Further Development of Education Standards and Healthcare Standards


In the third review of the AODA, the Honourable David Onley recommends needed improvements to the Act. One of these improvements is the need for further development of education standards and healthcare standards. During the public meetings Onley held while preparing his review, the government had postponed work on these AODA standards. Therefore, Onley’s review recommended that the government allow the standards development committees creating these standards to continue their work. Currently, these committees have resumed their work creating education and healthcare standards.

Further Development of Education Standards and Healthcare Standards

The AODA does not yet have an education standard or a healthcare standard. However, two committees have been created to recommend what an education standard should include. One committee will find barriers facing students from kindergarten to grade twelve. It will then recommend how an education standard should remove those barriers. In contrast, the other committee will find barriers facing students in university and college. It will then recommend how a standard can support these students. Similarly, a third committee has been created to recommend what a healthcare standard should include. At the time of Onley’s review, the Ontario government had paused the work of all three committees. However, the government has now allowed further development of education standards and healthcare standards. Nonetheless, Onley’s review has more recommendations for the government to better support these three committees. Now that the committees have resumed their work, they can implement the suggestions that Onley’s review recommends.

Recommendations for Education and Healthcare Standards Development Committees

For instance, the review discusses a new education policy from the Ontario Human Rights Commission. This policy indicates many accessibility barriers in the education system. Therefore, Onley recommends that the education standards committees address these barriers through the standards they develop. Moreover, addressing these barriers will help connect the AODA to the Ontario Human Rights Code.

Furthermore, Onley’s review states that the government advised the healthcare standards development committee to address barriers in hospitals. However, this type of mandate means that barriers would continue in other healthcare settings, such as:

  • Doctors’ offices
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Health regulatory colleges

Therefore, Onley’s review recommends that the healthcare standard address barriers throughout the healthcare sector.

Finally, Onley’s review recommends that all three committees introduce best practices for workers in both sectors. These best practices could support education and healthcare workers to make their fields more accessible. Moreover, best practices can reach the public before standards, because they take less time to develop than standards. As a result, workers in both fields can start implementing best practices while they are waiting for the standards. Onley’s review states that the terms of reference for both committees allow them to recommend best practices. Therefore, Onley’s review advises the committees to do so, to allow further development of education standards and healthcare standards.




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Healthcare Workers with Disabilities


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. In the meantime, however, there are still AODA requirements for healthcare providers to follow. The Employment Standards have regulations that apply to healthcare providers. When providers follow these requirements, they make the medical professions more accessible to healthcare workers with disabilities. For instance, employment standards in healthcare apply to:

  • Doctors’ offices
  • Hospitals
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Health Regulating Colleges

Employment Standards in Healthcare

Under the Employment Standards, healthcare providers need to make their employment practices accessible to job applicants and workers with disabilities. For example, all healthcare providers with at least one employee must:

Moreover, healthcare providers with fifty or more workers must have processes in place to create:

More Healthcare Workers with Disabilities are Needed

Nonetheless, our recent articles have been exploring the many improvements needed before the Ontario healthcare system can truly care for patients with disabilities. For instance, patients need more access to:

In addition, patients need a healthcare system that welcomes more healthcare workers with disabilities. Doctors, nurses, therapists, medical technicians, pharmacists, dieticians, and other practitioners with disabilities would help their colleagues understand the need to accommodate patients with disabilities. Furthermore, colleagues with disabilities would give their coworkers clearer ideas about the capabilities of their patients. Finally, when healthcare spaces become accessible for workers with disabilities, patients with the same disabilities can also access them.

Eliminating Attitudinal Barriers

The shortage of healthcare workers with disabilities may be due to attitudinal barriers. Medical schools may feel that they cannot accept students with disabilities into their programs. They may feel this way because they do not know about accommodations that healthcare professionals with disabilities use. For instance, doctors who are deaf can use stethoscopes with visual read-outs. Likewise, nurses with visual impairments can use magnification technology to examine patients.

