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DEPARTMENT OF HEALTH SERVICES Division of Medicaid ServicesSTATE OF WISCONSINF01812 (9/2020)WISCONSIN MEDICAID PROGRAM 2020 NURSING HOME COST REPORT SCHEDULE 1: Facility & Preparer Information 0 SECTION
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Crossroads care center is a facility that provides care services for individuals in need.
The administrators or authorized representatives of the crossroads care center are required to file.
The form can be filled out online or on paper, providing all required information accurately.
The purpose is to report the financial and operational status of the care center.
Information such as revenue, expenses, staff numbers, patient demographics, and care services provided.
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