Grammar guidelines


Using terms and grammar correctly allows readers to focus attention on your message, not your writing style or errors.

In order to produce a cohesive style throughout all our company communications (printed, digital, etc.), the following set of grammar guidelines were developed. Please refer to these as you are preparing internal and external communications.

All our materials are written following the Associated Press style (AP style).

This style guide will address proper grammar usage including abbreviations, punctuations and common mistakes. There are many aspects of grammar, spelling, punctuation and style that are not addressed in this guide. If you have a question or suggestion, please email [email protected].

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An abbreviation is a shortened form of a word or phrase. These specific abbreviations are sometimes used incorrectly. Visit the abbreviations and acronyms page to see commonly abbreviated terms at Blue Cross.

Always abbreviate Company, Corporation, Incorporated and Limited, when using after an organization’s name: Taylor Supply Co., Inc.
Always abbreviate Dr., Mr., Mrs. Ms., the Rev., Rep. and Sen., when using before a full name outside direct quotations. Spell out all (except Dr., Mr., Mrs. and Ms.) when they are used before a name in direct quotations.
Always precede "Rev." (when it comes before an individual's name) with the word "the" because, unlike the case with Mr. and Mrs., the abbreviation Rev. does not stand for a noun: The Rev. Jesse Jackson will lead the service.
Never place "Dr." before an individual's name (unless it is a direct quote), when first identifying someone as a doctor. Upon first reference, indicate the individual’s title with the designation after the name: John Norman, M.D.
“Dr. James Lowery is one of the best in the network,” she said.

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Always write the word “cents” in text. In charts and lists, the symbol “¢” is acceptable.

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Contractions may be used if the purpose of the communication is to be more conversational or personable: The group wouldn’t want a premium increase.

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Dates and events

Do not write out the whole month when giving a date: Dec. 25, 2020.

It is not necessary to use -st, -nd, -rd, -d or -th in dates unless the day is written before or is separated from the month: April 1; 1st of April

Do not use “on” or “held” with days and dates: The meeting will be May 1.

When announcing events, use the time-date-location sequence: The meeting will be at 10 a.m., Oct. 8, in Bldg. K.

Do not separate month and year with a comma: Construction in October 2020.

Use day and date when referring to an event: Deadline to sign up for the race is Tuesday, Dec. 4.

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Directions and regions

In general, lowercase compass points when they describe a section of a city or state: western Kansas, northeast Kansas. Capitalize compass points when part of a proper name (West Virginia) or when denoting widely known sections (Upper East Side of New York).

With names of nations, lowercase unless they are part of a proper name or are used to designate politically divided nations: western United States, South Korea.

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Always write dollar sign-number for amounts less than a million. For amounts greater than a million, write dollar sign-number-word “million:”
$4, $25, $500, $1,000, $650,000, $1 million, $1.5 million.

Exception: exact amounts such as $4,535,123.

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Hyphenations can be tricky. There are three general rules to follow to know when to hyphenate a word or not. Some examples are provided to help you out.

Hyphens are joiners. Use them to avoid ambiguity or to form a single idea from two or more words.

Use of the hyphen is far from standardized. It can be a matter of taste, judgment and style sense. Think of hyphens as an aid to readers’ comprehension. If a hyphen makes the meaning clearer, use it. If it just adds clutter and distraction to the sentence, don’t use it.

Helpful hint:
Many compound modifiers that are hyphenated before a noun are not hyphenated when they appear after a noun: We sell long-term care insurance. The company will reach its sales goal in the long term.

Hyphenate Do not hyphenate
Bed-patient Coinsurance
Brand-name drug Copay
Cost-effective Cost containment
Co-worker Inpatient
First-dollar coverage Lifestyle
E-learning Marketplace
Kansas-based Outpatient
Level-funded Prediabetes
Long-term care Precertification
Multi-option plan Prepaid
Non-accident Prepayment
Non-covered Vice president
Physician-hospital organization  
Value-added services  

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People should be referred to in the manner they prefer, if their identities are clear. The designation of junior and senior should be used only with full names of persons and should be abbreviated as Jr. and Sr. Do not precede by a comma: Joseph P. Kennedy Jr.