Alternatively, medical schools may think they are unable to accept candidates with disabilities because of technical standards. Technical standards are non-academic activities that all medical students must perform to gain their qualifications. For instance, medical students in residencies may need to physically examine patients, insert or remove stitches, and learn to use medical equipment. However, students and schools can work together to accommodate the needs of a student who cannot fulfill a technical standard. For example, a resident who is quadriplegic might work with a medical assistant. The assistant could follow the resident’s directions to perform physical tasks, while the resident uses their growing knowledge to assess each case and give the assistant instructions. Similarly, once this resident is a practising doctor, they can work with a nurse who performs the same role.

Another way of accommodating technical standards could be for schools to modify a student’s program based on their preferred area of specialization. For example, if a blind student plans to study psychiatry, their daily work will not involve the same tasks as the work of a family doctor. Therefore, a medical school or health regulating college could waive the technical requirements that this student would need to master but never use.

A More Inclusive Healthcare System is Needed

Schools or professional programs could also publicize their interest in accepting applicants with disabilities. More healthcare workers with disabilities would help to create a truly inclusive healthcare system.




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Stronger Transportation Standards in Healthcare are Needed


Our last article explored how transportation standards in healthcare make medical services accessible to some patients, workers, and visitors with disabilities. In this article, we discuss how stronger transportation standards in healthcare are needed to make medical settings accessible for patients using specialized transportation.

Stronger Transportation Standards in Healthcare

Increased demand for specialized services means that many specialized transportation companies can no longer obey all the regulations of the Transportation Standards. For instance, many companies no longer allow travellers to book rides on the days they need them. This practice means that some patients cannot reach a clinic if they have a health concern. They can reach hospitals by ambulance, but they must pay for this service. In contrast, people who can transport themselves on demand would only need to pay bus or cab fare.

Similarly, a patient must book in advance to travel to their doctor and then travel home again. However, they cannot change the booking if their doctor needs them to go to a lab or pharmacy. Instead, they must take another trip. Many companies require travellers to book trips three days in advance. Therefore, these patients would reach their lab or pharmacy four days after their original appointment.

Moreover, most specialized transportation companies offer shared-ride services. As a result, they cannot guarantee that patients will reach their appointments on time. Patients may lose their appointments and need to schedule another one before they see their doctor. If the doctor is a specialist, waits because of missed appointments may be months or years.

Potential Solutions

Increased demand for specialized transit will continue. As the Ontario population ages, more and more people will need to use this service when accessing healthcare. Stronger transportation standards in healthcare could meet this ongoing need in several ways. For instance, more regulations in the Transportation Standards should relate directly to healthcare, like the regulation for public hospitals. Furthermore, the standard could reserve several specialized transportation vehicles for healthcare. Patients could book them on the day of their trips to walk-in clinics. They could book in advance for appointments but the vehicles they booked could take them directly to their appointments so that they would always be on time. Patients could also arrange post-appointment trips once they knew where they should be travelling.

As more people develop disabilities, accessibility to transportation will become more important, in healthcare and all other sectors. Stronger transportation standards in healthcare will make medical care more accessible to the growing number of citizens with disabilities.




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Healthcare Transportation Services: Making Medical Services Accessible


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. In the meantime, however, there are still AODA requirements for healthcare providers to follow. The Transportation Standards have regulations that apply to healthcare providers. Healthcare transportation services make medical services more accessible to patients, workers, and visitors with disabilities.

Healthcare Transportation Services

Several sections of the Transportation Standards apply to healthcare providers. Public hospitals that transport patients between their campuses must make this service accessible. They may do so by using accessible vehicles when they transport all patients. Alternatively, if they cannot provide integrated service on conventional vehicles, they must have equivalent services on specialized vehicles.

Moreover, all regulations that apply to other conventional and specialized transportation providers also apply to public hospitals that offer these services. For instance, all public hospital transportation services must have:

In addition, conventional transportation services of public hospitals must have:

Stronger Transportation Standards in Healthcare are Needed

The Transportation Standards’ mandates concerning healthcare ensure minimal accessibility for patients with disabilities. However, vital healthcare services are still inaccessible to patients. New criteria in the Transportation Standards targeting healthcare settings could benefit both patients and healthcare workers.

