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this talkie actually developed out of my attempt to review the guidelines the changes in these guidelines for my practice group which is a joy I already mentioned Eastern Iamp;#39;ve got some slides that fall here that do a little bit of a demonstration but these are Shore rural health system is actually a series of five community health centers that run the length of the Eastern Shore of Virginia we are currently at about 40 providers most of whom are Family Practice internal medicine some nurse practitioners some pas Iamp;#39;m actually the only ob/gyn in the group and so I was test with trying to condense down these changes which have are admittedly somewhat cumbersome and complex my hope is that Iamp;#39;m going to be able to condense this down and give some background on this and make this a little bit less frustrating for for folks the reference these are the references just in case you didnamp;#39;t know thereamp;#39;s a Society for everything the first one is the American