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August 4, 2017Dear Patient,This letter contains important information about improvements in your primary care clinic.Over the past year we have been working behind the scenes to bring about numerousimprovements in the Senior Care and UMED Clinics to better serve you. We are happy toannounce that we have merged Senior Care and UMED to make one comprehensive adultprimary care clinic, serving ages 18 and older. We will continue to serve the senior populationand accept Medicare, Medicaid, Private Insurance and uninsured patients. This will allow ourpatients and families better access to care.One of our biggest efforts was to transform our traditional medical clinics into a Patient CenteredMedical Home (PCMH). A PCMH puts you, the patient and family at the center of the healthcare system. Within the PCMH we are able to provide improved and timely access to your careteam members. Part of this transition was to build care teams that are able to better addressyour needs even beyond the medical problems.CARE TEAMS:��� Physicians, Nurse Practitioners & Physician AssistantsOur care teams include a Physician, Nurse Practitioner (NP) or a Physician Assistant(PA). Both the Physician and the NP or PA take care of their own patients. The NP andPA also work with the Physician’s patients as needed, which allows for greater accessshould you need a same day or next day appointment. The NP’s and PA’s collaboratewith the Physicians as needed to ensure the highest quality of care.��� Social Workers & Health NavigatorsOur clinics will continue utilizing social workers to help assist with community resourcesand transportation arrangements. They are coordinating care and arranging familymeetings to discuss barriers to care and how to overcome them. Health Navigators workclosely with social workers and assist patients in following up on referrals and durablemedical equipment.��� Registered Nurse (RN) Case ManagersOur RN Case Managers will reach out to our patients after hospital discharges oremergency room visits to aid follow up as planned at the time of discharge. CaseManagers are also involved in chronic care management and making sure that ourpatients are up-to-date on their age appropriate screenings.��� Clinical PharmacistA clinical pharmacist joined our team last year and has been an excellent resource forour patients and providers alike. The pharmacist is located within the clinic, assists withmedication reconciliation and at the request of your provider may assist with patientmedication management and education.��� Integrated Behavioral HealthThe newest addition to our team is Behavioral Health. A psychiatric nurse practitioner isavailable to diagnose and manage psychiatric disorders including medicationmanagement with a referral from your provider. We have a psychologist starting in Aprilof 2017 to provide therapy for our patients who need it.The expansions of our care teams have been limited by our current office space and we haveneeded to utilize different offices throughout the Providence Hospital Campus. We would like toapologize for the inconvenience this may cause. We understand that this is far from ideal andwe have been working on a more permanent solution. Below is a list of all our providers andtheir tentative locations as of June 5, 2017.Tower B Tower B Tower C Tower CSuite 314 Suite 304 Suite 436 Suite 520(907) 212-3420 (907) 212-3420 (907) 212-2273 (907) 212-2273Dr. Salamon Dr. Funk Dr. Pope Dr. KimCynthia McGinty, NP Amy Paul, PharmD Collie Leamy, PA Megan Engler, PAWenc Fru, PA Jon Lundy, PhDKathy Chastain, NPIn addition to expanding our Care Teams we will implement Advanced Access Schedulingbeginning May 1st. What this means is that you will have greater access to your provider andCare Team members with the availability of same day and next day appointments to scheduleurgent or chronic care visits. You will no longer need to schedule appointments many months inadvance, but we will be able to accommodate your need for an appointment the same day ornext day. We hope this greater access will enhance your experience in our clinic.We appreciate your understanding and patience while we improve the care we provide you andyour family. We welcome your feedback and look forward to continuing to be a part of yourhealth care journey.Sincerely,Szilvia SalamonSzilvia Salamon, MDMedical Director
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1Dear Patient and Family:In keeping with its mission and core values, we are committed to providing health care for patients,regardless of their ability to pay.Our Financial Care:Medical bills may be difficult to pay. Patients who are unable to pay for all or part of their health careservices, may apply for financial care by completing and returning this completed and signed form.Patients and families who meet certain income requirements may qualify for free care based on theirfamily size and income, even if you have health insurance. To view our financial care policy and discountguidelines visit St. Luke’s online https://www.stlukesonline.orgYou must provide information on your family’s income. Income verification is required todetermine financial care. All family members 18 years old or older who are applying forfinancial care must disclose every identified source of income.Required documents for proof of income include the following:• Most recent year’s income tax return, including schedules, if applicable• Most recent pay stub(s)• Most recent bank statement(s), to include all transactions (deposits & withdrawals) for all bankaccounts. If self-employed, provide 3 months for all business and personal accounts• Documentation of any other source of income (proof of rental income, worker’s compensationincome statement, pension/dividends income statement, trust income statement, unemploymentbenefit statement, etc.)• Social Security award letter, if applicable• If receiving public or other assistance, please provide documentation (food stamp verification,cash assistance verification, etc.)Alternative documents to those listed above:• Written and signed statements from employers if unable to provide recent paystub• Most recent"W-2" withholding statement if unable to provide recent year’s income tax returnIf you have no proof of income or no income, please attach a letter of explanation.Please send the application along with all required supporting documentation to:Mail: St. Luke’s Health SystemAttn: Financial CareP.O. Box 2578Boise, ID 83701Fax: Attn: Financial Care(208) 706-7619If your application is incomplete, your information will be returned to you. Your account will beplaced on a 30 day hold awaiting the return of the completed application and additional requireddocument(s). Once a completed financial care application has been received St. Luke’s will sendwritten notification of the determination.If you would like to discuss your financial situation, please contact a Customer Care Representative.Call (208) 706-2333, toll free at 800-342-3432, or email pfscustomerservice@slhs.org.Version 11/7/182Patient Name(s): Date of Birth:Responsible Party Name: Marital Status:Address: City:State: Zip:Social Security#: Date of Birth: Phone:Employer: Phone: Hire Date:Address: City:Self Employed: Yes or No Occupation: State: Zip:Spouse/Significant Other/Partner Name: Social Security#: Date of Birth:Employer or Self Employed: Phone: Hire Date:LIST MEMBERS IN HOUSEHOLD (use the back of this form for additional dependents names, DOB, and relationship) →Dependents Name(s) Date of Birth RelationshipSOURCE OF INCOME RESPONSIBLE PARTY SPOUSE/SIGNIFICANTOTHER/ PARTNERWages (before deductions) $ $Child Support/Adult Support/Alimony $ $Disability/Worker’s Compensation $ $Pension $ $Social Security Income $ $Dividends/interest/ Trust/Estate/ Rental Income $ $Public Assistance/Food Stamps/Unemployment etc. $ $Income from other sources (please specify) $ $.Total $ $How much are you able to pay St. Luke’s Health System monthly?Version 11/7/18By signing