While public hospital transportation ensures that patients can travel reliably between hospital campuses, patients must use other modes of transportation for all other healthcare needs. For instance, patients must find their own ways of travelling to:

  • Doctor’s appointments
  • Walk-in clinics
  • Hospital emergency rooms
  • Labs
  • Pharmacies

Some patients can travel to all these places by driving or using conventional public transportation. For example, when someone starts to feel sick suddenly one evening, that person can take the bus to a walk-in clinic. Similarly, if someone’s doctor tells them that they need bloodwork or a prescription, they can take the bus, a cab, or their car to their lab or pharmacy. However, options like driving, cabbing, or taking the bus do not work for everyone. Instead, some patients use specialized transit to travel around their area.

Our next article will explore how stronger transportation standards in healthcare are needed to make medical settings more accessible for patients using specialized transit.



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Accessible Healthcare Websites


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. One issue that a healthcare standard should address is access to information. Healthcare providers should be required to make all information available to all patients. One way for providers to do so could be by posting information on accessible healthcare websites. 

Accessible Healthcare Websites

Under the AODA’s Information and Communications Standards, all public-sector organizations, and private sector organizations with fifty or more workers, must make their websites accessible by January 2021. In other words, public hospitals and other large healthcare organizations will soon be required to make themselves accessible online. However, when smaller organizations also offer online healthcare information, they can welcome more patients. 

Healthcare providers can start offering accessible information online by ensuring that their websites comply with Web Content Accessibility Guidelines (WCAG) 2.0, Level AA. This international standard gives web developers guidelines on how to make their webpages accessible to computer users with disabilities.

Highlights of WCAG 2.0

WCAG 2.0 guidelines describe how people viewing websites should be able to:

  • Perceive and navigate web content, such as with:
    • Text, instead of images of text
    • Information that can be enlarged up to 200 per cent without losing site functionality
    • Good colour contrast between text and background
    • Buttons labeled with words, not just with pictures, shapes, or colours
    • Captions available for all audio
    • Audio descriptions and captions available for all videos
  • Operate websites, such as with:
    • Keyboard commands instead of mouse clicking
    • Options to extend time limits
    • No elements that might induce seizures, such as flashing lights
    • Titles and headings that help users know where they are
  • Understand website information and layout, such as with:
    • Simple, linear layouts that are the same for each page of a website
    • Clear language, instead of figures of speech
    • Clear instructions for completing tasks, such as purchasing items or filling in forms
    • Text descriptions of errors when inputting information
    • Sign language interpretation
    • Definitions of unusual words and abbreviations
  • Visit websites using a variety of assistive technology, such as:
    • Screen readers and Braille displays
    • Screen magnifiers
    • Speech recognition programs

The WCAG webpage provides the full list of requirements, as well as technical guidance for website owners and developers on how to implement them.

All healthcare providers should work on making their websites comply with WCAG 2.0, level AA. In the meantime, however, providers can make their services accessible in other ways. For instance, healthcare workers can provide information to patients and visitors:

  • In person
  • By phone or teletypewriter (TTY)
  • By email

However, accessible healthcare websites allow more information to reach more patients. This method reduces the time that providers would otherwise spend giving similar information to each patient one at a time.



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Online Healthcare Information: Providing Accessibility Awareness


Our last article explored how various healthcare providers can make more information available online. This article will cover how healthcare providers can use their websites to make patients and visitors with disabilities aware of the accessible services they have. Providers need to be more conscious of accessibility when providing online healthcare information.