A nickname should be used in place of a person's given name in stories only when it is the way the individual prefers to be known: Jimmy Carter, Bill Clinton, Babe Ruth, Tiger Woods, Magic Johnson.

When a nickname is inserted into the identification of an individual, use quotation marks: Sen. Henry M. "Scoop" Jackson, Paul "Bear" Bryant.

Capitalize without quotation marks such terms as Sunshine State, the Old Dominion, Motown, the Magic City, Old Hickory, Old Glory, Galloping Ghost.

Use first and last name upon first reference.

  • For internal communications, use first name upon second reference.
  • For external communications, use last name upon second reference.
  • For external communications, when it is necessary to distinguish between two people who use the same last name, use the first and last name on subsequent references.

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Write out all numbers one through nine. Use numerals for 10 and above. (See the “Percent” section for exceptions to these rules.) The use of numerals is acceptable in charts and lists. Numbers beginning a sentence should always be expressed in words: The six examiners processed 200 claims today. Twelve claims were filed by the provider.

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Most words: Add s: boys, girls, ships, villages.

Words ending in –ch, –s, –sh, –sh, –ss, –x and –z: Add –es: churches, lenses, parishes, glasses, boxes, buzzes. (Monarchs is an exception.)

Words ending in –is: Change is to es: oases, parentheses, theses.

Words ending in –y: If y is preceded by a consonant or qu, change y to i and add es: armies, cities, navies, soliloquies. Otherwise add s: donkeys, monkeys.

Words ending in –o: If o is preceded by a consonant, most plurals require es: buffaloes, dominoes, echoes, heroes, potatoes. But there are exceptions: pianos.

Words ending in –f: In general, change f to v and add es: leaves, selves. (Roof, roofs is an exception.)

Form change: man, men; child, children; foot, feet; mouse, mice; etc. Caution: When s is used with any of these words it indicates possession and must be preceded by an apostrophe: men's, children's, etc.

Words the same in singular and plural: corps, chassis, deer, moose, sheep, etc. The sense in a particular sentence is conveyed by the use of a singular or plural verb.

Words in plural form, singular in meaning: Some take singular verbs: measles, mumps, news. Others take plural verbs: grits, scissors.

Compound words: Those written solid add s at the end: cupfuls, handfuls, tablespoonfuls.

For those that involve separate words or words linked by a hyphen, make the most significant word plural:

  • Significant word first: adjutants general, aides-de-camp, attorneys general, courts-martial, daughters-in-law, passers-by, postmasters general, presidents-elect, secretaries-general, sergeants major.
  • Significant word in the middle: assistant attorneys general, deputy chiefs of staff.
  • Significant word last: assistant attorneys, assistant corporation counsels, deputy sheriffs, lieutenant colonels, major generals.

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Proper word choice

Accept/except: “Accept” means to agree or to receive something offered: The vendor does accept checks.

“Except” means excluding or with the exception of. The ex- of except can help you to remember that it means excluding: Everyone except Rita went to the movies.

Access/excess: “Access” is a noun meaning a way of approach: Gaining access to the healthcare system can be difficult for some individuals.

“Excess” is a noun or an adjective meaning more than a specified amount: The excess provider directories will be stored in supply.

Adapt/adept: “Adapt” is a verb meaning to make an adjustment: They will adapt the claim payment according to the new guidelines.

“Adept” is an adjective meaning thoroughly proficient: Customer experience representatives are adept at answering member questions.

Adverse/averse: “Adverse” is an adjective meaning opposed, antagonistic, bad, and is applied to something that opposes or works against another thing or person: The company is sometimes adverse to legislative mandates.

“Averse” means disinclined, reluctant, loath, and is a personal feeling: She was averse to approving the overtime without having proper documentation for the need.

Advice/advise: “Advice” is a noun.“

Advise” is a verb. When you give suggestions, you advise. The suggestions themselves are the advice.

All right/alright: Never use “alright.”
Alternate/alternative: “Alternate” can mean to go back and forth from one to another, or to change at intervals.

