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FOR BHF USELL1 2022STATE OF ILLINOIS DEPARTMENT OF HEALTHCARE AND FAMILY SERVICES FINANCIAL AND STATISTICAL REPORT (COST REPORT) FOR LONGER CARE FACILITIES (FISCAL YEAR 2022) I.DPH License ID Number: Facility

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Begin by writing your first name, 'Camille', in the 'First Name' field.

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Next, write your last name, 'Lockhart', in the 'Last Name' field.

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