and submitting this application to St. Luke’s, I certify that all of the information I provided is true and complete to the best of my knowledge. If Iknowingly and with intent to defraud or deceive, provide false information, I will be denied financial assistance e for current and future services, and will beliable for any and all charges.I authorize St. Luke’s Health System to verify the information I have provided.Responsible Party Signature DateFor PFS Use Only: Epic Guarantor Number(s):If expenses are more than the income listed, please use the back of this form to describe how expenses are met each month. →Request for Financial Care Application(Behavioral Health/Primary Care Shortage Areas)3National Health Services Corp Locations*Please note: This application will only be used to review patient balances at the following St. Luke’s locations:St. Luke’s Clinic – Internal Medicine625 Pole Line Road W Suite 1A/2A Twin Falls, ID 83301St. Luke’s Clinic – Psychiatric Wellness Services703 S. Americana, Ste 150 Boise, ID 83702St. Luke’s Clinic – Behavioral Health Services414 Shoup Ave W Suite B Twin Falls, ID 83301St. Luke's Children's Center for Neurobehavioral Medicine1075 E. Park Blvd., Boise ID 83712St. Luke's Clinic – Physician Center775 Pole Line Road W Suite 105/111. Twin Falls, IDSt. Luke’s Clinic – Psychiatric Wellness Services9850 W. St Luke’s Drive, Ste 329 Nampa, ID 83687St. Luke's Clinic – Physician Center2550 Addison Ave E Suite A,B, F. Twin Falls, IDSt. Luke’s McCall Medical Center (hospital only)1000 State St. McCall, ID 83638St. Luke’s Clinic Physician Center529 Broadway Ave. S Buhl, ID 83316St. Luke’s Clinic- Payette Lakes Family Medicine211 Forest St. McCall, ID 83638St. Luke’s Clinic - Jerome Family Medicine132 5th Ave. W Suites 1 & 2 Jerome, ID 83338St. Luke’s Clinic- Behavioral Health Services301 Deinhard Lane McCall, ID 83638St. Luke’s Clinic – Mental Health Services1450 Aviation Dr Suite 202 Hailey, ID 83333St. Luke’s Clinic- Family Medicine1210 NW. 16th St. Fruitland, ID 83619St. Luke’s Elmore Medical Center895 N. 6th E. St. Mountain Home, ID 83647St. Luke’s Clinic- Trinity Mountain Medical465 McKenna Dr. Mountain Home, ID 83647St. Luke’s Clinic Eastern Oregon Medical Associates3950 17th St. Baker City, OR 97814Version 11/7/18
Dear Patient and Family Members:Welcome to Florida E.N.T. and Allergy, a Division of Select Physicians Alliance. We would like to take thisopportunity to welcome you to our practice. This letter contains answers to some of the most commonly askedquestions by patients entering our practice. We hope you find this information useful.Our office hours are Monday through Friday from 8:30 am to 5:15 pm. Our office telephone number is (813)-879-8045. In the event of an emergency outside of our normal business hours, please contact the office and thecall service will contact the doctor on call for you.We understand that in today’s busy world occasionally situations come up that are beyond your control. In thoseinstances, we request you extend us the courtesy of a 24-hour notice. This courtesy allows us to continue tooperate efficiently and use the time that was reserved for you to help other patients in need. It is our policy thatyou call our office at least 24-hour prior to your appointment time. If you fail to contact our office in advancethree times over the course of one year, you will be discharged from the practice.Patients should complete, sign and bring the following items to your first appointment:o Plan to arrive 20 minutes prior to your appointment time to finalize paperwork.o Bring healthcare insurance ID cards and picture ID.o Bring authorizations or referrals as required by your insurance carrier.o Complete and sign the Patient information, Notice of Privacy Practices. Medical History/MedicationList, Policies and Guidelines, Prescription Consent Form.o Complete the name, phone number, and address of your preferred pharmacy on form.o Have your referring physician office fax pertinent medical records, diagnostic and lab testing, and bringthem with you.o Bring a CD or Film of your most recent MRI and/or CT if applicable.On subsequent visits our front office staff will review your demographic and insurance information with you toensure we maintain your correct information on file. This allows us to submit claims to your insurance carrier ina timely manner.We are contracted with several insurance carriers for the benefit of our patients. You will want to check yourbenefits booklet or with the benefits department of your employer to verify if our physicians are listed asproviders within your network.As part of our contract with the insurance companies we are legally required to collect any co-pays ordeductibles from you at the time of service. We ask that you be prepared to pay your copay at the time of checkinprior to being seen by our providers. We accept cash, check, American Express, Discover, MasterCard, Visa,and CareCredit.Brandon Office1139 Nikki View DrBrandon, FL 33511Lutz Office4211 Van Dyke RoadLutz, FL 33558North Tampa Office3000 Medical Park Drive,Suite 200, Tampa, FL 33613Plant City Office511 W. Alexander St. Suite 1Plant City, FL 33563Riverview Office13015 Summerfield Square DrRiverview, FL 33578Tampa Office5105 N Armenia AveTampa Bay, FL 33603Wesley Chapel Office26853 Foggy Creek RoadBuilding 21, Suite 101Wesley Chapel, FL 33544Westchase Office7433 Monika Manor DriveTampa, FL 33625Name: ___________________________________________ Date of birth: ________________Office GuidelinesThank you for choosing our doctors for your ENT care. While it is our desire to provide you with the best carepossible, there are some limitations and restrictions that your managed care or insurance plan may imposewhich we cannot control. Because of this, there are certain polices and guidelines that we want you to be awareof and agree when dealing with our office as outlined below:1. Payment is due at time of service.2. Cancellation Policy: We require that you give our office at least 24-hour notice if you need to cancel orreschedule an appointment. For office visits you will be subject to a $50.00 charge, and for all in officeprocedures, such as, videonystagmography (VNG), allergy testing, CT scans, and speech evaluationsyou will be subject to a $100.00 charge. All surgery cancellations also require at least 72-hour notice oryou will be subject to a $100.00 charge.3. Obtain authorization (if necessary) prior to your visit to avoid delays or rescheduling.4. We expect that any lab test, x-rays, surgery, or other diagnostic exams that we order will be done within7-10 days. We are not party to or agree with your insurer or managed care plan if they denyauthorization or coverage. If your plan denies authorization for our recommendations we ask that youinitiate an appeal with them immediately and notify us in writing. If they require a letter from us, wewill provide it.5. Make a follow-up appointment within one week after you have done any diagnostic test (i.e. lab, xray,CT scans, biopsies, etc.) to discuss the results and recommendations. Do not wait for us to callyou.6. You are responsible to contact the physician or his staff for an appointment if your condition does notimprove within two weeks.7. Your condition may require further procedures and examinations as part of the workup for your medicalproblem; however, most insurance carries require prior approval. You will be financially responsible forall fees that your healthcare insurance deems as non-covered services or not medically necessary andservices must be paid at time of service.8. Self-pay patients initial payment is for consultation only. You will be responsible for in-officeprocedures. The patient, child’s parents, or responsible person will be made aware of any additional outof-pocketexpenses prior to the provider performing the procedure and services must be paid at time ofservice.9. Managed care, with its multiplicity of rules that govern the practice of medicine, make it difficult foreven us to be sure they are