Inspection·December 3, 2025

F 0628 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete discharge.R1's Order Summary Report includes 2 orders for pass 1. May go out for 2 hour independent pass, order date 5/13/25. 2. May go out on 30 min independent pass.R1's progress noted 5/19/25 - 5/21/25 has no notation that the family was notified that R1 has not returned to the facility. Community Pass Policy dated 7/2/24 states Residents who elect not to return to the facility while out on a pass may be considered discharged against medical advice and their physician will be appropriately notified.Discharge Against medical Advice policy dated 7/2024 states call the physician and Administrator to notify them of the pending AMA discharge. Discuss the situation and follow their instructions. If available involve the resident's responsible party (e.g. family). they may be able to talk the resident out of leaving. Use your best judgment as to what must remain confidential. Confidentiality should take second priority to your efforts to assure the resident's continued health and safety. Undated Signing out Against medical Advice (AMA) policy states if the resident refuses to sign the AMA form, the form will be signed by two staff members witnessing the resident's refusal to sign. Notations of the refusal and a description of the discharge will be documented in the resident's clinical record. A trusted staff member should follow the resident to the extent possible while he/she is out of the building. Event ID: Facility ID: 145764 If continuation sheet Page 2 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some Ensure that a nursing home area is free from accident hazards and provides adequate supervision to prevent accidents. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and review of records the facility failed to follow policy on providing Community Survival Skill Assessment. Failed to follow policy to involve responsible party/family to resident discharged against medical advice ([NAME]). Failed to follow policy in procuring physician order for independent pass and failed to follow community pass and care plan intervention on restriction of resident related to independent pass for 5 out of 11 residents (R1, R2, R3, R4, R11) reviewed for resident safety during community pass. These failures apply to 2 residents (R1 and R11) who was on independent pass and did not return to facility and applies to 3 residents (R2, R3 and R4) that were allowed to go out on independent community pass without physician orders and/or has care plan for restricted pass. Findings include: R1 is [AGE] years old, initially admitted in the facility on 01/06/2025. R1 diagnosis includes Schizophrenia, insomnia, auditory hallucinations, cocaine abuse, extrapyramidal and movement disorder, major depressive disorder and suicidal ideations. R1 cognition is intact has a BIMS score of 15 per MDS assessment dated [DATE]. On 11/12/2025 at 10:41 AM, V11 (Law Enforcement Detective) stated that R1 was reported by facility missing on 05/20/2025. V11 stated that she tried contacting facility multiple times via email and phone calls, but facility was not responsive to her communication or correspondence. Per V11 there was lack of cooperation on the part of facility and to do her job she needs cooperation from facility. On 11/12/2025 at 12:38 PM, V1 (Administrator) stated that R1 went out on pass on 05/19/2025 and did not came back in the facility. R1 has a history of not returning to the facility. V1 stated that she did not contact family members listed on the face sheet and does not know if any of facility staff contacted family members. V1 said, they should have contacted those (family) on the face sheet. V1 stated that R1's current location or status is unknown. V1 said, As for now, I do not know where R1 is. Per V1 (Administrator) there was no physical copy of police report. Only the report number was given by the police. V1 stated that IDPH was not notified because it was not a case of elopement but a discharge against medical advice. On 11/12/2025 at 01:00 PM, V7 (Director of Nursing) stated that residents that are on independent pass needs to have cognition that are intact and can navigate community safely. V7 stated that there needs to be social service assessment which is community survival skill assessment and doctor's order that the resident was clinically assessed to be independent. When a resident is allowed to go out on pass independently and does not come back it will be treated as discharge against medical advice or [NAME]. Same as in the case of R1 when he left the faciity on [DATE] he was considered as discharge against medical advice or [NAME]. V7 stated that they only contact family member when they are designated as POA / Power of Attorney not when resident is responsible to self as in the case of R1. V7 stated that independent pass is based on cognition and not