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Department of Health & Human Services Centers for Medicare & Medicaid Services OMB Approval No. xxxxxxxx Medicare Outpatient Observation Notice (MOON) Patient Name: Patient ID: Physician: Date: Time:
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Moon form - day is a form used to report lunar activities and observations on a specific day.
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Information such as date, time, location, type of observation/activity, and any relevant details must be reported on moon form - day.
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