being followed. It is not our intention to bill contrary to your plan. If youdiscover any errors in billings (surgical, laboratory, x-ray, or even ours) please inform us so that we cancorrect or help you to correct them.10. There will be a charge for any and all medical leave papers (FMLA) filled out by this office. As acourtesy, a one page diagnostic report will be furnished upon request.11. You can expect to be treated with respect and professionalism at all times. If you have a problem withany of our staff, please notify the doctor or the office manager.Signature _________________________________________________ Date _______________(Patient, Parent or Guarantor)Assignment of Insurance BenefitsThe undersigned hereby authorizes the release of any information relating to all claims for benefits submitted onbehalf of myself and/or dependents. I further expressly agree and acknowledge that my signature on thisdocument authorizes my physician to submit claims for benefits, for services rendered or for services to berendered, without obtaining my signature on each and every claim to be submitted for myself and/ordependents, and that I will be bound by this signature as though the undersigned. I further authorize myinsurance company to pay and hereby assign directly to Florida ENT and Allergy all benefits, if any, otherwisepayable to me for services as described on attached forms. I understand that I am financially responsible for allcharges incurred. I further acknowledge that any insurance benefits, when received by and paid to FloridaE.N.T. and Allergy, will be credited to my account in accordance with the above said assignment.Financial AgreementIn consideration of the services rendered to the patient, the undersigned agrees to accept full financialresponsibility for the patient’s account in accordance with the regular rates and terms of the facility. Should theaccount be referred for collection procedures, the undersigned shall pay responsible attorney’s fees andcollection expenses. At present, that fee is a minimum of 30% of charges collected and is payable before thepatient is seen in the office of Florida E.N.T. and Allergy at next visit.Signature _________________________________________________ Date _______________(Patient, Parent or Guarantor)Notice of Privacy Practices AcknowledgementBy law, we are required to make available to you a copy of our Notice of Privacy Practices (“Notice”). Bysigning below you acknowledge that you received, or been offered and declined, a copy of the Notice.A current copy of this Notice is also posted in the office, or is available to you upon request. If the Notice isrevised, you may review and obtain the new version at any time.You may decline to sign this acknowledgement.I have received, or declined, a copy of the Notice of Privacy PracticesPatient Name (print) _________________________________________________________________Signature of Patient (or Legal Representative) _____________________________________________*If Legal Representative, list relationship to patient _________________________________________Date _____________________________________For office use only:We were unable to obtain this written acknowledgement of Notice of Privacy Practices because: ________________________________________________________________________ . Staff Initials ______________Authorization for Release of InformationAs part of your healthcare, this practice originates and maintains paper and/or electronic records describing yourhealth history, symptoms, examinations, test results, diagnoses, and treatment, any plans for future care ortreatment and payment for the services or treatment we provide. We use this information to:��� Plan your care and treatment.��� Communicate with other health professionals or entities who contribute to your healthcare.��� Submit you diagnosis and treatment information for payment for the services or treatment provided toyou.To leave appointment reminders or other minimum necessary information related to your healthcare orhealthcare payments on your answering machine, your mobile voice mail or with a household family member.[ ] Please check here if you do not want us to leave message on your answering machine or with ahousehold family member.[ ] Please check here if you do not want us to leave a message on your mobile voice mail.Permission to TreatI, ______________________________, authorize Florida E.N.T. & Allergy and its personnel to provide medical services(Print name of patient/legal guardian)services such as medical examination and treatment, as they deem best for the patient’s physical or mental welfare._____________________________________ _______________________ ___________________________(Print Patient’s Name) (Date of Birth) (Social Security Number)
I authorize the following person/people to discuss any necessary treatments, medications and to authorize any tests and/orlabs that are necessary up to and including admission to the hospital. I authorize the following person/people to bring mychild in for treatment and to discuss any necessary treatments, medications and to authorize any tests and/or labs that arenecessary up to and including admission to the hospital.Name: __________________________________________________ Relationship to Patient: __________________Name: __________________________________________________ Relationship to Patient: __________________Name: __________________________________________________ Relationship to Patient: __________________Name: __________________________________________________ Relationship to Patient: __________________** All of the above listed will provide identification to be placed in the patient’s chart**I agree that unless I give specific instructions otherwise, medical information regarding my treatment or my child’streatment may be released to the biological parents, step parents, referring physicians and other practitioners, andmy insurance company.Signature _________________________________________________ Date _______________(Patient, Parent or Guarantor)STANDING CONSENT TO ACCESS EXTERNAL PRESCRIPTION HISTORYPlease sign only after you have read and understand the followingI, ____________________________, whose signature appears below, authorize Florida E.N.T.(Print name of patient/legal guardian)and Allergy, a Division of Select Physicians Alliance, PL and its affiliated providers to viewexternal prescription history via the RxHub service for the patient listed below.Please initial below an option below. By initialing, you are agreeing to the respective terms andconditions set below and are fully agreeing to the terms above.________ I understand that prescript history from multiple other unaffiliated medical providers,insurance companies, and pharmacy benefits managers may be viewable by my providers andstaff here, and it may include prescripts issued back in time for several years.