psychiatric diagnosis or mental illness. Resident with mental illness have medication to treat their symptoms. V7 stated that residents that have no access with medication when in the community can go to hospital. V7 stated that since police have been informed, they can help with finding R1 in the community. V7 stated that she was not aware that family was involved with R1's care or police was asking information from facility regarding R1. V7 said, Yes, if it was my family I would like to be informed. Social Service notes dated 04/29/2025 documents that R1's family is involved in his care. On 11/12/2025 at 01:35 PM, V8 (Family of R1) during phone conversation, stated that she was not informed by facility about R1. She only knew about R1 leaving when R1 went from place to place. Currently R1 at V17's (Another Facility-Current Location of R1.) On 11/12/2025 at 2:15 PM, V9 (Former Social Worker/Currently Dietary Aide) who did the Community Survival Skill assessment dated [DATE] stated that supervised pass is when someone accompanies the (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145764 If continuation sheet Page 3 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some resident compared to independent pass when resident by himself. V9 stated that family members and police need to be contacted. V9 when asked whether R1 was discharged or eloped? V9 said, I considered both as elopement and discharge. On 11/13/2025 at 11:08 AM, V4 (Licensed Practical Nurse) staff in charge when R1 went out on independent community pass and did not return to facility. V4 stated that there are two (2) kinds of out on passes. Yellow for 30 minutes and green for 4 hours. V4 stated that R1 has yellow or 30 minutes of independent pass. V4 stated that she did not check whether R1 had community survival skill assessment. According to V4 it is the nurse who first received the community survival skill assessment who will call the doctor to get the order for independent community pass. V4 stated that R1 was pretty much to himself or timid. V4 stated that it was around 06:45 PM to 06:50 PM during medication pass when she noticed that R1 cannot be located. V4 said, I notified DON (Director of Nursing), administrator and called the police. V4 stated that she cannot remember calling R1's family. He is responsible for himself. V4 stated that it was around 11:00 PM when she left the facility and R1 was not located. Nursing notes of V4 dated 05/19/2025 documents that R1 was on 30 minutes out on pass around 06:10 PM to 06:30 PM. R1 cannot be located afterwards. Nurse Practitioner and Nurse Manager was notified. Per nursing notes dated 05/20/2025 at 01:49 AM, police came in the facility. On 11/13/2025 at 12:07 PM V10 (Social Service Director) stated that Community Survival Skill Assessment will determine if resident is capable of independent community pass. Community Survival Skill Assessment is being done by social service department. After assessment is done by social service, nurse will be informed about the assessment. Nurse will then contact the doctor to give the order. V10 stated that Community Survival Skill Assessment purpose is to determine whether resident assessed can go on independent community pass. Community Survival Skill Assessment needs to be done upon admission then quarterly. V10 reviewed R1's Community Pass assessment dated [DATE]. V10 noted that R1 is capable of a supervised pass not independent pass and all newly admitted residents are on supervised community pass. V10 stated that R1 should have a follow up assessment after the initial assessment dated [DATE] since assessments are scheduled quarterly. During follow up assessment, facility staff are more familiar with R1 as compared to initial assessment. Per R1's Community Survival Skill assessment dated [DATE] day after R1 was initially admitted . It documents that R1 is capable of supervised pass not independent pass. On 11/25/2025 at 11:16 AM, V16 (Receptionist) stated that facility uses community pass forms since she started working last December 2024. Community pass forms are kept in the binder at the front desk. Residents need to let the nurse sign the pass and return to front desk for approval to leave the facility. V16 stated that it is only when receptionist allow R1 to leave the facility by pressing the red buzzer that disable the alarm and unlock the door. On 11/26/2025 at 09:48 AM, V18 (Receptionist) who worked at the time R1 left the facility stated that she cannot recall specifics about R1. V18 stated that once resident receive their community pass from receptionist. Residents take their community pass to the nurse for signing. Resident then give community pass to the receptionist desk to release the door lock and disable the alarm for resident to pass going out of the community. Per nursing notes of V12 (Licensed Practical Nurse) dated 03/24/2025 it documents that R1 did not return from