Messenger - August 1997_ Issue 55 by liuqingyan


   The Mes                     hysicians and
                                             Surgeons o
                                                       f Albe

               Co    llege of P

  In This Issue

College Symposium         1
Charging for Exchange     2
of Information
Web Site                  2
Going Strong
New Year’s Comes          3
PAR Project               4
Health Information        5
Protection Act
College says “No”         9
to Fen-Phen Program
Year in Review            9
CPSA Annual Report
Financial Performance    10
Medicine and the Law:    11
Did You Know?
Discipline               12
Employment               13

                              August 1997               Issue 55
                          COUNCIL OF THE COLLEGE (1997)

                                  President - Dr. (Betty) Flagler
                              Vice President - Dr. Doug A. Urness
                          Executive Member-at-large - Ms. Linda Hohol

Council Members are available throughout Alberta to answer questions and discuss current issues.

       DISTRICT               COUNCILOR                    PHONE             FAX

       1 - Medicine Hat       Michael L. Gammon            362-5501          362-8426 (fax)

       2 - Lethbridge         Joe Hope                     328-2326          327-0123 (fax)
                              R. Sebastian David           553-3351          553-4549 (fax)

       3 - Red Deer           Doug A. Urness               340-1500          342-4733 (fax)
                              Gerry A. Miller              227-3356          227-2702 (fax)

       4 - Camrose            “Kam” Gangopadhyay           352-2511          352-7599 (fax)

       5 - Northwestern       Gary S. Nelson               778-2224          778-2127 (fax)

       6 - Calgary            Sheila M. Malm               220-7990          283-8524 (fax)
                              “Betty” A. Flagler           282-8664          289-6677 (fax)
                              Walter B. Blahey             266-1246          233-9278 (fax)
                              John S. Bradley              233-8330          263-6547 (fax)

       7 - Edmonton           Trevor W. Theman             484-1122          489-4121 (fax)
                              Eugene M. Kretzul            484-8474          489-3836 (fax)
                              “Chuck” H. Harley            944-2706          425-4179 (fax)
                              Bonnie L. Abel               492-8432          492-4385 (fax)

       8 - Northeastern       Lyle Mittelsteadt            998-7757          998-0636 (fax)
                              Harvey E. Albrecht           458-8400          458-8402 (fax)

       University Representatives
                             Lorne Tyrrell, Dean           492-9728          492-7303 (fax)
                             D. Grant Gall, Dean           220-6842          270-1828 (fax)
       Public Members
                             Mrs. Carol A. Kraychy         271-0287
                             Ms. Linda M. Hohol            (416) 980-3010    (416) 980-5712 (fax)
                             Dr. W. John McDonald          492-3354          492-3408 (fax)

                                      THE MESSENGER
                              An official publication of the College of
                               Physicians and Surgeons of Alberta

                                          900 Manulife Place
                                           10180-101 Street
                                          Edmonton, Alberta
                                           Canada T5J 4P8

                               Next Publication: September 1997
                             Comments or Questions regarding The Messenger
                                          can be directed to:
                                            Lorie J. Webb
                                      Communications Assistant
                                           (403) 423-4764
College Sy

    In the past, the CPSA Annual General Meeting has been held in conjunction with the
    Alberta Medical Association’s annual meeting. This combination not only made it an
    exceptionally long event for attending physicians but also limited the amount of time
    available to present CPSA awards.

    This year will be different, and better than ever!

    The College is planning a stand-alone, one-day symposium around the theme
    “Enhancing Physician Effectiveness.” The meeting will also provide the opportunity
    to discuss College policies and directions.

    Content will focus on important issues including:

             • self-directed professional development
             • medico-legal issues
             • physician wellness
             • ethics of the profession
             • and more ...
    The program will also include presentation of Honorary Life Memberships and
    Certificates of Merit.

    Details of the symposium, announcing speakers and topics, will be mailed to
    physicians later this summer.

    See you there!
                                                         r 4, 199
                                Sa   turday,
                                                           4   :30 p.m
                                                  9 a.m. -
                        Ti m e
                                                                        tel, Ed   monton
                                                           We   stin Ho

                       for Exchange
              Charging rmation
                  of Info

                                     Council reconfirmed its stance that it is unbecoming conduct for one physician to
                                     charge another physician for the exchange of patient information.