________ I understand yet wish to revoke authorization.My signature certifies that I have read and understand that information above and that Iauthorize the access to my prescription history.Patient Name (print) _________________________________________________________________Signature of Patient (or Legal Representative) _____________________________________________*If Legal Representative, list relationship to patient _________________________________________Patient Information Date of Service ____/____/____Last Name _________________________________ First Name ____________________________ MI ______Date of Birth ____/____/____ Sex _________ Social Security Number _________________Address __________________________________City _____________________ State ________ Zip _______Home Phone ( ) _______________Cell Phone ( ) _______________ Work Phone ( ) _______________Email Address _____________________________________ Marital Status (circle) S M D W P SEPPreferred Language _______________________________ Ethnicity: Asian Asian Indian African American WhiteEmployment Status (circle) Employed Retired Student Other ___________ Race: ___________Referring Physician ____________________________ Primary Care Physician _________________________Pharmacy ____________________________________ Pharmacy Phone ( ) ___________________________Emergency Contact ____________________________ Relationship to Patient __________________________Emergency Contact Phone ( ) ___________________Responsible Party (Is the Patient the financially responsible party? If NO, please complete this section)Last Name _________________________________ First Name ____________________________ MI ______Date of Birth ____/____/____ Sex _________ Social Security Number _________________Address __________________________________City _____________________ State ________ Zip _______Home Phone ( ) _______________Cell Phone ( ) _______________ Work Phone ( ) _______________Email Address ___________________________________ Relationship to Patient ______________________Insurance InformationPRIMARY Insurance Plan Name _____________________________ Insurance ID # ____________________Insurance/Card Holder’s Name _________________________________ Relationship ____________________Insured’s Date of Birth ____/____/____ Insured’s Social Security # ____________________Insurance Plan Phone ( ) __________________ Insurance Plan Address ______________________________SECONDARY Insurance Plan Name _____________________________ Insurance ID # _________________Insurance/Card Holder’s Name _________________________________ Relationship ____________________Insured’s Date of Birth ____/____/____ Insured’s Social Security # ____________________Insurance Plan Phone ( ) __________________ Insurance Plan Address ______________________________Patient Name: DOB: Height: Weight:Drug Allergies: Other Allergies:Reason For Appointment:Pharmacy: Location: Phone#:SURGICAL /HOSPITALIZATION HISTORY See Attached ListOperation(s) Year Hospitalization(s) YearMEDICATION LIST See Attached ListPlease list ALL medications (include over the counter drugs) you are taking now, include dosage & frequencyMedication Dosage Frequency Medication Dosage FrequencyAlcohol Consumption: Never Rare Occasionally Socially N/A How Many Per Day?Smoking History Never Former Current Smoking Type: Cigarettes Cigar Pipe ChewHow many packs a day? When did you quit? How many years did you smoke?Has the patient been exposed to second hand smoke? Yes NoMEDICAL HISTORY Please indicate if you have/had a history of the following:Thyroid Disease High Blood Pressure Tuberculosis Malignant HyperthermiaHeadaches High Cholesterol HIV Blood/Bleeding DisorderAsthma Heart Disease Mental Illness Gastrointestinal/Stomach ProblemsLung Disease Kidney Disease Depression Hepatitis/Liver DiseaseEmphysema /COPD Diabetes Stroke/CVA/TIA Could you be pregnant?Rheumatic Heart Disease Cancer Arthritis Other: ________________________FAMILY HISTORY: Do any blood relatives have any of the following? State which relative.Diabetes Heart Disease/Attack Stroke Thyroid/Cancer High Blood Pressure Bleeding DisordersREVIEW OF SYSTEMS Please indicate if you are currently having problems with any of the following:Constitutional Visual Disturbance Hearing Loss Gastroenterology RespiratoryFever Dry Eyes Cardiology Loss of Appetite AsthmaRecent Weight Gain Double Vision Chest pain Nausea or Vomiting Shortness of BreathRecent Weight Loss ENT Irregular Heart Rhythm Heartburn CoughNight Sweats/Chills Nosebleeds Murmur Change in Bowels Spitting up BloodFatigue Hoarseness Endocrinology Difficulty Swallowing NeurologySkin Ringing in Ears Leg Swelling Hematology HeadachesSkin Cancer Allergies Sleep Problems Easy Bruising StrokeHealing Problems Runny Nose Temperature Intolerance Bleeding Disorder Paralysis/WeaknessRash Sneezing Excessive Thirst Anemia Tingling/NumbnessDiscoloration Snoring Blood Clots in Legs SeizuresEyes Throat Pain DizzinessGlaucoma Ear Drainage Memory LossI certify that I have disclosed all of my medical history known to me. I acknowledge that I am responsible to make your officeaware of any changes to my medical health. Patient Signature: ___________________________ Date: _________________WELCOME and THANK YOU for choosing Florida E.N.T. and Allergy for your healthcareneeds.We have exciting news regarding your health care!!As we continue in our efforts to provide you, our patients, with the highest quality of care andconvenient access to your health records, we are excited to announce that our practice nowoffers a “Patient Portal”. This will allow you the opportunity to use the power of the web totrack all aspects of your health care through our office.As part of the Affordable Care Act implemented by the Federal Government, we are requiredby law to provide our patients access to communicate with our practice easily, safely, andsecurely over the internet by means of a “Patient Portal”.During your visit, our office will provide you with your personal “Login Credentials” whichconsists of the Login URL, your user ID and your password. Our staff is dedicated to ensuringthat you are knowledgeable regarding the portal features and that you have access prior toleaving.However, TIME is of utmost importance for our office!If for any reason, you are not able or do not want to access the portal while at our office, pleasetake a few minutes to login once you get home.Due to governmental regulations and guidelines regarding Meaningful Use, our patients arerequired to login within 4 days of their office visit. However, although you have access to yourmedical records, please be mindful that our physicians will need adequate time to complete yourvisit summary prior to availability on the portal.Should you encounter an issue in completing this process, please allow one of our qualifiedstaff to assist you by calling the office (813) 879-8045.Once again, we welcome you to our Florida E.N.T. and Allergy healthcare family!Kind Regards,The Physicians and staff ofFlorida E.N.T. and Allergy
posted by Isaac Hobart at 10:03 AM 0 comments
Online Registration GuideStudent Administration and Support Division2INTRODUCTIONThis guidance will help you complete your online registration at the University of Liverpool using thestudent portal which is called Liverpool Life. There are ten steps you will need to take:1. Check and confirm your name and address;2. Provide emergency contact details;3. Provide information about your qualifications on entry (undergraduate students only);4. Check and confirm your personal details;5. Check and confirm your academic details (your programme and major);6. Complete your module registration;7. Provide your financial details;8. Update and confirm your previous attendance details;9. Upload your photo;10. Provide or confirm your email address;11. Employability: Provide information about the career interests that you haveUndergraduate students (exclusions apply): you may also be provided with a screen to register yourintentions relating to the Liverpool Bursary.You should also complete your registration for University computing facilities with ComputingServices once you have submitted your academic registration.BEGIN YOUR REGISTRATION BY VISITING:WWW.LIVERPOOL.AC.UK/STUDENT-ADMINISTRATION/STUDENT-ADMINISTRATIONCENTRE/STUDENT-RECORD3If you have already registered for an Managed Windows Service (MWS) network account with theUniversity you can also find Liverpool Life from the Student Digital University at:. Click on ‘Liverpool Life’ under the ‘Tools’ box.Enter your Student ID Number and PINTIP: Your Student ID Number is a 9-digit number and can be found on your offer letter and inyour academic registration email. Enter this in the ‘User ID’ field.LOGGING IN4NEW STUDENT REGISTRATIONThis page will take you to the start of the registration process – the Registration Checklist page.There are ten sections you will need to complete.When you complete a section it will be marked with a red tick You cannot submit your registration until all of the sections have been completed. Please read thenotes on each screen which will help you complete that part of your registration.
