Re: [openhealth] Re: list of diagnoses and procedures
Is it doable to create new descriptions from just the codes. Unless the meaning of each code is common knowledge then you have to make recourse to the original description, which makes your description a derived work at the very least. Is there any clean-room way of arriving at a description that could not be construed to have been derived from the AMA's original description? Presumably the patient has the right to see the actual codes that are used on his medical record. He also has knowledge (one would hope) of the procedures performed. But he has not seen the CPT list, and so can create a workable description that is not tainted by any copyrightable link to the original codes, nor by any other contractual relationship with the AMA. 80n On 12/12/06, Karsten Hilbert [EMAIL PROTECTED] wrote: On Mon, Dec 11, 2006 at 10:54:32PM -0800, Rod Roark wrote: Even absent the political ramifications, the resulting new system will have useful applications. A billing service accepting the new codes would still need CPT licensing, You guys need to keep straight what you are talking about. At least it gets me confused. One side suggests writing new *descriptions* for the *existing* CPT codes. In that case *there are no new codes* which would need any sort of acceptance by a billing service or even CPT licensing. The other party speaks about creating a whole different set of codes alltogether and trying to bring them into use for billing. Adrian Midgley proposes, as usual, the pragmatic solution: First, create new descriptions for the existing CPT codes and introduce those into use. This ought to be doable without interference by anyone. After all, the government cannot force me to use the AMA's descriptions. I can work with the codes alone (without *any* descriptions) if I so want - which is for all practical purposes exactly the same thing as working with alternate descriptions because the payor will never see those. Second, expand upon that established user base to introduce more codes for more purposes. I agree the first part seems doable. I am dubious about the second. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346 [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
All, It is interesting how much energy this conversation is getting. Now, I must admit that I am not pleased with any government granted monopoly. There are certain rights (and I am not a lawyer) granted under the referenced FARS/DFARS for end-users. You need to check those for yourself or collectively. In the big scheme of things though is it really worth it to pursue this? You can purchase the CPT's from the AMA for under $100 and as a vendor (as I recall) it only added about $10 to the EMR (both annual assessments). This is not out of line with the amount of work required to maintain and coordinate the distribution of a basic vocabulary on this scale. IMHO - if you have (mental/physical) cycles to spare then jump into one of the EMR projects, openEHR standards validation or even the drugref project. Your energies will be multiplied greatly. Thanks for your time. Tim [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
On Tue, Dec 12, 2006 at 10:24:52AM +, 80n wrote: Is it doable to create new descriptions from just the codes. Unless the meaning of each code is common knowledge then you have to make recourse to the original description, which makes your description a derived work at the very least. Ah, I missed that point. That might be a bit of a problem, indeed. Is there any clean-room way of arriving at a description that could not be construed to have been derived from the AMA's original description? On driver re-engineering this is sometimes done by two teams of people: one team knowing the original driver and describing how the *peripheral* (not the driver) works based on what can be derived from the original driver. The second team implements (clean-rooms) a new driver based on the description of how the peripheral works given by the first team. So, the first team could tell the second *in their own terms* (based on their knowledge) what the CPT codes *mean*. The second team could come up with a label for that code based on the description given by the first team. This might work. And it could indeed include the patient, too. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: [openhealth] Re: list of diagnoses and procedures
A derivative work includes some portion of the original verbatim and that should be avoided. In order to work for billing the codes themselves would have to be carried over from the CPT system. Thus making any attempt to re-describe CPT codes a derivative work and largely useless. -FT -- Fred Trotter http://www.fredtrotter.com [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
So could one use the CPT number for reimbursement without some certification that they are the same as the real CPT codes? Dave mspohr wrote: The codes would be the same as those that they currently accept (i.e. the AMA CPT codes) so there is no issue with the codes. The problem with the AMA is that they copyright the descriptions and prevent distribution of their copyrighted descriptions. The project would be to create new descriptions that were functionally the same and could be freely distributed under an open license such as the Creative Commons license (http://creativecommons.org/ http://creativecommons.org/). /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com, David Forslund [EMAIL PROTECTED] wrote: This effort would require commitment from the payor that they would accept those codes for reimbursement. Otherwise this effort will be relatively useless. Dave mspohr wrote: The goal of the CPT