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DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES MEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL ID: 160E PART I TO BE COMPLETED BY THE STATE SURVEY AGENCY Facility

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Kathryn Serie Unit Supervisor is a designated individual responsible for overseeing a particular unit within an organization.

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Information such as the name of the supervisor, unit details, and contact information must be reported on the Kathryn Serie Unit Supervisor form.

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