SECTION 1: NAME AND ADDRESSCheck the box to confirm that yourname details are correctUpdate your address information ifthe details are incorrect. NB Yourpermanent address is where youwould normally reside when youare away from University. 5
After completing a section, ared tick will appear If you are not in University ownedaccommodation you will need toenter the details of your term timeaddress, if known, by clicking on thelink. If you will be living in Universityaccommodation please check the box.6SECTION 2: EMERGENCY CONTACTTo add or amend youremergency contact click on therelevant link.Choose the ‘Click here to adda new Contact’ link to add anew emergency contact.Select the correct addressoption for your emergencycontact and follow theinstructions on the screen toprovide the address details.Enter the details using thedropdown menus and freetext fields and then click ‘Addthis contact’.8SECTION 3: QUALIFICATIONS ON ENTRY (UNDERGRADUATE STUDENTS ONLY)Qualifications on EntryCheck these details and confirm them.Last SchoolCheck the details and update them if necessary.TIP: If you have any qualifications missing you are able to add them here. SECTION 4: PERSONAL DETAILS9To add a missing qualification pleasefollow the instructions on the screenand enter the:• Subject• Level• Grade• Date of ExaminationCheck andconfirm yourpersonaldetails10SECTION 5: ACADEMIC DETAILSSECTION 6: MODULESCheck and confirm yourprogramme and major.If the information isincorrect please use theemail address on thescreen to contact theUniversity.This screen shows the moduleswhich are required for yourprogramme and year of study.You can click on the moduletitle to view the ModuleSpecification.Choose the ‘Click here toadd/drop optional modules’link to select optional modules.TIP: Read the AcademicAdvice before you selectoptional modules. 11Click on ‘Module Search’to find modules to add.You can either select thesubject and coursenumber if you knowthem, or click on ‘ModuleSearch’ without enteringany criteria to see all ofthe available modules foryour programme. This screen shows a listof modules available toyou.Click on the check boxnext to each module youwish to add.Once you have finished,click on ‘Register’.Once you have registered your additional modules you will be returned to the first screen whichwill show you the list of modules on which you are now registered.If you select too manymodules you will see thiswarning.13SECTION 7: FINANCIAL DETAILS
SECTION 8: PREVIOUS ATTENDANCETuition fee responsibilityIf you are responsible for paying your tuition fees you will answer this question as ‘yes’. If youanswer ‘No’ you will need to provide more information in the text box which will appear.When you have finished, click on the ‘Save Tuition Payment Information’ button (or if youanswered ‘Yes’ then click on the button to return to your registration checklist.If you have attendedanother institution orreceived a qualificationfrom another institutionthen you should updatethe information using thissection.Select the ‘Click here toupdate your previousinstitution’ link.Enter the InstitutionName and/or City andthen click on the ‘Searchfor Institution’ button.Select the check box forthe Institution you wishto add.15SECTION 9: UPLOAD PHOTOGRAPHComplete the remainderof the form byproviding:• Date From (datethat you started thecourse)• Date To (date that youcompleted the course)• Higher EducationQualification(Yes/No)• Qualification• Subject• Classification• Date of AwardYou must upload a photograph of yourself which meets UK passport standards.This must be an image file stored on your computer –click on the ‘Browse’ button to locate thisfile.Click on the ‘Upload Picture’ button to upload your photograph to your registration record.Your photograph will be used to produce your Student ID Card. SECTION 10: EMAIL ADDRESS
Pictures are validated andverifiedFacial recognition softwarewill initially confirm thatthe image you haveuploaded is acceptable.Once it has been acceptedyou will see this messageadvising you that the imagehas been sent forverification.If you need to updateyour email addressEnter a new one in the‘New Email Address’ fieldand, to verify it, provideit again in the fieldbelow. 17SECTION 11: EMPLOYABILITY
Completion of this section will provide information to inform employability provisionat the University. Access each section: Career Development Planning, Work ExperienceCareer Interests. Upon completion, click on ‘Submit’. LIVERPOOL BURSARY (UNDERGRDAUTE STUDENTS – EXCLUSIONS APPLY)You must first read importantinformation about the LiverpoolBursaryThen select a Liverpool Bursaryoption.Choose the relevant householdincome section and indicate yourintention to receive a fee waiveror cash bursary. 19REVIEW AND SUBMIT YOUR ACADEMIC REGSITRATIONYou have now completed your online academic registration. A red tick should now appear nextto each section. You can review and amend your information at this point if you wish to checkthat everything is correct.You are required to read the term and conditions of your registration, including the University’sintellectual property and data protection policies.WHEN YOU ARE READY TO SUBMIT YOUR REGISTRATION, CLICK ON THE ‘COMPLETE MY REGISTRATION’ BUTTON.REGISTER WITH COMPUTING SERVICESThe next stage, if you haven’t already completed it, is to register with Computing Services. Youmust register with Computing Services to use computing facilities and email in, for example,the library.For more information please read the Essentials booklet which is available from theComputing Services IT Quickstart website at Click on ‘Activate Account’You will be redirected to a screen where you can provide a password, security details, and analternative email address. 21FINALLY, WHEN YOU ARRIVE AT THE UNIVERSITY YOU MUST ALSO CONFIRM YOURATTENDANCE TO COMPLETE THE REGISTRATION PROCESS – YOU WILL RECEIVE ANEMAIL ADVISING YOU OF THIS BEFORE THE START OF TERM.ON ARRIVAL, CONFIRM YOUR ATTENDANCE
