Law For The Modification Of The Regulation Of Application No. 20 Of The Caixa Andorrana De Seguretat Social, 1-6-90

Original Language Title: Llei de modificació del Reglament d'Aplicació núm. 20 de la Caixa Andorrana de Seguretat Social, d'1-6-90

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Law for the modification of the regulation of application No. 20 of the Caixa Andorrana de Seguretat Social approved by the Hon. General Council in its traditional Sancogesma session of day 1 June 1990 Article only the regulation of application No. 20 of the Caixa Andorrana de Seguretat Social is modified as follows: Regulation of application No. 20 Saw the General Regulation, Seen the technical regulation, especially the articles 9th, 12th and 19th.

Chapter i. General provisions Article 1 The change listed in the annex of this regulation of application establish the relationship with the identification number, the letter-key and the coefficient of the professional acts that may make doctors and owners of clinical laboratories and, in the limit of its powers, the dentists and medical assistants.

These CPU cores are imposed to doctors, owners of clinical laboratories, to dentists and medical assistants, to communicate to the Caixa Andorrana de Seguretat Social, while respecting the professional secrecy, and in the interest of the patient, the type and the value of the technical acts carried out, in view of the calculation on the part of the box of their participation.

Article 2, letter identification number-key and All rate Act included in the nomenclature is designated by a number, a letter-key and a coefficient.

1) identification number: it is an alphanumeric code designating individually each Act professional.

2) Lyrics-key: it is a sign the monetary value of which is set in the legislative and regulatory provisions relating to the determination of the fees for the health care that is provided to the insured.

Key-letters that are used vary depending on the type of event: C: Query made in the Office of the general practitioner CS: Check made in the Office of the NPS Consultation by a physician specialist doctor or psychiatrist: neuropsychiatric made CD: Check made in the Office of dentist V: visit made to the address of the patient to a GP VS: visit made to the address of the patient to a specialist Q : Acts for surgical procedures k: Acts for diagnostic procedures a: Radiology Events B: clinical analysis of Acts: Acts relating to dental extractions carried out by dentists DQ: Acts relating to dental extractions performed by specialists in dentistry DO: Other acts of dentistry (made by dentists or specialists in stomatology) P: Acts relating to dental prostheses (made by dentists or specialists in stomatology) AMM : Acts carried out by physiotherapists and rehabilitators AMI: Acts carried out by graduates in nursing and nurses LOVE: Acts carried out by ortofonistes AMP: Acts carried out by the chiropodists AMU: Acts carried out by ortoptistes UD: scroll Unit 3) Coefficient: the coefficient is a number that indicates the relative value of each Act professional.

The events with key letters C, CS, NPS, CD, UD, V, VS do not have assigned an identification number.

Article 3 all healthcare professionals should indicate on the disease the notation of each Act, which will result in the identification number, the key-letter corresponding to the type of event and the quality of who runs it, the identification of the person who runs it, the total price of the Act and, finally, the coefficient laid down in the nomenclature.

Article 4 definition of the acts to assimilation If an event does not appear in the nomenclature can be assimilated to an act of the same importance is included, using, as a result, the same coefficient. In this case, the doctor should be mentioned about the disease the expression "Act assimilated to ..." followed by the identification number, the letter-key and the coefficient of the reference.

In all cases in which this procedure is used, it should be obliged to apply for the prior agreement of the Caixa Andorrana de Seguretat Social, as stated in article 7.

Article 5 Acts accepted by taking in charge or refund the box only can take charge or reimburse, as long as the people who run are in order in relation to the legislative provisions setting out the disciplinary and which refer to the exercise of their profession, the following acts: a) acts carried out personally by a doctor b) acts carried out personally by a dentist , a midwife, provided that they are of its competence c) acts carried out personally by a medical attendant, provided that they have been the subject of a written prescription, defined quantitative and qualitatively, and which are their competition except for the cases when this expressly Nomenclature, an act carried out on a patient can only be scored by a professional and be refunded if during the time of his execution, the only professional is dedicated to the care of this patient.

Article 6 Acts carried out by medium-level professionals, under surveillance and responsibility of the doctor in all cases in which a medium-level professional exercising his professional activity under the responsibility and direct supervision of a physician, you can monitor and intervene at any time, delimiting and the reimbursement is made on the basis of the key-letter corresponding to the quality of medium-level professional. In the event that the fees are received by the doctor, the disease "shall be jointly the medium-level professional, to certify the implementation of the Act, and the doctor, for the perception of the fees.