                                     In discussing this issue, Council again noted that physicians should be reasonable in
                                     their requests for records. Only information that cannot be obtained from an
                                     adequate history and physical examination should be requested from the previous

“   It is unbecoming
    conduct for one
                                     attending physician. This will minimize the administrative burden on colleagues.
                                     For example, physicians should specify what they actually need to know, rather than
                                     routinely asking for a copy of another physician’s entire chart.
    physician to charge
    another physician for            Please note that patients and third parties can be charged reasonable amounts for
                                     copies of medical records. When a physician leaves a group practice, there should
    the exchange of                  be a satisfactory arrangement made for the transfer of appropriate records; the
    patient information
                        ”            patient should not be left with the responsibility of obtaining them.

                                     Please refer to the College’s guidelines on Physicians’ Office Medical Records for
                                     a more complete description of the issues surrounding this topic.

                                e Going
                         Web Sit             Web Site Use
                                                                     Number of Hits

             The number of “hits” the College’s web site                              150
              receives each month is steadily increasing.                             100
              Thank you to all those who provided feedback and                         50
              suggestions for improvement.                                              0
                                                                                            J   F    M      A       M    J
              The College’s home page is updated monthly to
             provide timely and relevant information. Visit the                                     Months (1997)
             CPSA web site at:
         New Year ’s

For the renewal of College licenses, New Year’s will come earlier than usual. Council decided
to set December 1, 1997 as the deadline for renewing licenses for the new year.

 Every year it seems that holiday mail, end-of-year festivities, winter vacations and other
 diversions conspire to prevent some physicians from renewing their College license
 before the legislated deadline of January 1. The resulting license suspensions from late
 payment cause frustration, aggravation, fines and lost earnings.

 For 1998 renewals, the College will be following a different process:

 1)   Renewal notices will be sent out by the fourth week of October. They will accompany
      the Registration
      Information Forms, as usual.

 2)   Council has specified that renewals must be received by December 1, 1997.

 3)   Payment can be made by cheque, with an option of postdating it to
      December 31,1997, or by
      pre-authorized debit.

 4)   Notices will be sent to all those physicians who have not responded by December 1
      indicating that their payment is overdue and that their licenses will be suspended - no
      excuses, no retroactive reinstatements, no exceptions - unless payment arrives at the
      College by
      December 31.

 5) An updated Registration Information Form is still required from every physician as
    part of their licence renewal.

 6) This early renewal date does not shorten existing license terms: 1997 licenses will
    remain valid until the end of the calendar year.

 Discussions are under way with the major credit card companies for fee payment via these

                  PAR Project

         A recent chronology of events surrounding the College’s PAR project:

    1.   Bill 29 (amendments to the Medical Profession Act), which would have provided legisla-
         tive authority and protection for the PAR project, “died on the order paper” when the
         Legislature rose for the summer on June 16, 1997.

    2.   The ad hoc Physician Performance Assessment Committee (PPAC), which had been
         developing PAR and pilot-testing the
         questionnaire tools, recommended to Council on June 19, 1997 that the project be

    3.   Council strongly endorsed the project as proposed, despite the lack of legislative

    4.   In order not to lose momentum on the project,
         and to enable continuation of other development
                                                                                        PAR gets Council
         work, Council directed the current PPAC                                          go-ahead as
         members to continue in their full capacity.
    5.   Council further directed that bylaws be prepared                                  program
         outlining specifically how the project and operating committee
         will function. Bylaws are to be ready for the October 3, 1997
         meeting of Council.

    6.   Implementation of the PAR project as a voluntary educational program will commence this
         fall. Bill 29 will likely be reintroduced at the next sitting of the Legislature (spring).

    The Physician Performance Assessment Committee will be meeting again later this summer to
    map out implementation plans for PAR. A comprehensive outline of the project will be sent to
    all physicians once plans are set.

    Health Info
              ion Act

        Proposed Health Information Protection Act (HIPA)

The confidentiality of patient information has always been a primary ethical duty of physicians. Rules
for ownership, access and obtaining copies of records were clarified by the Supreme Court in 1992. With
the advent of electronic storage, transmission and linkage of patient information these issues are
becoming even more complex.