visit our archives at asapsports.comCoach Freeze - 07 17 14 1An interview with:COACH HUGH FREEZEKEVIN TRAINOR: We're joined by thehead coach of the Ole Miss Rebels, Hugh Freeze.COACH FREEZE: Good to see you guysagain in year three. Appreciate that.It's an honor always to represent our greatuniversity in any of the platforms that I get achance to do that. Today is no exception.We have some of the greatest fans in allthe world. Our faculty, our students, ouradministration has been phenomenal. ChancellorJones, AD Bjork have been so supportive in ourtwo years, heading into year three, with everythingthat they're driving for us. I'm very thankful andgrateful.I would also like to say publicly I know ourteam has adopted a young man by the name ofChance Tetrick, he's fighting for his life. I wantthem to know our team is thinking of him eventoday.One good thing about Media Days isCoach Spurrier isn't talking about Ole Miss asmuch, wanting to play us every year. Maybe that'sa good thing.I tell people all the time of the support thatI've received from the coaches in this league. It'sbeen phenomenal. He and Les Miles have beentremendous to me in helping me through my firstcouple years.Year three of our journey, we're aboutbeing all in, relentless effort. I don't read a ton ofbooks, but I read a couple every summer and try toget us a theme that we'll introduce into our fallcamp. This year's will be about us being all in withrelentless effort. Based upon the fact that I don'tknow anyone doing any job can have perfectexecution all the time, but you can be perfect inyour effort.Our spring practice certainly was reflectiveto me of that attitude. I couldn't have asked for abetter 15 days than we had. Very physical, verycompetitive. Looking forward to how that carriesover into fall camp.I'm excited to get the reports from ourstrength staff from what's going on there, theadditional depth we have incurred throughrecruiting and developing some of the kids that areon our campus. I'm very excited to see thoseguys.We talk a lot about buy-in percentage. Inour three years there, two, going on the third, Ithink the buy-in percentage from our kids, staff,everyone in our building is at an all-time high. It'snot totally there. I don't know that you ever gettotally there. But we do feel like the percentage isat a point now where it should help us meet ourexpectations.I think leadership will be the key. Wehaven't developed leadership within our lockerroom to the point that I am totally happy with.We're better than we were. I think Bo Wallace hasmatured quite nicely. I love the frame of mind he isin right now leading us. We need C.J. Johnsonand Cody Prewitt to come on as great leaderdefensively. We have great guys on the offensiveside, Laremy Tunsil, Laquon Treadwell, that areleading really well.D.T. Shackelford is our Chucky MullinsAward winner. He'll wear the jersey No. 38 inhonor of Chucky Mullins. He's in his sixth year atOle Miss and we're excited about the leadershipthat he brings to our team. When he was receivinghis award, one of the former winners said thatwhen he received the No. 38 jersey, it was one ofthe greatest athletic awards of his life. Hewondered if Chucky would say they got the rightguy. I know we got the right guy in D.T.Shackelford. One of the qualities he has is hefinishes. That's another theme we have.Our staff is all returning. I think that'salways a good sign. The continuity, thelike-mindedness in relaying who you are in corevalues and the message that you want to relate toyour people. I think that's very important.Academically I couldn't be more proud ofthe progress that we've made in the APR. We'veJuly 17, 2014 visit our archives at asapsports.comCoach Freeze - 07 17 14 2had two consecutive years of 965 or above. Wewere struggling some when I arrived there in thatregard and couldn't be more pleased with what'sgoing on with that.Offensively we've got to get better in redzone scoring. We were not good at that last year.It certainly was one of the factors in us not finishingthe season as strong as we started the season.We've looked at that very closely and hopefully aremaking adjustments. We've been very good in redzone scoring every year I've been a coach until lastyear.Defensively we have to get moretakeaways and continue to improve on third-downpercentage. We've been good in red zone scoredefense. We've got to improve on third down andturnovers.Special teams will be wide open. We'velost most everybody there. We can talk aboutspecific names later.But, you know, we know that thesummertime is over and we've had fun with ourfamilies. I've enjoyed golfing and fishing, justtalking with my daughters, hearing Ragan's list ofhow she lists the SEC coaches, Jordan andMadison, enjoyed being around them.This kind of signifies us getting into whatwe want to do, what we feel like we're made to do.The expectations have been risen around ourprogram, which we embrace. Can't wait to getstarted with our kids in a couple of weeks.KEVIN TRAINOR: Thank you, coach.We'll go ahead and take questions.Q. You've improved one game eachyear since you've been here. What are yourrealistic expectations for 2014 and how do youfeel the fans' expectations should be?COACH FREEZE: To be very candid, Ithink the journey that we've been on, I think it'sfaster than I thought possible. When I first arrivedthere, I really thought we would be going tohopefully a bowl game in year three. We wereable to do that in year one and two, and win bothof them.We had some very nice wins last year.Going to Texas and winning, beating No. 6 LSU inthe beginning of the year. Didn't finish the seasonlike we wanted, obviously. But with the recruitingthat our coaches have done and with those twosuccessful seasons, there's no question that theexpectations are raised.I think most fans that are close to ourprogram realize that we're still maybe a year or twoaway of looking like a total SEC team in the depthchart.But I said on day one that my expectationswere to make Ole Miss very relevant in the SECWest. And I think this year we should be that.That's my expectation, is that we should becompetitive in every single game.Obviously I can't control the health ofplayers, injuries, turnovers, how your quarterbackplays. All of those factors will kind of determiningthe ending result of win/losses. There's noquestion in my mind we're a better football teamtoday than we were in year one and year two andwe should be very competitive.Q. Over the last couple years you had agood backup quarterback in Barry Brunetti whois gone now. How do you plan on utilizingother guys? How is a guy who redshirted lastyear, Jordan Wilkins, coming along for yourteam?COACH FREEZE: Jordan had aphenomenal spring. Love the way he looks. He'sa big, physical kid that has good speed. I thinkthat the runningback position is one that we areready. We don't have to wait another year to bedepth what we should be. I think we have gooddepth there. So I'm pleased with his progress.Backup quarterback, I think we have thesame type of kid as Brunetti in DaVante Kincade.I'm pleased with he and Ryan Buchanan. Theyboth bring a little different skill set to us. The goodthing is they both have used their redshirt year, soI'm not afraid to throw them in for a series here or aseries there to see exactly what they do.Then you got the wildcards of the JeremyLigginses and the Anthony Alfords of the world thatcould possibly add to that position for somethingalso.I kind of like where we are at thequarterback position right now.Q. You referenced Steve Spurrier'scomments a couple years ago. Is thatsomething that has driven you? Has he eversaid anything to you about he was just jokingaround? With an experienced quarterback,does that open the window a little wider for OleMiss in the