Article 7 prior Understanding The Caixa Andorrana de Seguretat Social must express the prior agreement to reimburse the acts that do not appear in the nomenclature and of other acts which are expressly indicated.

A. Regardless of the cases indicated in other regulatory texts, they must undergo the formality of the previous agreement: 1. The acts which do not appear in the nomenclature and are reembossats by assimilation, in accordance with the provisions of article 4.

2. The acts or treatments for which the obligation of understanding previously indicated on the nomenclature by a particular mention, or with the letter E.

3. laboratory procedures listed in chapter I of Title XV of the nomenclature.

B. When the Act has been subject to this formality, the patient shall, prior to the enforcement of this Act, to direct a demand of understanding prior to medical supervision-filled and signed by the physician who should pay this event – even in the case of fees paid directly to the doctor.

When the Act is one or several laboratory procedures mentioned in paragraph 3 of this article,


the demand for prior agreement must be filled and signed by the owner of the laboratory that has to carry out this Act.

When the Act has to be carried out by a professional degree, the demand for prior agreement must be accompanied by a prescription that is prescribed or of a copy of this recipe.

When the fees are paid by the box directly to the provider of the services, especially in the event of a work-related accident, the demand for prior understanding is forwarded to the box by the lender and not by the patient.

C. the date of sending of the demand of understanding previously certified by the stamp and the post date or the date of delivery to the medical assessment.

The response of the box has to go to the patient or health professional, as appropriate, within a period of 10 days following the receipt of the demand.

In the event that the patient or health professional do not receive any response within this period, the agreement is considered to be awarded. In the latter case, the Medical Control you can always intervene to give your opinion in the box on the decision by the continuation of the treatment or of the acts.

When there is an urgency manifested, the doctor performs the Act but still has to complete the formalities indicated above by signing up there is the mention: "Emergency Act". In the event that the doctor prescribes the execution of an act urgently to another health professional, the first should state in its prescription that it is an act of urgent, and the second will be noted in the demand for prior agreement made "a posteriori" the "urgent Act".

D. When the demand for prior agreement refer to the realization of tooth prosthesis devices or to acts of dentifacial orthopaedics, the absence of response on the part of the box over a period of three weeks (by exception to the general rule provided for in paragraph C) is equivalent to refusal of the request and allows the insured to start the procedure foreseen by the current legislation.

The demands of previous understanding is made in the forms established for the purpose by the box.

Article 8 global Event and simple act in) Act global: acts and, in particular, are surgical procedures that have a coefficient equal to or higher than 15 are global events. This means that the price of the Act includes, in addition to the event itself, the preoperative care;

-the aid operation possible;

-in case of hospitalization, the postoperative care during the period of 20 days after the day of the performance. However, in the event that the insured leave the hospital before the 20th day, if the doctor who performed the surgery believes that you can trust the postoperative surveillance to another doctor, the latter may receive fees for this concept;

-in case of intervention without hospitalization, the aftercare for a period of 10 days. However, if the doctor who performed the surgery believes that you can trust the monitoring of the postoperative surveillance to another doctor, the latter may receive fees for this concept;

By contrast, the price of these acts do not understand:-acts of Radiology and clinical analyses are necessary depending on the State of the sick;

-the travel expenses of the ill, when this shift is necessary for the care after the intervention;

-the supply of care.

The fees for each doctor must be inscribed on sheets of different disease, especially those of the physician assistant who attends the performance and the anesthesiologist uplifting.

B) simple Act: 1) the acts and, in particular, the surgical procedures with a coefficient less than 15 are considered simple acts. In fact, the events (care, for example) after the interventions with a coefficient less than 15 are billed in addition to the initial act.

The doctor will only be charged a consultation or a visit if the aftercare sessions in the interventions are accompanied by an examination of the patient.

2) when it comes to multiple events carried out in the course of the same session (article 11B), the aftercare are paid in part, although the total coefficient corresponding to the set of events happen 15, provided that the coefficient of each of the acts is, at most, equal to 14.