code project would be to create a version of procedure codes for use in billing in the US that could be freely distributed. While it would be nice to fit this into an overarching ontology, this would introduce overhead which is not warranted. The CPT codes themselves are a dead end (except for billing in the US) from both intellectual property and information design standpoints and the task of an ontology of procedures is better left to something more suitable such as Snomed or ICD or even the HCPCS. I think KISS applies here. /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com mailto:openhealth%40yahoogroups.com, Adrian Midgley amidgley2@ wrote: Rod Roark wrote: Perhaps I don't understand what you mean, but CPT codes are just for procedures. The project I was suggesting was limited to restating the descriptions for them, with about the same standards for preciseness currently found in CPT. A broader scope would be very daunting. But if we are going to do (an) ontology, let us not handicap ourselves by building it for just one lot of data. It could be written one chapter at a time, certainly. _
Re: [openhealth] Re: list of diagnoses and procedures
I dont think so. From what I understood the codes themselves are copyright. Further, thier use is mandated by the government for use in medical billing. This issue has already been the subject of litigation. http://www.usdoj.gov/atr/cases/f2000/2076.htm -FT On 12/11/06, mspohr [EMAIL PROTECTED] wrote: The codes would be the same as those that they currently accept (i.e. the AMA CPT codes) so there is no issue with the codes. The problem with the AMA is that they copyright the descriptions and prevent distribution of their copyrighted descriptions. The project would be to create new descriptions that were functionally the same and could be freely distributed under an open license such as the Creative Commons license (http://creativecommons.org/). /Mark --- In openhealth@yahoogroups.com, David Forslund [EMAIL PROTECTED] wrote: This effort would require commitment from the payor that they would accept those codes for reimbursement. Otherwise this effort will be relatively useless. Dave mspohr wrote: The goal of the CPT code project would be to create a version of procedure codes for use in billing in the US that could be freely distributed. While it would be nice to fit this into an overarching ontology, this would introduce overhead which is not warranted. The CPT codes themselves are a dead end (except for billing in the US) from both intellectual property and information design standpoints and the task of an ontology of procedures is better left to something more suitable such as Snomed or ICD or even the HCPCS. I think KISS applies here. /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com, Adrian Midgley amidgley2@ wrote: Rod Roark wrote: Perhaps I don't understand what you mean, but CPT codes are just for procedures. The project I was suggesting was limited to restating the descriptions for them, with about the same standards for preciseness currently found in CPT. A broader scope would be very daunting. But if we are going to do (an) ontology, let us not handicap ourselves by building it for just one lot of data. It could be written one chapter at a time, certainly. Yahoo! Groups Links -- Fred Trotter http://www.fredtrotter.com [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
I agree. I don't think you would have to declare them something other than CPT codes even if they had the same number. With a different description, they couldn't be certified as the same and wouldn't come under the legal agreement of CMS (HCFA). I think it would be nice to have alternative to CPT, but this would require more than coming up with code descriptions. It would require calling it something else and entering into agreements with CMS and other organizations including states. This is not a free exercise. Dave Fred Trotter wrote: I dont think so. From what I understood the codes themselves are copyright. Further, thier use is mandated by the government for use in medical billing. This issue has already been the subject of litigation. http://www.usdoj.gov/atr/cases/f2000/2076.htm http://www.usdoj.gov/atr/cases/f2000/2076.htm -FT On 12/11/06, mspohr [EMAIL PROTECTED] mailto:mspohr%40yahoo.com wrote: The codes would be the same as those that they currently accept (i.e. the AMA CPT codes) so there is no issue with the codes. The problem with the AMA is that they copyright the descriptions and prevent distribution of their copyrighted descriptions. The project would be to create new descriptions that were functionally the same and could be freely distributed under an open license such as the Creative Commons license (http://creativecommons.org/ http://creativecommons.org/). /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com, David Forslund [EMAIL PROTECTED] wrote: This effort would require commitment from the payor that they would accept those codes for reimbursement. Otherwise this effort will be relatively useless. Dave mspohr wrote: The goal of the CPT code project would be to create a version of procedure codes for use in billing in the US that could be freely distributed. While it would be nice to fit this into an overarching ontology, this would introduce overhead which is not warranted. The CPT codes themselves are a dead end (except for billing in the US) from both intellectual property and information design standpoints and the task of an ontology of procedures is better left to something more suitable such as Snomed or ICD or even the HCPCS. I think KISS applies here. /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com mailto:openhealth%40yahoogroups.com, Adrian Midgley amidgley2@ wrote: Rod Roark wrote: Perhaps I don't understand what you mean, but CPT codes are just for procedures. The project I was suggesting was limited to restating the descriptions for them, with about the same standards for preciseness currently found in CPT. A broader scope would be very daunting. But if we are going to do (an) ontology, let us not handicap ourselves by building it for just one lot of data. It could be written one chapter at a time, certainly. Yahoo! Groups Links -- Fred Trotter http://www.fredtrotter.com http://www.fredtrotter.com [Non-text portions of this message have been removed] _