West?COACH FREEZE: Why blame Steve forsaying that. I've said that all along, too. At thatpoint who wouldn't have wanted to play Ole Miss. visit our archives at asapsports.comCoach Freeze - 07 17 14 3He and I, we talk frequently now. I don'tknow that we've ever had just a direct conversationabout that. But I didn't take it personally.I'm thrilled that I can call him one of mycolleagues and friends in the coaching business.I do think standing here today you wouldrather be in my shoes with a Bo Wallace comingback than without. Having said that, there's a lot ofpeople talking about the lack of returningquarterbacks and those things.But standing here last year no one talkedabout Nick Marshall either. Two years ago, beforeManziel's first year, nobody really talked about him.There's no doubt you feel like it mightmake it a bit wide open, but there will be somebodythat emerges from one of the programs in ourconference that has a breakout year at thatposition, I'm quite sure of it.Q. How does Ragan rank the SECcoaches?COACH FREEZE: My daughter Ragan,she keeps a ranking of the SEC coaches. If you'reat any of our games and viewing her an hourbefore game time, she's at midfield trying to findthe other head coach. That's how into this footballseason she is.I don't know that I will give you the wholeranking. But number one in her book is CoachMiles. In Baton Rouge he spent 10 minutes withher talking. Then last year when they came to ourplace, she was out there without me talking to him.To her, that's her, that's her favorite.Q. How old is Ragan?COACH FREEZE: She's 15 now.Q. How do you embrace social mediaat Ole Miss? You seem to tweet a lot of fishingpictures.COACH FREEZE: I caught big ones thisweek. I got to where I feel a bit guilty aboutposting the big fish I catch because I think peoplethink I'm being braggadocios of some sort and I'mspoiled with the lake I get to fish in.I try to use social media really to get thebrand of who I am and the core values of ourprogram out. I think it's important that anystudent-athlete or anyone that chooses to use itknows that when you hit send, tweet, retweet,you're building a brand for yourself.There's parts of it I do not like, but I dothink that it is in the platform God's given me. Ithink that's an avenue I can use to hopefully impactothers by getting the brand of who we really wantto be out.Q. You open the season in two NFLstadiums. You open in Atlanta as well. Howimportant do you feel like those games are forelevating that Ole Miss brand in terms ofrecruiting?COACH FREEZE: I think opening up inthe Chick-Fil-A game in Atlanta where we recruitextremely hard, playing in the Georgia Domewhere every SEC team wants to end their season,I think it's very important.We get to open college football. All eyeswill be on you on that Thursday night against avery good Boise program.So we're excited and hopefully embracethat opportunity and the magnitude it will have onexpanding our brand nationally. You certainlyknow that could help. Hopefully we get a chanceto embrace that opportunity and make the most ofit.Q. You had a CNN program with yourteam for a while, and athlete compensation wasa big part of that. How do you feel about yourplayers taking stances on those issues? Itcould certainly bring attention to your programthat may or may not be unwelcomed?COACH FREEZE: I've been clear on mystance on it. Hopefully my kids will follow.Number one thing I tell our kids andremind them every single week is to not forget theblessing. They are blessed individuals to be at anSEC program, to receive compensation to playathletics, and for your education, that many, manypeople would trade places with you. So don'tforget that, don't lose sight of that. You're blessed.Hopefully our kids understand that.At the same time we as SEC coaches andas a conference have certainly been in favor ofgetting full cost of attendance for our kids.I hope that's the message that our kidsget, that they portray when they have theopportunity to speak about it.Q. Last year you had Alabama andAuburn on the road. How big of a deal is it thisyear to get them at home?COACH FREEZE: It's always big to havehome games. Certainly you're going to have fourSEC at home and four away. But looking at it this visit our archives at asapsports.comCoach Freeze - 07 17 14 4year with what everybody expects to happen,which doesn't always occur, but everyone expectsthose to be the top two teams in the SEC West.Having them at home certainly isadvantageous and could be big. Playing in front ofour home crowd hopefully in a game that we'revery competitive in and get into the fourth quarter,and our Rebel Nation will be very important havingthem at home for that.Q. You closed out last year beatingGeorgia Tech in the Music City Bowl. How bigwould it be to go up there and play Vanderbiltafter Derek Mason already talked earlier howit's going to be a big celebration being inNashville with the Vandy fans?COACH FREEZE: I'm not sure of thecomments. But we love Nashville. There's a lot ofRebels in Nashville. Nashville has been good tous. We won there twice last year, had theexperience of playing at LP Field. I know that willbe advantageous. I know we can get more Rebelsin that stadium.We're excited the game's there and lookforward going back to Nashville.Q. When you look back at last season,all those freshmen you really had to count on alot, did some of those guys get fatigued late inthe season? If so, what have you done thisoff-season knowing you're going to have tocount on them so much this coming season?COACH FREEZE: I think fatigue tookplace if not physically, definitely mentally. I had alearning curve on that, too, last year that I've hadto look at some of the things we do.We depended on so many of those youngkids. The way we opened up the season with somany road games in a row. Every road game wasat 7, 8 at night, we're getting back at 3, 4 a.m.Somewhere in there, for the freshmen, it's a wholenew world for them. I do believe it took somewhatof a toll on them, whereas an upperclassmen hasbeen through it, handled it a little bit better. I don'tknow.We certainly need to look at some of thosethings and it's on my radar to always be aware ofyoung kids that are having to play an enormousamount of snaps in games. If that occurs againwhere we're on the road that much or have longweeks for some reason, I will be much more awareof it.Q. Can you give us an injury update onCollins Moore and how that affects the passinggame?COACH FREEZE: We had an unfortunateinjury this week with Collins Moore, who was votedour most improved player this spring at thereceiving position. That is one position we thinkwe have good players there, but we're not as deepas I would like to be. So losing him for four to sixweeks certainly doesn't help us.We think that's all it will be, is a four-weekto six-week recovery. We lost Chief Brown as