Article 9 Delimiting a second act in the term from 10 to 20 days if, during the 10 days or 20 days fixed in article 8 above quoted, a second intervention due to a modification of the status of the patient or by a condition intercurrent, the second act opens a new period, which anul.la the time you lack to cover 20 days if there was hospitalization or 10 days If it is not there.

Article 10 Procedure of a second doctor in the period of 10 or 20 days if, during the 10 or 20 days fixed in article 8 above quoted, is a medical condition that required a doctor's intervention intercurrent different from what took place the intervention, the care provided are reason for billing of fees, regardless of those who are related to the surgical procedure.

Article 11 multiple Events in the same session) Acts carried out in the same session of a query.

The fees of the consultation and of the visit cannot be accumulated with other acts executed during the same session, saved from the exceptions set forth then.

In the disease, just score the event that has the higher fees.

Exceptions: a) authorises the doctors and physicians qualified specialists, pediatricians, cardiologists or pneumotisiòlegs the accumulation of fees provided by the radioscòpic examination of the thorax with the fees of the query.

b) authorises physicians pulmonologist, and physicians of the header of the fees established by lung x-ray with the fees of the query.

c) authorises the medical GP the accumulation of fees provided by the radiological examinations of the skeleton and of the abdomen with the fees of the query up to a limit of 20.

d) the query made by a surgeon or a specialist who examines a patient for the first time in a health care setting, can only be noted about the disease, in addition to the intervention that then takes place, when this procedure is done with urgent and involves the patient's hospitalization.

B) Acts with the key-letters K, Q, AMM and AMI, made in the course of a single session.

1) When, in a single session, the same doctor performs several acts listed in the nomenclature, in the disease, will sign the Act with the highest coefficient.

The second act is then 50% of its coefficient. However, the second Act will be to


75% of its coefficient in the case of identical surgery on two symmetrical parts or organs of the body.

The events that follow the second do not motivate fees and does not have to score on the disease. Anyway, in case of multiple traumatic injuries and recent, the third act possible operative, exceptionally, scores at 50% of its coefficient.

2) in case of multiple events in the course of the same session, the doctor would not be the global coefficient, but the coefficients corresponding to each of the acts carried out, specifying, for each medical Act, the identification number.

3) When in the same session are several events on the same sick, can only motivate fees for several doctors if they are competent specialists in exclusive, or medical auxiliaries, from many different disciplines.

The acts by each doctor are scored in accordance with sections 1 and 2 indicated above.

4) the provisions of this section B) do not apply in the following cases: a) for events that require the use of ionising radiation in sessions of radiotherapy.

b) for electrodiagnostic of stimulation and for electromyogram contained in title III, Chapter 1 article 1 of the nomenclature of medical activities.

c) On the exercise of the specialists in dentistry, when a different isolated act is accomplished in the time of one of the sessions of a global treatment.

Article 12 Acts made in several time) When an act inscribed in the nomenclature in globally includes actually several successive interventions (acts on several times), the doctor is not signing the disease until they are over the different time of the intervention. In the event that interrupt these partial interventions, the doctor indicates the partial payment of the sessions made (example: Q-50 x 1/3).

Whether it is the interruption of a series of sessions with a number of established beforehand, the professional indicates the number of sessions actually made.

B) When a treatment that involves a series of repeated acts appears in the nomenclature as a global event, it must be registered in the disease only in this form and cannot be broken down into several simple events.

C) When the execution of an event planned for the naming in a single time has been carried out at various times, the global coefficient does not experience any increase, if there is no indication in the nomenclature.

Article 13 travel expenses for acts carried out in the patient's home When the health professional should carry out an act in the patient's home, you can charge a supplement in price-made for travel expenses, if the address of the patient and the doctor's professional or the laboratory analyses are not located in the same agglomeration or set of peoples.

In order to fix this supplement in price-made by displacement, will outline the Andorran territory in 11 agglomerations or sets of the following villages: 1) Agglomeration of Andorra la Vella, STA. Coloma and Escaldes-Engordany.

2) Crush of Encamp, and Les Bons.

3) Agglomeration of Canillo, meadows, l'aldosa, Plans and Ransol.

4) Soldeu and El Tarter.

5) Pas de la Casa.

6) Agglomeration of La Massana, Sispony, l'aldosa and Anyós.

7) Pal, Erts and stick.

