reviewed by the enzi staff and these incorporate time ago and limited technical qualifications to tonawanda they are not changes and on a direct subsidy of policy. a there are editing typos. there is notable clarification which includes corrections to the definitions of the patients entered a medical home. it includes senator dodd's clarification regarding evidence informed information rather than evidence based information and as i understand senator dog that comes from the national academy of pediatrics and also included senator hatch's clarifying amendment to include chiropractors as part of the community health teams which is more than agreeable to us. in ens the standard of iom to define what is primary care and the rise authorization for such sums as may be necessary to carry out this title so that is a brief description of the amendments and ask unanimous consent that both mikulski and donna be accepted. >> is there objection? of those in favor say aye. by unanimous consent they are a great. >> the amendments are agreed to? >> yes, ma'am. >> i understand the first amendment senator r