Online Healthcare Information: Providing Accessibility Awareness

All health care providers can use their websites as a way to advertise their accessible features. For instance, providers can state on their websites if they have accessible structural features, such as:

In addition, providers can advertise other accessible equipment they have, such as:

  • Height-adjustable examination tables
  • Lifts
  • Accessible diagnostic equipment, such as scales

Larger organizations should also mention any accessibility equipment or services available on-site for patients or visitors, such as:

  • Wheelchairs
  • Assistive listening systems
  • Sign language interpretation
  • Closed, open, or real-time captioning
  • Teletypewriters
  • Communication boards
  • Augmentative or alternative communication (AAC) devices

Smaller providers that do not have such services or equipment available on-site can state their willingness to accommodate patients who bring or arrange their own. For instance, providers can state their welcome of patients or visitors who use communication supports or devices.

Standardized Online Healthcare Information is Needed

Hospitals around Ontario offer widely different amounts and kinds of accessibility information on their websites. For example, Toronto’s Hospital for Sick Children (Sick Kids) provides detailed information about where patients and families can find or request a variety of accessible services. In contrast, other hospitals, such as Georgian Bay General Hospital, have shorter accessibility pages that direct patients to their AODA-mandated accessibility plans. This type of page does not give patients useful information such as:

  • Which door they can enter using a wheelchair
  • Whether volunteers are available to escort patients
  • How far in advance to book an American Sign Language (ASL) interpreter

Furthermore, some hospitals have strong accessibility pages, but they do not address all accessibility concerns, or they overlook accessibility when they implement unique services. For instance, the Kingston General Hospital has placed whiteboards in all of its patient rooms, so that different medical professionals and family members involved in a patient’s care can communicate more easily. However, their accessibility page does not mention how they would make this unique and valuable service accessible to a patient, visitor, or healthcare professional who is blind or deafblind.

Similarly, the London Health Sciences Centre (LHSC) accessibility page offers detailed information about accessible entrances, parking, teletypewriters, and wheelchairs. However, these details are not listed under headings on the main page, so that people can quickly find the information they need. Instead, tabs to the information appear below details about the centre’s policy and plans. This layout makes it easy for people to overlook information. Moreover, these topics only highlight a few accessibility concerns. The page makes no mention of other accessibility concerns, such as accessible washrooms or Sign language interpreters.

Addressing the Gaps

In other words, hospitals are uneven in their posting of online healthcare information. An AODA healthcare standard should address this gap, so that all healthcare providers offer the detailed information that patients need and deserve.

The first step to creating online health care information is for providers to make their websites accessible. Our next article will offer more information about accessible websites.



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Online Healthcare Information


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. One issue that a healthcare standard should address is access to information. Healthcare providers should be required to make all information available to all patients. One way for providers to do so could be by posting information on accessible websites. Patients or other visitors with disabilities can read online healthcare information on accessible computers or phones.

Online Healthcare Information

Different kinds of healthcare providers should post online healthcare information. For instance:

  • Doctors’ offices
  • Hospitals
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Healthcare regulating colleges

What Information should be Accessible Online?

Different providers could post different kinds of information. For example, hospitals could post guides or videos for patients if it is their first time:

  • Staying in hospital
  • Having surgery, x-rays, etc.

For instance, the Hospital for Sick Children (Sick Kids) in Toronto offers information for first-time patients through videos and text in simple language. Some other hospitals offer only text information but they do not offer plain-language versions.

Similarly, pharmacies could upload guides or videos of how to take different kinds of medication. There could also be a multi-pharmacy database archiving instructions for medications. Patients with print disabilities could log on to learn how to use medications that doctors have prescribed for them. Moreover, the archive could also contain plain-language versions of prescription instructions. Simple language, and pictures or diagrams, could be helpful for patients with intellectual disabilities, patients learning English, or patients with low literacy.

Likewise, doctors’ offices, clinics, and labs could make copies of print forms available online for patients. Instead of handing every patient a print form, health practitioners could give all patients the option to fill the form out in print or submit it online. Many patients might prefer this option, because it would be environmentally friendly.