community pass for 2 days since 03/21/2025. R1 refused to submit to drug test and was transferred to the hospital. R1 was positive for cocaine. [R1 has a history of not returning in the facility after community pass.] On 12/02/2025 at 02:28 PM V12 stated that after community pass on 03/21/2024, she did not see R1 for 2 days until 03/24/2025. A resident (which she could not remember) informed her (V12) that R1 was seen sleeping on the train. V12 stated that R1 was under the influence with drug and liquor upon returning in the facility, refused drug test and that was the reason that R1 was transferred to the hospital. V12 stated that when R1 came back (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145764 If continuation sheet Page 4 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some he was a different person very aggressive. Review of R1's full care plan does not address community pass identified concerns dated 03/24/2025. On 12/03/2025 at 10:14 AM, V20 (Nurse Practitioner) stated that she knows R1 because she transferred R1 from hospital to nursing home. Per V20, R1 was transferred to nursing home because he has nowhere to go and needed a place to stay. V20 stated that to get community pass, social services needs to evaluate or assess the resident. V20 said, Resident who did or has history of drug abuse should be restricted. But I cannot say up to when. Per V20, resident cannot forever be restricted for community pass. V20 stated she will give the order for independent community pass when facility staff tell her that the resident was assessed to be capable of independent pass. V20 stated that she relies on facility staff to give the information. Per V1 (Administrator) email sent on 11/26/25 reads: Those passes were not maintained; we have a different social service team. Facility is referring to R1's Community Pass form which cannot be located. R1 physician order dated 02/28/2025 documents that R1 may go out on supervised community pass with family. Physician order was changed to 2 different orders on the same date 05/13/2025. First was for 30 minutes, second was for 2 hours. R1's care plan reviewed. Care plan does not include a community pass status or history of not returning while out on pass.R1's Progress notes dated 3/18/25 states R1 is out on an independent, 2 hour pass in stable condition. The next progress note is dated 3/21/25 and states the resident has not returned to the facility from pass. DON and MD made aware. Progress notes 3/22/25 - 3/24/25 state R1 remains out of facility. On 3/24/25 progress note states writer instructed to Quick ADT resident out the system. A progress note entry for incorrect documentation is crossed off dated 3/24/25. On 3/24/25 at 8:30PM progress note entry states R1 returned to the facility 2 days later from a pass that was provided 3/21/25. R1 refused to take a drug test upon return. R1 sent to hospital via stretcher. Progress note 3/25/25 states at 4:30AM R1 returned to the unit from hospital. Per report R1 tested positive for Cocaine.Per facility's list of discharged residents for November 2025, 3 residents were discharged against medical advice. Out of 3 residents, 1 resident (R11) was discharged against medical advice after going out of the facility via community pass. Review of R11's community survival skill assessment dated [DATE] documents that R11 was on 30-day restricted community pass due to not adhering to community pass privileges. On 11/26/2025 at 01:18 PM, V1 (Administrator) stated that she does not know if police or family were informed, or why R11 was able to leave with restricted community pass. V1 provided information of R11's current apartment address and unit number and that R11 currently staying with his nephew. At 02:01 PM, V10 (Social Service Director) stated that R11 was restricted community pass for 30-days due to refusal to take a drug screening and non-adherence to community pass regulation. V10 stated that she called and left a message to R11, but R11 did not call back. V10 stated that R11 went out for community pass on 11/07/2025 due to signing of a lease agreement of his apartment as per progress notes. On 11/13/2025 at 10:07 AM, R2 was seen in front of the building, stated that he was a veteran during the war. R2 was able to verbalize during conversation with a bit hard to articulate. At front desk inside facility, V16 (Receptionist) stated that resident with independent pass needs to have a form presenting community pass forms for R2, R3, R4 and R5. On that same form the date when resident was out of the facility with time. Per V16 right now R2, R3, R4 and R5 are on independent pass. Review of R2, R3, R4 and R5's records identified concerns are as follows: R2 diagnosis includes schizoaffective disorder, depressive time. R2's physician orders dated 04/05/2025 documents that R2 may go out on supervised pass with medication. R2 has another physician order dated 