8) Agglomeration of Ordino, Segudet and Sornàs.

9) Ansalonga, La Cortinada, Llorts, Arans, El Serrat and arcalis.

10) Agglomeration of Sant Julià de Lòria.

Auvinyà, Juberri, Fontaneda) 11 Bixessari, Certers, Llumeneres, Nagol, Aixirivall and.

The various clusters or groups of villages are separated by distance units, as defined in the following sketch: Sketch HERE THERE was a SKETCH the supplement in price-fact applicable will be the product of: a) the sum of the units that separate the patient's address of the doctor's or health professional at the laboratory of analyses, within a unit.

b) The monetary value of the displacement unit, which will be set in the agreement between the doctors and the out of the box.

The result of this product will be added to the value of the V, VS, or the value of the act carried out, defined by the nomenclature of medical activities.

The additional displacement will be in the disease with the letter-and a key to the result of equivalent coefficient UD the operation described in the preceding paragraph).

Article 14 Acts carried out during the night, Sunday or on a holiday When, in case of emergency justified by the condition of the patient, health professional intervention is sought during the night, Sunday or holiday, the events made motivate a supplement of the normal fees and, in any case, the compensation of offset.

Are considered to be acts of the night carried out between 22:00 and 9:00 pm. These acts will only motivate supplement if the request of the physician has been made between 21:00 and 08:00 hours.

A) Acts carried out by doctors, dentists and midwives. Visits on Sunday, on legal holidays, tours and pricing-made part.

The value of the key-letters V, VS and, exceptionally, C, CS and NPS, and also those of the events in Q, K, R and the price-fact part, add a supplement of Sunday or at an additional cost of night, the value of which is determined under the same conditions as the key-letters provided for in article 2.

In part, it is considered only for the granting of this supplement, the time of birth.

B) Views of the Saturday afternoon.

On visits to the home of patients who made the doctors on Saturday afternoon, is added to the value of the letter V key-a supplement of Sunday or a surcharge at night, as long as the patient has requested the doctor after 13:00.

The value of this supplement is determined as is mentioned in section A) of this article.

C) Acts carried out by medium-level professionals (and midwives when working for nursing care).

The value of the supplements in price-made for acts carried out during the night, Sunday or statutory holidays shall be determined under the same conditions as the value of the key-letters provided for in article 2.

For repeated acts of nursing, these supplements can only be registered if the prescription of the doctor indicates the imperative of an execution at night or strictly everyday.

When the health professional has received an additional fee, you will have to score on the disease.

Article 15 content of the consultation, and visit the consultation or visit generally involves a questioning of the patient, clinical examination and, if necessary, a therapeutic prescription.

Are considered to be included in the query or in the visit the diagnosis used in current practice (the measurement of the blood pressure, the exam with Speculum, the


vaginal or rectal touch, etc.) and also the small technical acts that derived (subcutaneous injection, intramuscular, intradèrmica, little care, etc.).

The query or the visit of the specialist carries the current diagnostic procedures specific to your specialty.

However, when these procedures were not accompanied by an examination of the patient (especially if they have been carried out in series), the intervention of the doctor does not have the technical value of a query. In this case, the doctor will not be entered a query or a visit, but the identification number, the letter-key and the coefficient of the diagnostic procedure performed.

Article 16 Visit to several patients When a doctor made a visit to the home of several people of the same family, only the first act is considered a visit; the following questions are considered.

The attention given to each patient has to score on a specific disease for each of them.

Article 17 Consultations in the Office of the doctor or the patient home visits Are acts which consist of doctors ' visits or consultations of doctors ' and specialists ' header, neuropsiquiatres, psychiatrists or neurologists have a coefficient equal to 1.

Article 18 medical support assistant in a surgery the physician assistant in a surgery has the right to receive a fee equivalent to: Q-10 for the acts of which the coefficient is between Q-50 and Q-79, both inclusive.

-Q-15 for the interventions with a coefficient of Q-80 or higher.

Chapter II. Provisions relating to medical fees for care for hospitalized patients Article 19 medical fees in price-made by attention to hospitalized patients do not accumulate with the acts with the letters Q and K key.

On the other hand, the fees mentioned above comprise the subcutaneous injections, intramuscular, intravenous, intradèrmiques or other acts listed in Title XVI of the nomenclature.