Bill 30, the proposed Health Information Protection Act, is being circulated widely for discussion and
input. The College has been asked by the Minister of Health to provide feedback from the medical
profession. This issue of The Messenger contains a summary of the provisions of the proposed Act, and
a fax-back sheet to facilitate responses. Your views will be collated and presented to Council at its next
meeting, October 3, 1997.

Your comments, suggestions, questions and the impact that these proposals would have on you, your
patients and your practice are very important; tell us what you think!

For a copy of the proposed Act, or further information about its provisions, contact Alberta

                                          Judith Dyck
                                         (403) 427-7164

                                       Roger Mariner
                                  Information Management
                                       (403) 427-8089

            Tell Us What You Think!
                                      HIPA Fax-Back Form
I     Individuals have the right to access their health information.

      Custodians are responsible for maintaining, protecting and safeguarding health information.

III   Different kinds of information are set out.

      Limits would be placed on the collection of health information.

V     Rules would be set for the use and disclosure of health information.

VI    A Health Information Commissioner would monitor the legislation, investigation of complaints and resolution
      of disputes.

VII   There would be serious penalties for the inappropriate collection, use or disclosure of health information.

                                                        Fax this HIPA form and any additional
                                                        comments to the College office at:

                                                             (403) 420-0651
                       What is the HIPA?
                   ft Act
         of the dra
·   Establish strong and effective mechanisms to protect the privacy of individuals with respect to health information.
·   Provide individuals with a right of access to their health information held by a “custodian”
    (subject to limited and specific exemptions as set out in the Act)
·   Provide individuals with a right to request corrections to their health information held by a custodian.
·   Prescribe rules for the collection, use and disclosure of health information, in the most limited manner and with the
    highest degree of anonymity possible.
·   Establish strong and effective remedies for violations of the Act.
·   Provide for independent reviews of decisions made by custodians under the Act, and the resolution of complaints under
    the Act.

Key Feat
Individuals have the right to access their health information.

·   Health records are owned by the individual or organization that collects and keeps them, but individuals have access to
    their own health information.
·   Individuals also have the right to request corrections to their health information if they think it is incomplete or
·   Fees cannot be charged if a person wants only to access their health record. Fees can only be charged for covering the
    costs of copies.

Custodians are responsible for maintaining, protecting and safeguarding health information.

·   The draft Act designates a range of specific health providers, organizations, regional health authorities, hospitals,
    professional bodies (such as the College), boards, agencies and the Minister of Health as “custodians” of health
·   As custodians, these groups are responsible for ensuring the terms and conditions of the legislation are met.
·   Custodians have 1) a “duty of care,” 2) are expected to take reasonable steps to ensure information is accurate and
    complete, and 3) to maintain safeguards to protect the integrity and confidentiality of health information.
·   Because of their wide-ranging responsibilities, certain custodians have fewer restrictions on their ability to access, use
    and disclose health information. These custodians are called “health oversight agencies,” and include the Minister of
    Health, regional health authorities, the Provincial Mental Health Advisory Board and the Alberta Cancer Board.
·   People or agencies who receive information but are not custodians have a responsibility to protect health information and
    only use it for its intended purpose.

Different kinds of information are set out.

·   Health information includes a broad range of oral and recorded information about health and health services. Health
    information comes in several different forms, depending on whether or not it is possible to identify individuals.
·   The draft Act also outlines the requirements for registration information. This includes the kinds of information needed to
    register people who may be eligible to receive health services in Alberta. Registration information is used for a number of
    purposes related to managing Alberta’s health system.
·   “Health service provider information” is defined in the draft Act. This includes information about the kinds of services
    different providers are authorized to provide in the province, their licensing information, and so on.
                                                                                            continued on page 8 ...      7
         ... HIP

Limits would be placed on the collection of health information.

·       Only information clearly related to the purpose for which it is collected can be recorded.
·       Individuals can request that certain parts of their health information not be shared with some other health service
        providers. This “lock box” concept means people have the option not to share sensitive health information with other
        health service providers.
·       Upon request, custodians are responsible for informing people 1) why health information is collected, 2) how it may be
        used and disclosed, 3) how people can access their health information and 4) how people can make necessary corrections.
        Custodians are responsible for informing people about their option of “locking” certain types of health information.

Rules would be set for the use and disclosure of health information.