Re: [openhealth] Re: list of diagnoses and procedures
I think the issue is bigger than that. The AMA has a legal agreement with CMS/HCFA for reimbursement of CPT codes. If the code isn't an official CPT code, then reimbursement would be denied by CMS, even if you weren't sued by the AMA. If the descriptions didn't match the AMA's then they would easily claim it wasn't official. Dave mspohr wrote: This decision addresses the question of whether the AMA's copyright becomes invalid when the government mandates it for reimbursement. It uses some tortured logic to say that the CPT is NOT a system (that therefore would not be eligible for copyright) but rather an specific expression that can be copyrighted. Following this, it would seem that you could use the system (of numbers) but with a different expression (descriptions) and not tread on the AMA's copyright. Other cases (such as with telephone directories) have reaffirmed that you cannot copyright the numbers themselves. However, the AMA would probably sue you anyway. /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com, Fred Trotter [EMAIL PROTECTED] wrote: I dont think so. From what I understood the codes themselves are copyright. Further, thier use is mandated by the government for use in medical billing. This issue has already been the subject of litigation. http://www.usdoj.gov/atr/cases/f2000/2076.htm http://www.usdoj.gov/atr/cases/f2000/2076.htm -FT On 12/11/06, mspohr [EMAIL PROTECTED] wrote: The codes would be the same as those that they currently accept (i.e. the AMA CPT codes) so there is no issue with the codes. The problem with the AMA is that they copyright the descriptions and prevent distribution of their copyrighted descriptions. The project would be to create new descriptions that were functionally the same and could be freely distributed under an open license such as the Creative Commons license (http://creativecommons.org/ http://creativecommons.org/). /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com, David Forslund forslund@ wrote: This effort would require commitment from the payor that they would accept those codes for reimbursement. Otherwise this effort will be relatively useless. Dave mspohr wrote: The goal of the CPT code project would be to create a version of procedure codes for use in billing in the US that could be freely distributed. While it would be nice to fit this into an overarching ontology, this would introduce overhead which is not warranted. The CPT codes themselves are a dead end (except for billing in the US) from both intellectual property and information design standpoints and the task of an ontology of procedures is better left to something more suitable such as Snomed or ICD or even the HCPCS. I think KISS applies here. /Mark --- In openhealth@yahoogroups.com mailto:openhealth%40yahoogroups.com mailto:openhealth%40yahoogroups.com, Adrian Midgley amidgley2@ wrote: Rod Roark wrote: Perhaps I don't understand what you mean, but CPT codes are just for procedures. The project I was suggesting was limited to restating the descriptions for them, with about the same standards for preciseness currently found in CPT. A broader scope would be very daunting. But if we are going to do (an) ontology, let us not handicap ourselves by building it for just one lot of data. It could be written one chapter at a time, certainly. Yahoo! Groups Links -- Fred Trotter http://www.fredtrotter.com http://www.fredtrotter.com [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
I find this discussion of CPT codes reimbursement interesting. Let me paraphrase: To petition your Government (for reimbursement), you need to submit your request in Elvish. Organization XYZ owns the Elvish language. Ergo, to communicate with your Government, you need to buy a license from XYZ to use Elvish. This seems quite an incredible state of affairs. -- Bhaskar
Re: [openhealth] Re: list of diagnoses and procedures
On Mon, Dec 11, 2006 at 02:16:32PM -0700, David Forslund wrote: I think the issue is bigger than that. The AMA has a legal agreement with CMS/HCFA for reimbursement of CPT codes. If the code isn't an official CPT code, then reimbursement would be denied by CMS, even if you weren't sued by the AMA. If the descriptions didn't match the AMA's then they would easily claim it wasn't official. It seems I recall several people saying that the CMS/HCFA *doesn't see* the descriptions? Because they *are not* on the bill ? But rather the *code only*. Which, by all accounts anyone could put there by hand off the top of their head without owning any EMR at all. Karsten -- GPG key ID E4071346 @ wwwkeys.pgp.net E167 67FD A291 2BEA 73BD 4537 78B9 A9F9 E407 1346
Re: [openhealth] Re: list of diagnoses and procedures
