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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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Obtain the admission form from Crest View Nursing Home.
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Fill in all the required personal information such as name, address, contact details, and medical history.
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Sign and date the form before submitting it to the nursing home.

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Individuals who require 24-hour skilled nursing care.
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Crest View Nursing Home is a long-term care facility providing skilled nursing care for elderly residents.
The administrators or designated representatives of Crest View Nursing Home are required to file necessary documentation.
To fill out Crest View Nursing Home documentation, administrators or designated representatives must provide accurate and complete information regarding the facility's operations and residents.
The purpose of Crest View Nursing Home is to provide quality care and support for elderly residents who require skilled nursing services.
Information such as resident demographics, medical conditions, medications, care plans, and facility operations must be reported on Crest View Nursing Home documentation.
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