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Medical care services, namely, providing outpatient care services for chronic obstructive pulmonary disease management that encompasses the recommendations of international guidelines for the diagnosis and treatment of obstructive lung diseases and the identification of individuals at risk for suffering obstructive lung diseases, namely, diagnosis and staging by spirometry, tobacco smoking cessation intervention, stage-specific treatment of chronic obstructive pulmonary disease, immunization for influenza and pneumococcal disease and pulmonary rehabilitation referrals in patients for whom these interventions are medically indicated