welland that hurts. We're just hopeful we don't loseany more.Q. Back in the spring meetings, youand Steve Spurrier and Gus Malzahn playedgolf together one day. Since you and Gus areno-huddle guys, can you talk about the pace ofplay? I understand Spurrier won a bet withyou.COACH FREEZE: We played in underthree hours. We teed off at 6:50, I do rememberthat. There's not many practice swings in thatgroup. As a matter of fact, I don't remember any.So it was a quick round of golf. We got to play withGus several times this summer. We understandthat.My hair is quite shorter than normal today.Spurrier takes credit for that. If he won our match,come to Media Day, you had to buzz cut your hair,so that's why my hair is so short today (laughter).Really there is some truth to that andthere's another story behind it, too, but we'll giveSpurrier the credit for that.Q. Last year you brought in a talentedfreshmen group and they played very well.What are you looking to get out of those guyswho are now sophomores?COACH FREEZE: I certainly hope thatanother year in the off-season program with PaulJackson and being a college student-athlete, thatthe grind of what we ask them to go through ismore common to them so that they are betterequipped and better prepared to go through thegrind of the season that we're going to ask them togo through.Physically I look at them right now andcouldn't be more pleased. It's hard to judge themental state of exactly where they are until we getinto the camp mode and get to spend more time visit our archives at asapsports.comCoach Freeze - 07 17 14 5with them like that.But there's no question that those guys,when we look back on this season, those guys willhave a huge role in defining how successful weare.Q. All in all being in year three, is thisprogram where you expected it to be when youoriginally took this job?COACH FREEZE: Being perfectly candid,I think we're ahead. This will be the first seasonthat we're at the full allotment of 85 scholarshipsthat have been recruited. My first year, we werearound 68. Last year I awarded six scholarships towalk-ons to fill out the 85.But this will be our first season where wehave 85 guys who we recruited to be onscholarship. So I didn't think, with knowing theSEC, being around it my whole life, following it,coaching circles, I wasn't sure we couldaccomplish what we had in year one and year two.So I think it's expedited some than what Ianticipated.Q. I understand you not wanting toshare Ragan's complete list. Where do you fallon it?COACH FREEZE: She doesn't put me onthe list. I would be her number one, I hope. That'smy girl.She lives and dies with this football now.It's probably not as healthy as it needs to be.Hopefully as she ages a little more, she kind ofgets out of that. But, man, her little heart beats ahundred miles an hour when you win, she'scrushed when you lose.Our families, the families of our coachesprobably have it harder than we do. All three of mygirls and my wife are so supportive. I'm thrilledthat I'm still thrilled I'm somebody she wants to bearound.My fear is as they get older, my girls don'twant to be around their dad. That hasn't happenedyet and I hope it never changes.Q. With all the talk about thequarterbacks in the league, the down year, BoWallace returns as a leading passer, what doeshe have to do to take the reins as the guy in theSEC?COACH FREEZE: I think to continue whathe's done. He's just been overshadowed by somereally good players. Continue to cut down on histurnovers, make sure he's making smart playsmost of the time.The guy has a chance to, you know, ownevery passing record in Ole Miss history before heleaves there. Like I've said in many interviews,there's no way we win two bowl games without himthe past two seasons.I think he's matured quite nicely in the wayhe leads our team, the way he goes about ourbusiness. He feels finally healthy and confident. Ireally think he's at a point where he certainly hasevery avenue right now to step in and be one ofthe guys in this conference.Q. You said you thought you wereahead of schedule on rebuilding. When youlook at what Auburn has done so quickly, whatis it you attribute to the ability for these teamsto come in and rebuild faster than ever? Haveyou talked about a guy like Bret Bielema similarto what you inherited when you got to OleMiss?COACH FREEZE: Bret and I have talked,but I don't know if that's a subject that's come up.Every coach has their own way of going aboutdoing what they're going to do.I do think one common factor in all of it,and again this is no reflection on staffs that werebefore these staffs that you're mentioning, but Ithink one common thread you would see in all ofthose that have had quick turnarounds andsuccessful seasons is accountability to the littlethings. I just don't believe it's possible for teams inthis league to have any kind of sustained successif you're not accountable to those little things.For some reasons sometimes attention tothose wanes a bit. It affects the team adversely.I'm sure there's a lot of other things, the systems,communication and all that. But I would venture toguess that all would say accountability is one ofthose core things that you have to have.Q. You commented earlier on thefreshmen that came in last year and had a bigseason, one of those names being LaquonTreadwell. Comment on the progressionyou've seen from him between the end of lastseason and now and what you expect of himthis year.COACH FREEZE: Couldn't be morepleased with his leadership right now and the wayhe's developed himself. He's gained another 12 visit our archives at asapsports.comCoach Freeze - 07 17 14 6pounds. He's a physical specimen. He's ablocking machine. His hands are good. He reallytakes serious his role of being a leader on theoffensive side of the football.I think year two he knows that we'vemoved him outside now. He knows quite a bit ofattention would be geared toward him. I think it'simportant that Vince Sanders and QuincyAdeboyejo and those other receivers have a goodyear with helping being more balanced in theirdesign of coverages. But really excited to seewhat Laquon is going to do this year.Q. The pass-rush last year was kind ofa weak spot. How do you see that improvingthis year?COACH FREEZE: Getting C.J. Johnsonback helps us. When we lost him, it certainlychanged us some. Marquis Haynes I'm reallyexcited about also. Fadol Brown. Of course, theother guys that you know we have.But you've got to have some speed guysthat can give you some great rush in this league.We now have C.J. and Marquis and Fadol. We'regoing to see what Breeland and G. Mack can do infall camp.I know looking on paper, I feel a lot betterabout it going into this year than last year.KEVIN TRAINOR: Coach Freeze, thankyou for your time.COACH FREEZE: Thank you. FastScripts by ASAP Sports
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