Health Fund RTE
40 Reserve Bank Health Society RBH
41 S.G.I.C. Health Pty Limited SGI
42 South Australian Police Employees' Health Fund
Incorporated SPE
43 South Australian Public Servants SPS
44 St Luke's Medical & Hospital Benefits Association SLM
45 "The Sydney Morning Herald" Hospital Fund SMH
46 Transport Friendly Society TFS
47 United Ancient Order of Druids UAD
48 United Ancient Order of Druids Registered
Friendly Society Grand Lodge of New South
Wales, The UAF
49 Eastern District Health Fund Ltd WDH
50 Yallourn Medical and Hospital Society, The YMH
(NOTES:
* Mutual Community is owned and operated by National Mutual. In Victoria,
Mutual Community trades as HBA.
** Australian Natives' Association and Manchester Unity Independent Order of
Oddfellows Friendly Society in Victoria now trade as Australian Unity Friendly
Society.)
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