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Get MO 580-2761 2016-2024

Will complete the following based on a census which includes residents who are currently out of the facility for any reason, but whose return is anticipated. FACILITy NAme RCFI AddRess (sTReeT, CITy) CApACITy NO. Of ReSIdeNTS CeNsus 1. 2. 3. 4. 5. 6. 7. 8. RCFII ALFI ALFII AduLT dAy CARe pARTICIpANTs FACILITy Id NumBeR dmh pLACed ResIdeNTs CATegORy Residents using canes walkers wheelchairs (list number of each) Residents requiring staff assistance with tran.

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