·       For disclosure of health information, the general principle is a custodian needs prior consent in writing or in electronic
        form before individually identifiable health information is disclosed.
·       Non-identifiable health information must be used wherever possible. Information identifying the individual may only be
        used where necessary.
·       Health information may be used only for certain purposes, all of which are related to providing health services, health
        protection and promotion, development of public policy, and effective management of the health system.
·       Health information should only be used for the purposes in which it was collected or for a directly related purpose.
         This is subject to individual consent and some exceptions set out in the draft Act.
·       Specific circumstances are set for when health information can be disclosed without consent. That includes situations
        where disclosure is necessary to provide continuing care to the person; where it can be used to prevent or minimize
        danger to the individual or to others; if an individual’s family needs to be informed about their condition in a hospital; so
        that next of kin can be identified; for peer review by professional bodies; for audits or legal situations. Different rules
        apply when an individual has chosen to include certain information in a “lock box.”
·       Custodians must keep a log of all non-routine disclosures of health information. Individuals have a right to information
        about when their health information has been disclosed.
·       The use of health information to market services or to solicit money is prohibited without individual consent.
·       Non-identifiable health information may be disclosed to anyone for any purpose.
·       Specific rules exist for disclosure of health information for research purposes.

A Health Information Commissioner would have the power to monitor the legislation, investigate complaints and resolve

·       A Health Information Commissioner would be appointed by the Lieutenant Governor in council to monitor legislation
        administration and ensure its purposes are achieved.
·       The Commissioner can review, investigate and attempt to resolve complaints relating to 1) access to health information, 2)
        fees charged, 3) correction of health information, or 4) the collection, use or disclosure of health information.

There would be serious penalties for inappropriate collection, use or disclosure of health information.

·       There are penalties for offenses such as violating the legislation in relation to 1) collection, use or disclosure of health
        information, 2) gaining or attempting to gain unauthorized access to health information, 3) misleading or obstructing the
        activities of the Commissioner, 4) failing to comply with an order, 5) destroying records to evade a request for access, or 6)
        failing to comply with a request for information.
·       Maximum penalty for an offense is a $50,000 fine.

                          s “NO”
               College say ogram
                     Phen P
             to Fen-
Prescrib                                           Fen-Phen, the short name for the drugs
                                                   fenfluramine and phentermine, is gaining popular-
 Fen-Phen                                          ity in the U.S. as a treatment for obesity, severe
                                                   allergies, asthma, chronic fatigue syndrome,
                                                   chronic pain and several other chronic conditions.
The Council of the College of
                                                   Although patients claim relief from this
Physicians and Surgeons of
                                                   combination, its long-term effects are not yet
Alberta considers it                               completely clear. There are early indications of
unacceptable medical                               serious cardiovascular complications with
                                                   long-term use.
practice, except in the context
of clinical research,                              With knowledge about the safety of this treatment
to use fenfluramine and                            still in a preliminary stage, the College of
                                                   Physicians and Surgeons of Alberta considers the
phentermine in dosages
                                                   prescribing of the Fen-Phen program unacceptable
substantially                                      medical practice, except in the context of clinical
larger or for                                      research approved by an appropriate Research
                                                   Ethics Board.
indications other
than those                                                    For more information contact Dr. Bryan Ward
currently                                                     at the College.
recommended by
the manufacturer.

                                  Year In
                                  The 1997 edition of the College’s annual report has recently been mailed.
                Entitled Year In Review this publication focuses on College initiatives and strategic planning.

 The format of this report has been changed significantly from previous years based on feedback from the
 recent communications audit. The College has saved a significant amount of money in redesigning the
 format and content, and hopes the report becomes more widely read.
 Please let us know what you think.

 Additional copies of the CPSA annual report are available to the public through the College office.
 Contact Marnie at (403) 423-4764 or 1-800-561-3899.
      inancial Perfo

     For the 1996 financial year, the College showed a net income of $174,151 on revenues of $4,401,253. This reflects
     the College’s commitment to Goal nine, fiscal responsibility.

     For comparison, figures for 1995, and the budget approved for the 1997 operating year also appear.

     Continuing implementation of the College’s strategic plan will make 1997 a challenging year from a budgetary
     perspective. A net income of $2,263 is projected by the 1997 budget. To date, the College’s operations are on track
     with this budget.