10/13/2025 that documents may have 30 minutes pass to community. R2 does not have physician order that specifies independent pass. Per R2's community pass form states he was out of the facility and came back for 46 minutes. R3 diagnosis includes schizophrenia. R3 (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145764 If continuation sheet Page 5 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0689 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Some FORM CMS-2567 (02/99) Previous Versions Obsolete does not have any order to go out on independent pass. R3 has been in and out of the facility based on his community pass form. Per community pass form, R3 went out on community pass on November 4, 5, 6, 7, 8, 10, 11, 12 and 13 of 2025. R4 does not have any order to go out on independent pass. On R4's care plan dated 10/28/2025 it reads that R4 is on restricted pass due to exceeding his pass time. Community Pass Policy dated 07/02/2024: Defines the facility's and the resident's responsibility when a resident leaves the facility with community pass. A Community Survival Skills Assessment will be completed by Social Services upon resident admission, quarterly, and when there is significant change in condition. Decisions regarding pass privileges, including independent privileges or being accompanied by a responsible individual, are determine by physician's orders and social services assessments. Residents who demonstrate consistent maladaptive and problematic behaviors may not be candidates for independent privileges. Resident who elects not to return to the facility while out on pass may be considered discharged against medical advice and their physician will be appropriately notified. Policy and Procedure Discharge Against Medical Advice dated 07/2024: If available, involve the resident's responsible party (e.g. family). They may be able to talk to resident out of leaving. Also, if the resident does leave and an untoward event occurs, the responsible party would have been appropriately informed about the AMA discharge. Use your best judgment as to what must remain confidential. Confidentiality should take second priority to your effort to assure the resident's continued health and safety. Policy and Procedure Missing Resident dated 01/2025: It is the policy of this facility to report and investigate all reports of missing residents. Should an employee discover that a resident is missing from the facility, he or she should: a. Immediately report the missing resident to the Charge Nurse or Nursing Supervisor. b. Review the physician order to determine if the resident is out on an authorized leave or pass. c. Inform all staff that a resident is missing. d. Make a thorough search of the building and the premises. e. Notify the Administrator and Director of Nursing immediately if a resident is not found after the search. f. The Administrator and Director of Nursing will evaluate the situation and develop a plan of action based on the individual resident. The following steps should occur: 1. A nurse should notify the attending physician. a. Review with physician his opinion of the resident's ability to be out of the facility unsupervised. 2. Notify the resident's legal representative/ responsible party. a. Determine if friends or family know where the resident may be attempting to go. b. Contact any individuals who may be helpful in locating resident's possible destination. 3. Notify the sheriff and/or police department and file a missing person report. 4. Provide search teams with resident identification information. 5. Increase search by a more extensive search of surrounding area (several city blocks). a. Include areas where the resident had a history of spending his or her free time, etc. 6. Remain in contact with hospitals, nursing facilities, family members, etc., at least every shift. 7. Complete the incident report. 8. Initiate missing person check-off list. 9. Document appropriate notations in the medical record. 10. Contact the morgue if the resident has not been located for 24 hours. Event ID: Facility ID: 145764 If continuation sheet Page 6 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm Residents Affected - Few Safeguard resident-identifiable information and/or maintain medical records on each resident that are in accordance with accepted professional standards. **NOTE- TERMS IN BRACKETS HAVE BEEN EDITED TO PROTECT CONFIDENTIALITY** Based on interviews and review of records the facility failed to coordinate with law enforcement agency in providing information related to 1 out of 5 residents (R1) reviewed for independent out on pass. These failures affected 1 resident (R1) who left the facility during community pass did and not return. The facility is unable to report R1's whereabouts and status. Law enforcement agency unable to proceed in finding or knowing resident (R1) status due to lack of cooperation by facility.Findings