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DEPARTMENT OF HEALTH SERVICES Division of Long Term Reinstate OF WISCONSINF01812 (4/2015)WISCONSIN MEDICAID PROGRAM 2014 NURSING HOME COST REPORT Completion of this form is required by Section 1.171

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Maple Lane Health AMP is a form used to report health information for Maple Lane Health facilities.

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Health facilities operating under the Maple Lane Health system are required to file the Maple Lane Health AMP form.

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