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Medicare
Line 115--If this is an all inclusive rate provider (see instructions in CMS Pub. 15-1, 2208), enter the applicable method (A, B, or E only) in column 2
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CR-115 DEFENDANTS STATEMENT OF ASSETS
It is a misdemeanor to make any willful misstatement of material fact in completing this form. (Pen. Code, 1202.4(f)(4).) (Attach additional sheets if the
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