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PRINTED: 12116/2015 FORM APPROVED OMS NO. 09380391DEPARTMENT OF HEALTH D HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF Deficiencies AND PLAN Of CORRECTION0(1) PROVIDERiSUPPLIERlCUA

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Aex32 print - nursing is a form used to report nursing activities related to patient care.

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Information such as patient demographics, care provided, medication administration, and any incidents or complications must be reported on aex32 print - nursing.

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