include:R1 is [AGE] years old, initially admitted in the facility on 01/06/2025. R1'S diagnosis includes Schizophrenia, insomnia, auditory hallucinations, cocaine abuse, extrapyramidal and movement disorder, major depressive disorder and suicidal ideations. R1 cognition is intact has a BIMS score of 15 per MDS assessment dated [DATE].On 11/12/2025 at 10:41 AM, V11 (Law Enforcement Detective) stated that R1 was reported by facility missing on 05/20/2025. V11 stated that she tried contacting facility multiple times via email and phone calls, but facility was not responsive to her communication or correspondence. Per V11 there was lack of cooperation on the part of facility and in order to do her job she needs cooperation from facility. On 11/12/2025 at 12:38 PM, V1 (Administrator) stated that R1 went out on pass on 05/19/2025 and did not came back in the facility. R1 has a history of not returning to the facility. V1 stated that she did not contact family members listed on the face sheet. And does not know if any of facility staff contacted family members. V1 said, they should have contacted those (family) on the face sheet. V1 stated that R1's current location or status is unknown. V1 said, As for now, I do not know where R1 is. V1 stated that she will check her email to confirm about V11's email. Per V1 (Administrator) there was no physical copy of police report. Only report number was given by the police. V1 stated that IDPH was not notified because it was not a case of elopement but a discharge against medical advice. On 11/12/2025 at 01:00 PM, V7 (Director of Nursing) stated that residents that are on independent pass needs to have cognition that are intact and can navigate community safely. V7 stated that there needs to be social service assessment which is community survival skill assessment and doctor's order that the resident was clinically assessed to be independent. When a resident is allowed to go out on pass independently and does not come back it will be treated as discharge against medical advice or [NAME]. Same as in the case of R1 when he left the faciity on [DATE] he was considered as discharge against medical advice or [NAME]. V7 stated that they only contact family member when they are designated as POA / Power of Attorney not when resident is responsible to self as in the case of R1. V7 stated that independent pass is based on cognition and not psychiatric diagnosis or mental illness. Resident with mental illness have medication to treat their symptoms. V7 stated that residents that have no access with medication when in the community can go to hospital. V7 stated that since police have been informed, they can help with finding R1 in the community. V7 stated that she was not aware that family was involved with R1's care or police was asking information from facility regarding R1. Yes, if it was my family I would like to be informed. Social Service notes dated 04/29/2025 documents that R1's family is involved in his care. Per nursing notes dated 05/20/2025 at 01:49 AM, police came in the facility. On 11/12/2025 at 02:04 PM V3 (Medical Records) denies receiving email or call from V11 (Law Enforcement Detective). V3 stated face sheet is allowed to be given to law enforcement agency, and she will address the issue.On 11/13/2025 at 11:50 PM, V2 (Assistant Administrator / Human Resource) denies any email or call from V11 (Law Enforcement Detective). V2 stated that that kind of email will be received by V1 (Administrator). On 11/13/2025 12:49 PM, V1 (Administrator) confirmed that she received email from V11 and has yet to respond. V1 was also informed that besides email, phone calls (continued on next page) FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145764 If continuation sheet Page 7 of 8 Printed: 05/15/2026 Form Approved OMB No. 0938-0391 Department of Health & Human Services Centers for Medicare & Medicaid Services STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CLIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION 145764 B. Wing A. Building (X3) DATE SURVEY COMPLETED 12/03/2025 NAME OF PROVIDER OR SUPPLIER STREET ADDRESS, CITY, STATE, ZIP CODE Morgan Park Healthcare 10935 South Halsted Street Chicago, IL 60628 For information on the nursing home's plan to correct this deficiency, please contact the nursing home or the state survey agency. (X4) ID PREFIX TAG SUMMARY STATEMENT OF DEFICIENCIES (Each deficiency must be preceded by full regulatory or LSC identifying information)

F 0842 Level of Harm - Minimal harm or potential for actual harm were also made by V11. V1 stated she will address issue at hand. V1 provided an email dated 10/18/2025 that documents V11 asking information and notifying facility that a call to V3 (Medical Records Manager) was made multiple times. Residents Affected - Few FORM CMS-2567 (02/99) Previous Versions Obsolete Event ID: Facility ID: 145764 If continuation sheet Page 8 of 8