“Alternative” indicates a choice among two or more possibilities.

Among/between: Use “among” with more than two objects: The members talked among themselves.

Use “between” with only two: The child chose between a plain or peanut cookie.

Anybody/any body: “Anybody,” in the sense of any person, should not be written as two words: Did anybody turn on my computer?

“Any body” means any corpse or any human form or any group. The same rule holds true for everybody, nobody, somebody, for the same reason. In the sense of a person, they are best written as one word: Is anybody interested in donating to Project Topeka?

Anymore/any more: The compound word “anymore” means now or hereafter or further and is properly used with a statement that has a negative connotation, or sometimes with a question: I don’t need help anymore.

“Any more” means any additional: Do you have any more work to send to the document processing center?

A while/awhile: “A while” is an article and a noun meaning a period of time. Use it with the prepositions “for” and “in.” It is always two words: In a while I will send the memo.

“Awhile” is an adverb meaning for a short period of time. It is never used with a preposition, since “for” is already included in its meaning and is written as one word: I will be in the meeting awhile.

Benefits/covered services: “Benefits” are paid at.

“Covered services” are paid at.

No other words besides benefits and covered services should be used.

Call/phone/contact: “Call” or “phone” should be used when providing only a telephone number.

Use “contact” when providing a telephone number along with an email or mailing address.

Capital/capitol: “Capital” is either wealth, an uppercase letter, or a city or town that is the seat of a government.

“Capitol” is a building in which a legislative body meets. The U.S. Capitol is always capitalized.

Can/may: “Can” means am able.

“May” means have permission.

Cite/site/sight: “Cite” is a verb meaning to refer to: Please cite your source of information provided for literature.

“Site” is a noun meaning place, scene or point of something: Bldg. B is the site for Blue’s Café.

“Sight” refers to vision: My sight is better since they adjusted my monitor.

Complement/compliment: “Complement” is both a noun and a verb, meaning the completion of something or to enhance something: Your letter will complement the package we mail to new members.

“Compliment” also functions as both a noun and verb, but means to praise, or an expression of praise:  Thank you for the compliment on my presentation.

Confidently/confidentially: Both are adverbs, but “confidently” means self-reliantly: She confidently authorized the claim payment.

“Confidentially” means secretly:  He confidentially filed the report.

Continual/continuous: “Continual” means repeatedly. If something is “continual,” it goes on and on, but stops in between, like rain. If something is “continuous,” it goes on and on without stopping, like life: The member made continual phone calls about her prescription allowances.

“Continuous” means without any interruption: As long as the premiums are paid, the insurance coverage remains continuous.  

Contracting providers/contracting healthcare providers: “Contracting providers” and “Contracting healthcare providers” refer to hospitals or doctors who agree to contract with BCBSKS.
Different: “Different” is followed by “from,” not “than.”
Disinterested/uninterested: “Disinterested” means impartial: The facilitator was disinterested during the team meeting.

“Uninterested” means not interested: The insurance commissioner was uninterested in hearing excuses.

Either/each: “Either” means one or the other: Either lead or follow but keep going.

“Each” means more than one, but as individuals: Each time you lead a team, more things are accomplished.

Ensure/insure: “Ensure” is used to mean guarantee: We ensure our product is the best for the money.

“Insure” is used in reference to insurance: Blue Cross and Blue Shield of Kansas insures many members.

Everyday/every day: “Everyday” is an adjective and must modify a noun: Her computer crashing is an everyday occurrence.

“Every day” is an adverbial phrase that tells when something happens: She seems to be learning more every day.

Farther/further: “Farther” is used to speak of distance: He must drive farther than the other representatives.

“Further “is used for intangible measurements, like time, degree or quantity: She can stretch her abilities further than he can.

Fewer/less: “Fewer” indicates things that can be counted. Generally, use “fewer” before a plural noun, “less” before a singular noun: Document processing received fewer requests for copies this year.

“Less” indicates things that cannot be counted: Blue Cross and Blue Shield of Kansas is less of a competitor for high-risk prospects.