These security fees, you can just register a single doctor, per day and per patient examined.

Article 20 Hospitalization for medical cause For sick day and examined, the fees are as follows:-When the fees are perceived one doctor: C 0.90 x, if it is a general practitioner, or CS x 0.90, if it's a specialist. From the 30th day of hospitalization, the above coefficient is reduced to 0.50.

-When the fees are received several doctors in different specialties: C x 0.50, if it is a general practitioner, or CS x 0.50, if it's a specialist. In these cases, the intervention of more than one doctor may only take place for three days, consecutive or not.

Article 21 Hospitalization for surgical cause 1) if the patient is submitted to a surgical intervention of a coefficient equal to or greater than 15, the fees of the Act include the operative patient care during the 20 days after the intervention.

If the hospital stay lasts more than 20 days, the fees for patient care are limited to a price-made diary of C x 0.50, if it is a general practitioner, or CS x 0.50, if it's a specialist, for each additional day.

2) if the Act is of a coefficient of less than 15, the fees are fixed at: C x 0.50, if it is a general practitioner, or CS x 0.50, if it is a specialist doctor, per day and per patient examined.

3) in the event that the patient is hospitalized under observation for a cause is not surgical, finally, subject to no intervention, daily fees for your attention will be the same as article 20 sets for hospitalization for medical cause.

Article 22 Hospitalization due to The fact that it includes the part price-obstetric care for the midwife during the 12 days that follow childbirth. In exceptional cases in which the pathological State imposes the prolongation of hospitalization, the surveillance fees are fixed per day and ill due to: C x 0.50, if it is a general practitioner, or CS x 0.50, if it's a specialist.

Article 23 Establishments for mentally ill Per day and for medical surveillance, the fees examined ill fix C x 1, provided that the number of doctors from the property, qualified as a neuropsiquiatres or specialists in Psychiatry, ensuring constant surveillance in these establishments, represent at least a doctor for 30 patients; It is well understood that the same specialist cannot pretend to examine 30 patients in the course of a single day.

When, as a result of specific agreements, medical surveillance is taken into account at the time of determining the price of the day, the benefit of these agreements cannot be accumulated with the fees established above.

Chapter III. Specific provisions relating to acts of anesthesia-reanimation-reanimation anaesthesia procedures Article 24 were in charge of the Case, provided that anesthesia be administered by inhalation, injection or infiltration of roots, trunk, or by a nervous plexuses, or a combination of these methods, and carried out personally by a doctor other than the one that performed the surgery.

The acts of anesthesia-reanimation that accompany an act not warranted by a pathological State have no right to refund.

Article 25 the coefficient of each Act covers a whole anaesthesia for herself and all the events are usually entrusted to the physician who practiced anaesthesia and resuscitation (for example: intubation, blood perfusion or medicamentosa, monitoring of blood pressure, etc.), during the day of the operation and during the intervention.

The coefficient covers also the preoperative care the wake of the intervention, the postoperative surveillance and acts linked to the techniques of Resuscitation: a) in the case of hospitalisation, during the period of 15 days following the surgery. However, in the event that the patient out of the hospital before the 15th day, if the doctor who performed the anesthesia believes that you can trust the postoperative follow-up to another doctor, the latter may receive fees for this concept.

b) in the case of intervention without hospitalization, during the period of 15 days following the surgery. However, if the doctor who performed the anesthesia believes that you can trust the postoperative follow-up to another doctor, the latter may receive fees for this concept.

Article 26 the acts of anesthesia-reanimation have their coefficient indicated in the nomenclature, next to the intervention in which they are carried out.

The acts of anesthesia-reanimation which do not appear in the nomenclature with a coefficient itself and which is carried out by


in diagnostic procedures or treatment are applied to Q 25.

The acts of anesthesia-reanimation made for a diagnostic procedure or treatment that does not appear in the nomenclature, the delimiting of which is fixed in application of article 4, are valued by application of this same article.

Article 27 The acts of a particular delimiting anesthesia, such as local subcutaneous infiltration, or submucoses, have been to affect with this single delimiting.

Article 28 The anestèsies practiced in children under 4 years of age or in adults of more than 80 years, give rise to a charge of Q-10 of fees provided for in the nomenclature.