Online Awareness of Accessible Features

Finally, all healthcare providers can use their websites as a way to advertise their accessible features. For instance, providers can state on their websites if they have accessible structural features, such as:

In addition, providers can advertise other accessible equipment they have, such as:

  • Height-adjustable examination tables
  • Lifts
  • Accessible diagnostic equipment, such as scales

Larger organizations should also mention any accessibility equipment or services available on-site for patients or visitors, such as:

  • Wheelchairs
  • Assistive listening systems
  • Sign language interpretation
  • Closed, open, or real-time captioning
  • Teletypewriters
  • Communication boards
  • Augmentative or alternative communication (AAC) devices

Smaller providers that do not have such services or equipment available on-site can state their willingness to accommodate patients who bring or arrange their own. For instance, providers can state their welcome of patients or visitors who use communication supports or devices.

Standardized Online Healthcare Information is Needed

Moreover, hospitals around Ontario offer widely different amounts and kinds of accessibility information on their websites. For example, Sick Kids provides detailed information about where patients and families can find or request a variety of accessible services. In contrast, other hospitals, such as the Georgian Bay General Hospital, have shorter accessibility pages that direct patients to their AODA-mandated accessibility plans. This type of page does not give patients useful information such as:

  • Which door they can enter using a wheelchair
  • Whether volunteers are available to escort patients
  • How far in advance to book an American Sign Language (ASL) interpreter

Furthermore, some hospitals have strong accessibility pages, but they overlook accessibility when they implement new or unique services. For instance, the Kingston General Hospital has placed whiteboards in all of its patient rooms, so that different medical professionals and family members involved in a patient’s care can communicate more easily. However, their accessibility page does not mention how they would make this unique and valuable service accessible to a patient, visitor, or healthcare professional who is blind or deafblind.

In other words, hospitals are uneven in their posting of online healthcare information. An AODA healthcare standard should address this gap, so that all healthcare providers offer the detailed information that patients need and deserve.

The first step to creating online healthcare information is for providers to make their websites accessible. Our next article will offer more information about accessible websites.



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Proactive Communication in Healthcare is Needed


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. In the meantime, however, there are still AODA requirements for healthcare providers to follow. The Information and Communications Standards have regulations that apply to healthcare providers. When providers follow these requirements, they make healthcare settings more accessible to patients, workers, and visitors with disabilities. Communication in healthcare applies to service in:

  • Doctors’ offices
  • Hospitals
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Healthcare regulating colleges

Communication in Healthcare

Under the Information and Communications Standards, healthcare providers need to create, provide, and receive information and communications in ways accessible to people with disabilities. For instance, providers must:

In addition, all public sector providers, and private sector providers with fifty or more workers, must make their websites accessible by January 1st, 2021.

Proactive Communication in Healthcare is Needed

The Information and Communications Standards mandate many important requirements for healthcare providers and other organizations to become accessible. However, providers could improve their services by providing information more proactively. For example, England’s National Health System contains an Accessible Information Standard. Under this standard, healthcare providers ask all patients if they have any information or communication needs. Providers then create records of individual patients’ needs and share these records with other providers, when possible. This procedure allows providers to make the formats and supports each patient needs available before their arrival, or quickly afterward. For instance, if a patient with a print disability needs blood work, their lab can prepare paperwork in the format the patient needs. Similarly, if a patient who uses plain-language documents comes to pick up a set of prescriptions, the pharmacy can have the information the patient needs available at the time of pick-up.

Stronger Communication in Healthcare is Needed

Under Ontario’s current Information and Communications Standards, these patients must explain their needs to every new provider they meet. Furthermore, they must request formats or supports at the time they are needed and wait until the provider can create them. Admirably, the Standards mandate that formats and supports must be available in a timely manner. However, in situations involving health, patients may need information immediately. For example, the patient picking up plain-language prescription information may wait days before understanding how to use their own prescriptions. Instead, they would need a loved one or volunteer to read information. Likewise, the patient needing blood work would need to have someone else read and fill in the form. Both these set-ups violate people’s right to privacy.

As more people develop disabilities, accessibility to information will become more important, in healthcare and in all other sectors. Our next few articles will explore ways to make more information available to more patients.