Alex Caldwell wrote: Thanks Tim, I was going by the agreement on this page on the CMS site which links to the download for the Excel file: http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf It did not seem to me as restrictive as what you are quoting there. I notice many doctors do things with CPT, such as having them printed by a local printing house on their own customized superbills. I've never heard of anyone being pursued for that. It would seem that if you included a subset of the CPT codes that you use in your own practice in order to interact with Medicare for billing transactions in the course of your own business, and you get them yourself for your own personal use, not distributed with the EMR, but just loaded into it by yourself, it would not violate the conditions. I cannot see that loading a subset of CPT codes into your EMR would be any different than printing them on a superbill or having your coder enter then into your claims. But that's just the way I look at it, which may not hold up. I imagine CMS and other 3rd party payors and clearinghouses must have agreements with AMA to use CPT. Do their agreements extend in any way to cover individual providers that do business with these 3rd party payors that use CPT? Alex I should have provided a reference for my quote. It is from the clickable license agreement on the AMA site. https://catalog.ama-assn.org/Catalog/cpt/cpt_search.jsp?checkXwho=done As far as interpretation I would refer you to your attorney. That's what we did. Of course use for submission to Medicare etc is covered under the referenced DFARS. Cheers, Tim -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ EMAIL: [EMAIL PROTECTED] SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
Tim Cook wrote: I should have provided a reference for my quote. It is from the clickable license agreement on the AMA site. I should have probably also noted that they are available from the AMA on CD in ASCII for less than $100 / year. So it would be cheaper to purchase them than to pay for an attorney's interpretation of the license or risk raising red flags about open source projects circumventing their copyrights. Just my 2cents. Cheers, -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ EMAIL: [EMAIL PROTECTED] SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed]
Re: [openhealth] Re: list of diagnoses and procedures
This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n On 12/9/06, mspohr [EMAIL PROTECTED] wrote: The AMA CPT codes have a tortuous history and are currently in a legally ambiguous place supported by aggressive AMA lawyers. It is similar to the legally tenuous position of the RIAA that they can control what you can do with the music you have purchased. A short history. In testimony before congress in 1997, T. Reginald Harris, Chairman of the AMA CPT Editorial Board stated: The AMA has taken additional steps to make CPT available over the Internet and is expected to complete an agreement with the HCFA in the very near future. Under the agreement, complete public access to HCFA data files containing CPT will be available, free of charge, both domestically and internationally. Congress then passed legislation mandating use of the CPT codes for medical billing. However, the AMA did not make the codes freely available domestically and internationally. Instead, they have been selling the codes under very restrictive licensing agreements and in fact earn tens of millions of dollars a year from these fees. The AMA has been very aggressively policing misuse of the codes (for example, taking legal action against people who have made the codes freely available on the Internet). Their legal position is tenuous and has never been tested fully in court. Instead, they have relied on the intimidation of their lawyers to produce compliance. Similar cases such as Feist v. Rural Telephone and DrewTech v. SAE have produced results which would seem to prohibit the AMA from charging for the codes. That said, it is probably best not to challenge the AMA. Our corrupt politicians should address the problem but of course, they will not go against a big contributor. You can buy the codes for use (under their restrictive license) from the AMA and that is probably the best course of action. /Mark Alex Caldwell wrote: --- In openhealth@yahoogroups.com openhealth%40yahoogroups.com, Tim Cook [EMAIL PROTECTED] wrote: Alex Caldwell wrote: The way I interpret the agreement on the site, I believe it is OK to do this as long as you just do it just for yourself for your own internal use, but you are not allowed to re-distribute them. So perhaps it would be OK to distribute the Open Source EMR minus these codes, but include instructions for the user for downloading this file and importing the codes themselves into their own personal copy of the EMR: DISCLAIMER: IANAL but Grant and Limitations. You, as an individual, are authorized to use CPT only as contained in the CPT(r)/Medicare Relative Value Payment File (the File) solely for your own personal information and only within the United States. specifically EXCLUDES any use outside of the (Excel) file and any use outside the US. It goes on to say that you are prohibited for using them in place of purchasing the CPT book or creating any derivative work. When we licensed CPTs for use in FreePM the AMA was very attentive to the distribution and we had to submit quarterly audits to them. I suggest you ensure you adhere to their licensing restrictions I understand they are very aggressive in pursuing their copyright on their government granted monopoly. Cheers, -- Timothy (Tim) Cook, MSc Thanks Tim, I was going by the agreement on this page on the CMS site which links to the download for the Excel file: http://www.cms.hhs.gov/apps/ama/license.asp?file=http://new.cms.hhs.gov/apps/ama/report_xyz.pdf It did not seem to me as restrictive as what you are quoting there. I notice many doctors do things with CPT, such as having them printed by a local printing house on their own customized superbills. I've never heard of anyone being pursued for that. It would seem that if you included a subset of the CPT codes that you use in your own practice in order to interact with Medicare for billing transactions in the course of your own business, and you get them yourself for your own personal use, not distributed with the EMR, but just loaded into it by yourself, it would not violate the conditions. I cannot see that loading a subset of CPT codes into your EMR would be any different than printing them on a superbill or having your coder enter then into your claims. But that's just the