                                                                    Budget 1997 Actual 1996 Actual 1995
                         Annual Fees                                    3,695,800    3,675,376      3,112,097
                         Professional Corporation Fees                    242,659      261,587        254,899
                         Registration Fees                                 40,000       44,950         39,100
                         Education Registration & Certificates             30,850       43,240         59,072
                         Other Revenue                                    134,550      113,028        152,310
                         Investment Income                                370,000      263,072        233,117
                         Total Revenue                                  4,513,859    4,401,253      3,850,595

                         Administration                                 2,205,710    2,148,443      2,357,320
                         Special Programs (other strategic goals)         710,805      617,337        605,601
                         Complaints & Discipline (goal #5)                626,727      646,248        333,707
                         Quality of Care Program (goal #1)                494,355      255,751        172,623
                         Council & Operating Committees                   335,000      365,009        367,840
                         Office of the Registrar                          140,500      194,314        136,024
                         Total Expenditures                             4,511,596    4,227,102      3,820,124

       Net Income                                                           2,263     174,151          30,471

                  e Law:
    edicine and th ..?
       id You Know.
                                         Proper Charting
                               -prepared by Bryan & Company, Barristers and Solicitors-

Members of the medical profession are often given advice regarding the importance of proper medical charting.
Guidance comes from both licensing bodies and the CMPA.

The fact that medical care is objective and demonstrated by clearly documented records is a well-accepted
principle of medical practice. These records should contain

          ·     personal history
                family history
                presenting problem(s)
                                                                                          A medical chart
                                                                                          exists for the benefit
          ·     results of clinical examination and diagnosis
                                                                                          of both the patient
A chart should also contain progress notes describing the success of the
care provided and thoughts as to possible alternative treatment.
                                                                                          and the physician
A medical chart exists for the benefit of both the patient and the physician.

Medical charts are a continual reminder of the decided treatment plan and its success. They provide another
treating physician with a clear history of past complaints and resulting care.

Equally important, a chart documents a total record of the care provided. It is objective evidence of what occurred
during each medical encounter. The chart provides, or should provide, a clear record of care. It is, or should be,
proof positive evidence that the physician met quality of care standards.

Physicians often complain detailed charting is impossible because of overwhelming time demands. Physicians
shorten the process to the extent that in some situations, a single entry notation is followed by a prescription.
Some of these physicians face civil action for malpractice and/or a complaint to the College. Either can be initiated
by the patient. The medical chart should be the first line of defense to either process, but all too often fails
miserably to provide that protection.

What is the long and short of this situation? On the one hand, the patient displays an excellent recollection as to
all conversations with the physicians, type of examination conducted and the opinion expressed by the physician.
On the other hand, the physician is desperately trying to remember the same incidents without the benefit of any
written record.

The Government of Alberta is presently considering major changes to the Limitation of Actions Act. In the
simplest terms, if the new Act is passed, it will allow an injured party (patient) up to ten years to commence an
action against a physician.
How good is your memory without the assistance of a properly prepared chart?

Information presented is not intended to focus on particular cases
but rather present common legal issues and practical advice.
                                 Di scipline
                                  R  eports

Dr. Dhanji Lalji

On January 23, 1997, the Council of the College of Physicians and Surgeons of Alberta found Dr. D. Lalji guilty of demon-
strating a lack of skill or judgment in that:

1)    between July 20, 1995 and August 3, 1995 given the presenting complaints of his patient as noted in his chart he did fail to
      institute appropriate and timely assessments of his patient’s condition such as noting the respiratory rate of his patient,
      conducting an oxygen saturation measurement, peak airflow measurement, and chest x-ray.

Council ordered that:

PURSUANT to Section 51(1)(d) of the Medical Profession Act, the registration of Dr. Lalji be subject to the following

          1)       Dr. Lalji shall submit himself immediately on the request of the Registrar for peer review to assess Dr.
                   Lalji’s competence in all aspects of history taking, physical examination and diagnosis.

          2)       Should the written assessment of such peer review identify a deficiency and recommend retraining at any
                   kind of facility, then the physician’s name shall be transferred to the Educational Register in accordance
                   with Section 25(2)(d). The physician shall submit himself for such retraining for such a period of time and
                   at such location as is approved by the Registrar until he receives certification of his continuing compe-
                   tence. Upon receipt of such certification by the Registrar, the name of the physician shall be restored to
                   the Alberta Medical Register.

