MEPS-HC Survey Instrument

PATIENT LABEL

REPEATING IDENTICAL VISITS CONTINUATION SHEET
FOR
HOSPITALS FOR REFERENCE YEAR 2005

M:\7690\7690.19.04\MPC 2005\Forms\HOSP\Hosp A7c ContSheet.doc - 1/26/2006 - 11:36 AM - LA

A7c. Please tell me the dates of those other visits.

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M:\7690\7690.19.04\MPC 2005\Forms\HOSP\Hosp A7c ContSheet.doc - 1/26/2006
- 11:36 AM - LA
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|__|__|
OFFICE
USE ONLY

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