Health care/healthcare: Use "healthcare" when speaking broadly, but "health care" when referencing a specialty such as mental health care, behavioral health care, etc.
Infer/imply: “Infer” means to conclude from the evidence: You can infer from the crime scene that a gun was used.

“Imply” means to express indirectly: He implied that he was in a hurry to leave.

Its/It’s: “Its” is the possessive form of “it:” Marketing gains its contracts through the sales representatives of BCBSKS.

“It’s” is a contraction for “it is:” It’s a good morning to stay at home.

Long term/long-term: "Long term" is a noun that is used when talking about what happens over a long period of time or in the future.

"Long-term" is an adjective that describes something that has or will continue for a length of time: A full recovery is expected in the long term. BCBSKS sells long-term care insurance.

You should hyphenate these words when they are used to describe a noun that follows them.

Lose/loose: “Lose” is a verb meaning to suffer the loss of; it is the opposite of win: You will lose your coverage if you fail to pay your premium on time.

“Loose” is an adjective meaning not tightly fastened, or a verb meaning to free: Loose-fitting hospital gowns often result in embarrassing moments.

Over/more than: “Over” refers to spatial relationships: I keep my employee handbook on the shelf over my desk.

“More than” is used with numbers: BCBSKS employs more than 1,600 people.

Payer/payor: Per legal and compliance, always use the term “payer”. “Payer” is used to designate one who pays, or should pay, a bill or note, etc.: He is a prompt bill payer.
Personal/personnel: “Personal” is an adjective signifying individuality: Remove your personal items from your car.

“Personnel” is a noun meaning persons employed: The credit union personnel are available to help members with their banking needs.

Proceed/precede: “Proceed” means to go or move forward: We will proceed to process your claims after receiving written documentation of  your referral.

“Precede” means to go before.

Remember that the correct spellings of the participles are “proceeding” and “preceding.”

Proved/proven: Both forms of the past participle are acceptable, but “proved” is preferred as the verb: Test results proved the diagnosis of the medical staff was correct.

“Proven” is usually used as the attributive adjective (one that comes ahead of the noun): The drug in question is a proven treatment for this condition.

Secondly, thirdly: Leave off the “ly” and use "Second, third."
Since/because: “Since” refers to time: There have been no claims filed since your last dental appointment.

“Because” refers to a reason for doing something or for an occurrence:  The reason your ambulance claim was denied is because it wasn’t considered a medical emergency.

Sit/set: “Sit” is an intransitive verb requiring no action and having no object: Because he was late to the meeting he had to sit in the back.

“Set” is almost exclusively a transitive verb — conveying action from the subject to the predicate — so it must have an object. Like “lay,” “set” can be replaced with “put:” The leader had the chairs set.

Sometime/some time: As one word, “sometime” means at some indefinite or undefined time in the future: We will revise the claim form sometime this year.

As two words, “some time” means just an indefinite or undefined period: There hasn’t been a premium increase for some time.

There/their/they’re: “There” is an adverb indicating direction: We went there for a meeting.

“There” is also used with the force of a pronoun for impersonal constructions in which the real subject follows the verb: There are no papers on the table.

“Their” is an adjective meaning belonging to them: The providers feel their needs are being met.

“They’re” is a contraction of “they are:” They’re all going to the workshop together.

Two/to/too: “Two” is a number: The two of us will attend the provider workshop.

“To” is a preposition showing direction: All interoffice mail is to be delivered promptly.

“Too” means also: She too believed coverage was denied in error (additionally, also, further, excessively).

Use/utilize: As a verb, the word “use” means to put or bring something into action or service; to handle or consume something.

As a verb, the word "utilize" means to make use of something in a new, practical, or profitable way.

Who/whom/that/which: Use “who” and “whom” for references to human beings and to animals with a name.  Use “that” and “which” for inanimate objects and animals without a name. “Who” is the word when someone is the subject of a sentence, clause or phrase: The person who answered the phone said she was from the customer service center.

“Whom” is the word when someone is the object of a verb or preposition: The person to whom you spoke is an employee.

“That:” The claim for the hospital admission that you’re referring to has been paid at 100% of the maximum allowance.