          3)       Should the physician fail to undertake such peer review and/or retraining, then the physician shall stand
                   suspended from the practice of medicine until he has met such condition, such suspension to continue and
                   to be reviewed semiannually by the Council for a period not to exceed three years. If these conditions have
                   not been met by the end of three years, this matter shall be returned to Council for consideration of
                   striking of the name of the physician from the Alberta Medical Register.

          4)       The cost of peer review shall be paid by the physician within thirty (30) days of receipt of an invoice to be
                   forwarded to him by the Registrar.

          5)       If there is any cost assessed for retraining at the specific facility, the physician shall pay to such facility
                   such assessed cost within thirty (30) days of receipt of an invoice provided to him by such facility.

Dr. Lalji was assessed the full costs of the investigation and hearings in the amount of $9,724.88 payable within 30 days of
service of the Order. The costs were paid.

         Emplo yment

Increased demands on College staff coupled with internal realignment have created an
opening for another Assistant Register at the College of Physicians and Surgeons of

Applicants must be eligible for licensure with the College of Physicians and Surgeons of
Alberta, and have ten years of clinical experience. Training or equivalent experience in
administration is an asset.

The successful candidate will have proven expertise in conflict resolution, and
demonstrate effectiveness in oral and written communication.

Within the Complaints Department, this Assistant Registrar will:

•   review complaints to gain a clear understanding of the issues or concerns of the
•   liaise with the physician(s) and complainant(s) to explain the process;
•   attempt to resolve the matter informally and, if so, proceed to conclude the
    complaint process, including written communication to the complainant and
•   ensure that an evaluation of the process is undertaken from the perspective of
    both complainants and physicians;
•   identify systemic problems that could be the focus of education for the
    physician or the profession.

The successful candidate should be available to commence employment no later than
January 1, 1998.

Compensation will be in accordance with the present College salary scale; a comprehen-
sive benefit package is also offered.

Written applications can be submitted in confidence to:

                                    The Registrar
                    College of Physicians and Surgeons of Alberta
                                 900 Manulife Place
                                  10180-101 Street
                               Edmonton, AB T5J 4P8

Competition closes August 31, 1997.                                                        13
                        Moving with the Sun
                                                          “Moving with the Sun” project links the University of Alberta and
                                                          High Level Hospital to Hong Kong and Beijing, China

At midnight on July 1, 1997,             tele-video to the Faculty of   delegates regarding hepatitis     partnership involves the
Hong Kong was                           Medicine at the Prince of       research; Drs. Moores and         sharing of ideas related to
reunited with the People’s              Wales Hospital at the           Nordi discussed the use of        the delivery of health care.
Republic of China. This                 Chinese University, and the     telehealth for practicing rural   With current technology, this
event was of great signifi-             People’s Liberation Army        family medicine and Raven         takes on a truly global
cance to the University of              Hospital in Beijing. After      Makkenaw exchanged ideas          perspective, as demonstrated
Alberta, which has a                    greetings were received         with Beijing regarding the        by events like this.
reciprocal agreement with               from Rod Fraser, President      use of herbal medicines for
the Chinese University of               of the University of Alberta,   native healing. The Chinese       For more information, please
Hong Kong. To celebrate                 video presentations were        University ended the informa-     contact:
this event, the Chinese                 made by each location,          tion exchange session with a      Murray Diduck University of
University organized a 24               giving all involved a sense     video presentation and            Alberta, Faculty of Medicine
hour worldwide telehealth               of the local culture within     discussion on endoscopic          Tel: (403) 492-6561,
Conference called “Moving               each country. This was          surgery.                          E-mail:
with the Sun”. This project             followed by a series of                                 
involved a total of 15 sites            telehealth presentations        The conference ended with a
outside China. With assis-              made by the University of       long-distance champagne           Andy Burgess, TELUS
tance from TELUS, the                   Alberta and High Level. Dr.     toast made between Alberta        Telehealth Project Manager,
University of Alberta and               Lorne Tyrrell, presented        and China to celebrate the        Tel. (403) 493-3542
High Level Hospital were                findings and answered           partnership between the two       E-mail:
linked via interactive                  questions from the Chinese      countries. This continued

                               This article appears to acknowledge the support Telus provides the College’s
                                                      Triplicate Prescription Program

          The Mes

      900 Manulife Place, 10180-101 Street                                                                 00919098 99
      Edmonton, Alberta, Canada T5J 4P8

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