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DEPARTMENT OF HEALTH SERVICES Division of Medicaid ServicesSTATE OF WISCONSINF01812 (9/2017)WISCONSIN MEDICAID PROGRAM 2017 NURSING HOME COST REPORT Completion of this form is required by Section
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Obtain the necessary forms from ManorCare Health Services.
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Fill out the forms with accurate and complete information.
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Make sure to include all required documents such as insurance information and medical history.
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Submit the completed forms to the appropriate department at ManorCare Health Services.

Who needs manorcare health services?

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Individuals who require skilled nursing care and rehabilitation services.
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Seniors who need assistance with daily activities and medical treatment.
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People with chronic medical conditions requiring long-term care.
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ManorCare Health Services offers a range of rehabilitation, skilled nursing, long-term care and hospice services.
Healthcare facilities and providers who offer services covered by ManorCare Health Services.
ManorCare Health Services forms can be filled out electronically or by hand, following the instructions provided.
The purpose of ManorCare Health Services is to provide quality and compassionate care to patients in need of rehabilitation, skilled nursing, long-term care, and hospice services.
Information such as patient demographics, medical history, insurance information, and details of services provided must be reported on ManorCare Health Services forms.
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