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Protecting, MaintainingandImprovingtheHealthofAllMinnesotansElectronicallySubmitted July22,2019 Administrator JohnsonMemorialHospital&Home 1290LocustStreet Dawson,MN56232 RE:ProjectNumberH5485006 DearAdministrator: OnJuly1,2019,anextendedsurveywas
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Gather all necessary personal information such as name, address, date of birth, and insurance information.
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Fill out the patient information section accurately and completely.
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Sign and date the form to acknowledge that the information provided is true and accurate.
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Submit the completed form to the designated department at Johnson Memorial Hospital.

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Johnson Memorial Hospital AMP Home refers to a specific reporting form or program related to healthcare facilities or services offered by Johnson Memorial Hospital.
Typically, healthcare providers or entities associated with Johnson Memorial Hospital that meet certain criteria or thresholds are required to file this report.
To fill out the form, you should provide accurate information regarding your healthcare services, patient data, and other required fields as specified in the instructions provided with the form.
The purpose of this form is to collect data on healthcare services to ensure compliance with regulations, monitor quality, and improve healthcare delivery within the hospital system.
Information typically includes patient demographics, service utilization data, outcomes measures, and financial data related to services provided.
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