“Which:” The new employee didn’t know on which floor the office was located.

Whose/who’s: “Whose” is the possessive form of who: Whose claim are you working on?

“Who’s” is a contraction of “who is:” Who’s the representative working on the claims problem?

Your/you’re: “Your” is the possessive form of you: The claim for your visit to Dr. Smith is being processed.

“You’re” is the contraction of “you are:” You’re going to be promoted to supervisor of the unit.


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Incorrect punctuation can change the meaning of a sentence. It can also cause the reader to lose track of what is being said and make the sentence hard to understand.

As a general rule, if punctuation does not help make clear what is being said, it should not be there.

Ampersand [&]: Never use the ampersand in copy, unless it's part of a company's formal name or in a composition title.

a.m., p.m.: Lowercase, with periods

  • When writing the time in body copy, do not use minutes unless it falls on something other than the top of the hour (Examples: 8 a.m., 9 a.m. or 9:15 a.m., 10:30 a.m.)
  • When writing time as part of an agenda or list, always display the minutes (Example: 8:15 a.m., 10:00 a.m., 1:30 p.m.)

Apostrophes (‘)
Add “’s” to plural nouns not ending in “s.”

Add only an apostrophe to plural nouns ending in “s:” the girls’ toys, the VIPs’ entrance.

Add only an apostrophe to nouns plural in form, yet singular in meaning: the measles’ effects.
Apply the same principle when a plural word occurs in the formal name of a singular entity: The United States’ wealth or Kansas’ industry.

For nouns which are the same in singular and plural, treat them the same as plurals, even if the meaning is singular: one corps’ location, the two deer’s tracks.

Add “’s” to singular nouns not ending in “s:” the church’s needs, the girl’s toys.

Add “’s” to singular common nouns ending in “s,” unless the next word begins with “s:” the hostess’s invitation, the hostess’ seat.

Use only an apostrophe for singular proper names ending in “s:” Achilles’ heel, Kansas’ schools.

Personal interrogative and relative pronouns have separate forms for the possessive. None involves an apostrophe: mine, ours, your, yours, his, hers, its, theirs, whose.

Caution: If you are using an apostrophe with a pronoun always double-check to be sure that the meaning calls for a contraction: you’re, it’s, their’s, who’s.

Use a possessive form after the last word if ownership is joint: Fred and Sylvia’s apartment.

Use a possessive form after both words if the objects are individually owned: Fred’s and Sylvia’s books.

Do not add an apostrophe to a word ending in “s” when it is used primarily in a descriptive sense: Blue Cross and Blue Shield of Kansas employees, BCBSKS customers.

Bulleted list
Put a space between the dash or bullet and the first word of each item in the list. Capitalize the first word following the dash or bullet.

Use parallel construction for each item in a list:

  • Start with the same part of speech for each item (in this example, a verb).
  • Use the same voice (active) for each item.
  • Use the same verb tense for each item.
  • Use the same sentence type (statement, question, exclamation) for each item.
  • Use just a phrase for each item, if desired.

Introduce the list with a short phrase or sentence:
Our partners:
These are our partners:
Our partners are:


Best practices for bullet points:

  1. Emphasize the beginning of the bullet point, when the first few words capture the main idea. That way, readers can skim easily.
  2. Make bullet points consistent in structure. Use parallel structure. For instance use the same verb tense at the beginning of each bullet.
  3. Punctuate bullets consistently.
    1. If all bullets are sentences, end each one with a period.
    2. If all bullets are phrases or fragments, use no end punctuation.
    3. If the lead in sentence and the bullet make a complete sentence, end each bullet with a period.
  4. Avoid ending bullet points with semicolons.
  5. Number bullet points when you have more than five.
  6. Avoid bullet points when you want to build rapport or deal with a sensitive issue.

Colons (:)
The most frequent use of a colon is at the end of a sentence to introduce lists, tabulations, texts, etc. Do not capitalize the first word after a colon unless if it is a proper noun or the start of a complete sentence.

