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["FORM CMS-2552-10 (DRAFT) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 4058)"]
["Rev. 1",{"$nulls":10},"40-633"]

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["40-634",{"$nulls":10},"Rev. 1"]

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["FORM CMS-2552-10 (DRAFT) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB. 15-II, SECTION 4060)"]
["Rev. 1",{"$nulls":10},"40-635"]

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[]
["Note:  The data for the SNF and NF on lines 8 through 11 are included in the Medicare and Medicaid lines 4 through 7."]
{"$rows_empty":30}
["FORM  CMS-2552-10 (DRAFT) (INSTRUCTIONS FOR THIS WORKSHEET ARE PUBLISHED IN CMS PUB.  15-II, SECTION 4063)"]
[]
["Rev. 1",{"$nulls":6},"40-645"]