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Accessible Formats in Healthcare


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. One issue that a healthcare standard should address is access to information. Healthcare providers should be required to make all information available to all patients. For instance, all healthcare information should be available in accessible formats for patients who need them. Accessible formats in healthcare settings would help create quality medical care for all Ontarians.

Accessible Formats in Healthcare

Under the Information and Communications Standards, healthcare providers must make the information that they create available in accessible formats upon request. Likewise, under the Customer Service Standards, healthcare providers must serve customers in ways that take their communication needs into account. These two provisions seem to ensure that a patient’s service experience should be fully accessible already. However, there is an important service gap which a healthcare standard should fill. Although the service patients receive must be accessible, the goods they receive do not yet need to be.

For instance, when a patient with a print disability purchases medication in Ontario, the pharmacist who sells the medication must provide accessible customer service. However, medication names and instructions are only in standard-sized print. The patient must then make their own labels or systems to recognize which of their medicines is which. They must also find ways to access the medication instruction booklets. They might use software to scan and read instructions, but this process is often time-consuming and full of errors. Alternatively, to ensure that they receive accurate information about the medicine they use, a patient may instead ask loved ones or volunteer readers to go through the instructions verbally. However, this arrangement violates patients’ right to keep personal information confidential.

Accessible Prescriptions

Certain companies and regions have developed small-scale and large-scale solutions for the on-going information gap in healthcare. The Shoppers Drug Mart Pharmacy chain has created an online platform where patients can log on and access the instructions for their medications in alternate formats. Moreover, companies that produce medications in the European Union include Braille labels on all their products. The AODA’s new healthcare standard could implement these strategies for giving all patients access to medication, or suggest other options. A mandate within the AODA’s new standard to provide accessible formats in healthcare would help create quality medical care for all Ontarians.



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Providing Accessible Information and Communication in Healthcare


Currently, the AODA does not have a healthcare standard. A committee is making recommendations about what a healthcare standard should include. In the meantime, however, there are still AODA requirements for healthcare providers to follow. The Information and Communications Standards have regulations that apply to healthcare providers. When providers follow these requirements, they make healthcare settings more accessible to patients, workers, and visitors with disabilities. Communication in healthcare applies to service in:

  • Doctors’ offices
  • Hospitals
  • Walk-in clinics
  • Wellness centres
  • Pharmacies
  • Labs
  • Healthcare regulating colleges

Communication in Healthcare

Under the Information and Communications Standards, healthcare providers need to create, provide, and receive information and communications in ways accessible to people with disabilities. For instance, providers must:

In addition, all public sector providers, and private sector providers with fifty or more workers, must make their websites accessible by January 1st, 2021.

Proactive Communication in Healthcare is Needed

The Information and Communications Standards mandate many important requirements for healthcare providers and other organizations to become accessible. However, providers could improve their services by providing information more proactively. For example, England’s National Health System contains an Accessible Information Standard. Under this standard, healthcare providers ask all patients if they have any information or communication needs. Providers then create records of individual patients’ needs and share these records with other providers, when possible. This procedure allows providers to make the formats and supports each patient needs available before their arrival, or quickly afterward. For instance, if a patient with a print disability needs blood work, their lab can prepare paperwork in the format the patient needs. Similarly, if a patient who uses plain-language documents comes to pick up a set of prescriptions, the pharmacy can have the information the patient needs available at the time of pick-up.

Stronger Communication in Healthcare is Needed

Under Ontario’s current Information and Communications Standards, these patients must explain their needs to every new provider they meet. Furthermore, they must request formats or supports at the time they are needed and wait until the provider can create them. Admirably, the Standards mandate that formats and supports must be available in a timely manner. However, in situations involving health, patients may need information immediately. For example, the patient picking up plain-language prescription information may wait days before understanding how to use their own prescriptions. Instead, they would need a loved one or volunteer to read information. Likewise, the patient needing blood work would need to have someone else read and fill in the form. Both these set-ups violate people’s right to privacy.

As more people develop disabilities, accessibility to information will become more important, in healthcare and in all other sectors. Our next few articles will explore ways to make more information available to more patients.

 



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