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Hospital and Community Patient Review Instrument HC-PRI NEW YORK STATE DEPARTMENT OF HEALTH OHSM-Division of Quality and Surveillance for Nursing Homes and ICFs/MR RUG II Group print name RHCF Level of Care HRF SNF Use with separate Hospital and Community PRI Instructions I. PATIENT NAME AND COMMUNITY ADDRESS IF REVIEWED IN COMMUNITY 11A. DATE OF HOSPITAL ADMISSION OR INITIAL AGENCY VISIT 49-56 - 18-25 11B. DATE OF ALTERNATE LEVEL OF CARE STATUS .

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