Article 29 An anesthesiologist uplifting that examines for the first time, in anticipation of an intervention, a patient hospitalized, register your query to CS though go followed by an act of anesthesia. The fees of this query are not included in the price-fact of anesthesia.

Anyway, the anaesthetist uplifting can only score a single CS before a hospitalization or during the course of this.

This CS can not accumulate or the surveillance fees or an act in Q different from price-fact of anesthesia. It must be accompanied by a report, which could be directed to the doctor Advisor of the box, to their demand.

Article 30 When a diagnostic procedure or treatment carries a surcharge or a reduction of your initial delimiting for the doctor to perform, this supplement or this reduction is applicable to the procedure of anesthesia-reanimation that accompanies it.

Article 31 the procedures of anesthesia-reanimation that accompany an act of curieteràpia are bounded, in case of intervention in the head or neck, Q-30.

Article 32 When in the course of a part, the doctor tocòleg requires the presence of an anesthesiologist uplifting that does not execute any act in Q, the latter can check a fee equal to K-10 for the surveillance of the midwife.

Article 33 A peridural anesthesia of a duration of at least two hours, made by obstetric indication in a part, with permanent presence of a doctor anesthesiologist, will invoice Q-40.

A continuous peridural anesthesia with a permanent catheter placement for treatment of pain, the rebels out of all intervention, will invoice Q-40 a day, for a maximum period of five days.

Chapter IV. Provisions relating to clinical laboratory procedures Article 34 the title XV of the nomenclature describes all clinical laboratory procedures that can make the headlines of clinical laboratories. Article 4 of this Regulation is not applicable to this title and the box does not accept billing in any laboratory procedure defined by assimilation.

Article 35 multiple Analysis in case of multiple analyses, the headline notes about the disease each and every one of the analyses carried out, respecting the order of the prescription and indicating, for each one of them, the corresponding identification number, the letter B key, the coefficient fixed in the nomenclature and the total price.

When the analysis has been sent to a laboratory in the other, the annotation of the Act is carried out in a particular disease by the laboratory running.

Article 36 minimum price When the exams with taking blood, made by a clinical laboratory, for the same sick, give rise to a total sum of coefficients of less than 20, will be able to score, in addition to the exams with taking blood, an act on premium, so that the total sum of the coefficients is 20. The identification number, the letter-key and the coefficient of this event will be the premium provided for in the nomenclature in the chapter of "acts in premium" of Title XV.

Article 37 Majoracions by the analyses carried out during the night and on public holidays.

When the Act is carried out during the night or on a holiday, the owner of the lab will be able to register the corresponding Add-ons, foreseen in the chapter of Title XV of the nomenclature.

You can only register a single add-on for all acts carried out during the night or during the day a holiday, to the same patient.

When the add-in has been perceived by the owner of the laboratory, this will have to score on the disease.

Are considered as acts carried out during the night are carried out between 22:00 and 9:00 pm, provided that the demand in the laboratory of clinical analyses has been carried out between 21:00 and 08:00 hours.

The premium is not applicable when the analyses are carried out in a laboratory implanted in a health establishment, either outpatient or hospitalization.

Article 38 multiple Extractions in the course of the same session.

When in the course of a single session is carried out several extractions, rank in the nomenclature above, on the same patient, regardless of the number of people who have made, the head of the laboratory of clinical analyses can only score on the disease the following acts, and to charge the corresponding fees:-the Act the coefficient is the highest , with the corresponding identification numbers, letter-key and coefficient.

-The second act carried out, with the corresponding identification numbers, followed by a "2", letter-key and coefficient, decreased 50%.

The other tooth extractions do not give rise to the perception of fees or must be annotated on the disease.

The provisions of this article do not apply to the multiple extractions of blood the number is greater than or equal to four. In this case, we write only the screenplay slug line planned for multiple extractions in the preliminary Chapter of Title XV of the nomenclature.

Final provisions Unica in order to allow the necessary streamlining in procedures to modify and update the nomenclature, the Government is empowered to pass the appropriate modifications prior proposal of the Board of Directors of the box or, failing that, the Minister of labour and Social Welfare.

Any amendment approved by the Government will result in the publication of the relevant Regulations to give it public knowledge.

Casa de la Vall, 1 June 1990 The General Deputy Speaker

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