Re: [openhealth] Re: list of diagnoses and procedures
That leads me to ask: does the AMA claim copyright on the CPT codes themselves, or just on the descriptions of the codes? If the latter, I think there would be a lot of merit in a community project to create and maintain new descriptions. I've been told that the AMA's descriptions are not very physician-friendly. Rod www.sunsetsystems.com On Saturday 09 December 2006 10:18, 80n wrote: This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n
Re: [openhealth] Re: list of diagnoses and procedures
I think, then, a good web-based community project would be the creation of a whole new set of codes and descriptions. However the codes would happen to map one-to-one with the CPT codes, and the mapping would be created/shared only among those with CPT licenses. Publications that reference CPT codes could be trivially changed to reference the new codes, and individual practitioners would have no need or use for the mapping table or anything else containing CPT codes. Rod www.sunsetsystems.com On Saturday 09 December 2006 13:18, mspohr wrote: Copyright covers expressions of ideas and as such covers the AMA's descriptions. Theoretically, if you wrote different descriptions, they would not be covered by the AMA copyright. However, the AMA has been very aggressive in defending their monopoly on the codes so they might threaten a community project. There is also the issue of the codes themselves. Even though you can't copyright lists of numbers (codes)... the famous telephone directory case, the AMA might try to claim that they own the numbers also. /Mark --- In openhealth@yahoogroups.com, Rod Roark [EMAIL PROTECTED] wrote: That leads me to ask: does the AMA claim copyright on the CPT codes themselves, or just on the descriptions of the codes? If the latter, I think there would be a lot of merit in a community project to create and maintain new descriptions. I've been told that the AMA's descriptions are not very physician-friendly. Rod www.sunsetsystems.com On Saturday 09 December 2006 10:18, 80n wrote: This reminds me of a similar situation in the UK with postcodes (their equivalent of zip codes). Unlike the US where zip codes are in the public domain, the British Post Office owns the postcode database and protects it agressively. An enterprising group of people recently started an initiative at www.FreeThePostcode.org to reverse engineer the postcode database by getting people to record their own postcode and geographic location on the web-site. So far they have not been closed down by the post office. I'm wondering if anything like a similar approach could work with CPT codes? 80n
Re: [openhealth] Re: list of diagnoses and procedures
Payers will always invent excuses to reject claims. However in my experience the CPT description is not submitted as part of a claim. Rod www.sunsetsystems.com On Saturday 09 December 2006 14:53, Peter Holt Hoffman wrote: I have a question about this though: don't at least some payers reject claims where the description is not 100% identical to what the AMA publishes? -- Peter. --- In openhealth@yahoogroups.com, Rod Roark [EMAIL PROTECTED] wrote: I think, then, a good web-based community project would be the creation of a whole new set of codes and descriptions. However the codes would happen to map one-to-one with the CPT codes, and the mapping would be created/shared only among those with CPT licenses. Publications that reference CPT codes could be trivially changed to reference the new codes, and individual practitioners would have no need or use for the mapping table or anything else containing CPT codes. Rod www.sunsetsystems.com
Re: [openhealth] Re: list of diagnoses and procedures
Alex Caldwell wrote: The way I interpret the agreement on the site, I believe it is OK to do this as long as you just do it just for yourself for your own internal use, but you are not allowed to re-distribute them. So perhaps it would be OK to distribute the Open Source EMR minus these codes, but include instructions for the user for downloading this file and importing the codes themselves into their own personal copy of the EMR: DISCLAIMER: IANAL but Grant and Limitations. You, as an individual, are authorized to use CPT only as contained in the CPT®/Medicare Relative Value Payment File (the File) solely for your own personal information and only within the United States. specifically EXCLUDES any use outside of the (Excel) file and any use outside the US. It goes on to say that you are prohibited for using them in place of purchasing the CPT book or creating any derivative work. When we licensed CPTs for use in FreePM the AMA was very attentive to the distribution and we had to submit quarterly audits to them. I suggest you ensure you adhere to their licensing restrictions I understand they are very aggressive in pursuing their copyright on their government granted monopoly. Cheers, -- Timothy (Tim) Cook, MSc Health Informatics Consultant Jacksonville, FL Ph: 904-322-8582 http://home.comcast.net/~tw_cook/ EMAIL: [EMAIL PROTECTED] SKYPE: timothy.cook Yahoo IM: tw_cook [Non-text portions of this message have been removed]
