Get the IN LIEU OF FORM CMS-2552-96(042005) PREPARED 11242008 1147 FORM APPROVED OMB NO - hfs illinois

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Health Financial Systems MCRIF32 FOR OAK PARK HOSPITAL THIS REPORT IS REQUIRED BY LAW (42 USC 1395g; 42 CFR 413.20(b)). FAILURE TO REPORT CAN RESULT IN ALL INTERIM PAYMENTS MADE SINCE THE BEGINNING
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