Commas (,)

  1. Commas are always inside quotation marks.
  2. Use commas to separate elements in a series, but do not put a comma before the conjunction in a simple series: The flag is red, white and blue.
  3. Put a comma before the concluding conjunction in a series; however, if an integral element of the series requires a conjunction, a comma before the concluding conjunction may be desirable for clarity in a series of phrases: I had orange juice, toast, ham and eggs, and cereal for breakfast.
  4. Use a comma before the concluding conjunction in a complex series of phrases: The main points to consider are whether the athletes are skillful enough to compete, whether they have the stamina to endure the training, and whether they have the proper mental attitude.
  5. Use a comma between two adjectives (of equal rank) that describe the same noun: The sad, tired traveler barely caught her flight.
  6. An essential clause must not be set off from the rest of the sentence by commas: Employees who do not read the handbook should not criticize their supervisors. (The writer is saying that only one class of employees, those who do not read the handbook, should not criticize their supervisors.)
  7. A comma normally is used to separate an introductory clause or phrase from a main clause: When he had finished the project in New York, he moved back to Kansas.

Dashes (—)
Use em dashes to denote an abrupt change in thought in a sentence or an emphatic pause: We will fly to New York — if I get a raise.

Em dashes are longer than a hyphen. Put spaces on both sides of an em dash in all uses except the start of a paragraph.

Parentheses ()
Use sparingly.
Place a period outside a closing parenthesis if the material inside is not a sentence (such as this fragment).

(An independent parenthetical sentence such as this one takes a period before the closing parenthesis.)

When a phrase placed in parentheses (this one is an example) might normally qualify as a complete sentence but is dependent on the surrounding material, do not capitalize the first word or end with a period.

Percent: Always use the % sign

  • Use figures for percents and percentages (Example: 1%, 2.5%)
  • For amounts less than 1%, precede the decimal with a zero (Example: The cost of living rose 0.6%.)
  • Always use numerals with percentages, except at the beginning of a sentence. (See “Numbers” section)

Periods (.)
Periods are always inside quotation marks.

Quotation marks (“)
If a full paragraph of quoted material is followed by a paragraph that continues the quotation, do not put close-quote marks at the end of the first paragraph. Do, however, put open-quote marks at the start of the second paragraph: "I am so horrified; in fact, I will ask for the death penalty."

When using quotes within quotes, alternate between double quotation marks (“or”) and single marks (‘or’): She said, “I quote from his letter, ‘I agree with Kipling that “the female of the species is more deadly than the male,” but the phenomenon is not an unchangeable law of nature,’ a remark he did not explain.”

Use three marks together if two quoted elements end at the same time: “He told me, ‘I love you,’” she said.

Use “said” or past tense verb when identifying attribution: "Now that I've worked with a dietitian I'm more aware of portion control," Hillary said.

For placement with other punctuation, follow these rules:

  1. The period and comma always go within the quotation marks.
  2. The dash, the semicolon, the question mark and the exclamation point go within the quotation marks when they apply to the quoted matter only. They go outside when they apply to the whole sentence.
  3. Use double quotation marks for quoted words, phrases and sentences.
  4. Use single quotation marks for quotations within quotations and when emphasizing a word under discussion

Semicolons (;)

  • In general, use the semicolon to indicate a greater separation of thought and information than a comma can convey, but less than the separation that a period implies. A semicolon is used before the final “and” in a series: Katie likes prime rib; Fred is a vegetarian.
  • Place semicolons outside quotation marks.
  • Use a semicolon when a coordinating conjunction such as “and,” “but” or “for” is not present: The package was due last week; it arrived today.
  • Use semicolons to separate elements of a series when the items in the series are long or when individual segments contain material that also must be set off by commas: He is survived by a son, John Smith, of Chicago; three daughters, Jane Smith, of Wichita, Kansas, Mary Smith, of Denver, and Susan, of Boston; and a sister, Martha, of Omaha, Nebraska.
  • If you're using "however" to indicate a shift in perspective, place a semicolon before and a comma after the word "however:" The movie got good reviews; however, I did not like it.

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Sentence spacing

Never double space after any punctuation. Always use a single space.

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