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NHSN.10.9Hi everyone. Welcome to today’s webinar. Thank you so much for joining us to go over the requirements for Healthcare Personnel Influenza Vaccination Summary Data Reporting in Inpatient Rehabilitation Facilities in NHSN. If you have any questions during the webinar, please enter them into the Q&A box that appears in the Adobe Connect screen, and we will answer them aloud after the slide presentation. It is my pleasure to turn things over to Elizabeth Kalayil.Thank you, Megan. Welcome to the Healthcare Personnel Safety Component Training Session for the Influenza Vaccination Summary of the Healthcare Personnel Vaccination Module. My name is Elizabeth Kalayil, and I work as a contractor in the Immunization Services Division at CDC. So, this presentation will cover several topics. The first objective is to provide an overview for NHSN users on using the Healthcare Personnel Safety Component. We will then review the reporting requirements for the Healthcare Personnel Vaccination Module. Next, we will go over how to enter data in the module and how to verify successful submission of data. We will now go over a few aspects of using the Healthcare Personnel Safety Component. As you know, inpatient rehab facilities, or IRFs, can either be freestanding facilities or units within affiliated acute care or critical access facilities. There are important differences in the way healthcare personnel influenza vaccination summary data are entered into NHSN for these two types of IRFs. Please be sure to pay special attention to the guidance for your specific facility type. Freestanding facilities will be referred to as freestanding IRFs and units within affiliated acute care or critical access facilities will be referred to as IRF units. To combat NHSN access issues due to staff turnover, vacation, or extended leave, we recommend that each facility has at least two individuals who can at least add, edit, delete, and analyze the healthcare personnel influenza vaccination summary data in NHSN at all times. Any current user with administrative rights, which includes the NHSN facility administrator, can add a new user to the NHSN facility. To add an additional user to an NHSN facility, click on ‘users’ and then ‘add’ on the left-hand navigation bar. On the ‘add user’ screen, complete all fields that are marked with an asterisk. The user ID can be any combination of letters and numbers. For example, the user’s first initial and last name or the user’s internal employee ID number. Next, please enter the user’s first name, last name, phone number and e-mail address. Then click on ‘save.’ The ‘edit user rights’ screen will appear after you save the new user information. Select the appropriate level of rights to give to the new user. This step must be completed for new users to have access to any system features within the Healthcare Personnel Safety component. If you are unsure about the level of user rights to assign to a new user, please contact the NHSN HelpDesk for assistance. Once the new user information has been saved, that user will receive an automated welcome to NHSN e-mail with the instructions to begin the process of becoming an NHSN user. After agreeing to the NHSN rules of behavior, the new user will receive an automated e-mail to register with SAMS. SAMS stands for Secure Access Management Services and provides secure online access to CDC applications such as NHSN. All NHSN users are required to complete the same SAMS identity verification process prior to gaining access to NHSN. After registering with SAMS, the new user receives instructions to create a SAMS account and complete an identity verification process. During this process, new users should be sure to follow the instructions carefully to prevent delay in processing documentation. The user will receive confirmation from SAMS once these documents are approved and a SAMS grid card will be delivered to their home address. They will then be able to access the NHSN facility using SAMS credentials.Please keep in mind that the new user has 30 days to begin the SAMS registration process and 60 days to return the identity proofing documentation. If those deadlines are not met, the user will need to reach out to NHSN to be re-invited to SAMS to start the process from the beginning. Please note that it can take at least two to three weeks for a new user to be able to access NHSN. CDC recommends that new users begin the onboarding process well in advance of reporting deadlines. Users should be sure to login to NHSN using their SAMS card at least one time each year so that it will remain active. Please note that if your account is inactive and you try to enter your data, this may delay your reporting. Because the SAMS card is user-specific and not facility-specific, an individual with user access to multiple NHSN facilities through the same e-mail address could enter data into multiple NHSN facilities using the same single SAMS card. Additionally, an individual can keep their SAMS card and simply change the e-mail address on the SAMS account if they should begin working at a new facility. More information about the SAMS process can be found using the link listed on the slide. NHSN highly recommends that if there is a change in the NHSN facility administrator, he or she should transfer that role to another user in NHSN prior to leaving the facility. This saves a significant amount of time for the newly designated facility administrator and prevents a gap in access to your NHSN facility. If the previously designated NHSN facility administrator has left your facility prior to reassigning that role to another person, you will need to reach out to the NHSN HelpDesk to have that role manually re-assigned to the new administrator. To complete this process, a letter must be faxed to the NHSN HelpDesk using the number listed on the slide. The letter should be from an official at your facility requesting that you be assigned as the new NHSN facility administrator since the previous facility administrator is no longer with the facility. In addition to the name and e-mail address of the new facility administrator, the letter should include the name and e-mail address of the old facility administrator as well as the facility name and 5-digit NHSN ID number, if that’s known. Please do not re-enroll this facility in NHSN. After the NHSN HelpDesk receives the fax and completes the re-assignment, the newly designated facility administrator will receive the welcome to NHSN e-mail to start the new NHSN user onboarding process. If the newly-assigned facility administrator was already an NHSN user with a SAMS card, then no further action is required. Now we will review the specific reporting requirements for the healthcare personnel influenza vaccination summary data. There are three required denominator categories. One category consists of employees while the other two categories consist of non-employees. One non-employee category is licensed independent practitioners and the other non-employee category includes adult students, trainees, and volunteers. To be included in the denominator, all healthcare personnel must be physically present in the facility or at least one working day during the reporting period, and this is between October 1st through March 31st. This slide shows the top portion of the healthcare personnel influenza vaccination summary form which lists all the denominator categories. The first required denominator category is employees. Employees are defined as all persons receiving a direct paycheck from the healthcare facility regardless of clinical responsibility or patient contact. The second denominator category consists of non-employee licensed independent practitioners; specifically, physicians, advanced practice nurses, and physician assistants who are affiliated with the healthcare facility but are not on the facility’s payroll and that’s regardless of clinical responsibility or a patient contact. This category also includes post-residency fellows. The third required denominator category consists of non-employee adult students, trainees, and volunteers who are age 18 and over. This is defined as medical, nursing, or other health professional students, interns, medical residents, or volunteers age 18 or older who are affiliated with the healthcare facility but are not on the facility’s payroll, again, regardless of clinical responsibility or patient contact. The fourth denominator category consists of non-employee contract personnel. Reporting for this category is optional at this time. Contract personnel are defined as persons providing care, treatment, or services at the facility through a contract and who do not fall into any of the other denominator categories. Some examples include dialysis technicians, occupational therapists, admitting staff, and pharmacists. Please refer to appendix A of the healthcare personnel influenza vaccination summary protocol for a suggested list of contract personnel. If a facility decides to report contractor data, it can note which categories of contract personnel are included in their data by using the comments function in NHSN. The numerator includes healthcare personnel who received an influenza vaccination during the time from when the vaccine became available, for example, August or September through March 31st of the following year. There are five numerator fields in the NHSN module covering four numerator categories and these are mutually exclusive. This slide shows the numerator fields as they appear on the healthcare personnel influenza vaccination summary form. The categories include influenza vaccinations received at the healthcare facility or elsewhere, medical contraindications, declinations, and unknown vaccination status. The first numerator category is healthcare personnel who received an influenza vaccination either at this healthcare facility or elsewhere. Please note that these are two separate fields in the NHSN module. The first field includes healthcare personnel who received an influenza vaccination at this healthcare facility since influenza vaccine became available this season. The second field includes healthcare personnel who were vaccinated outside the healthcare facility since influenza vaccine became available this season and provided a written report or documentation of vaccination. Acceptable forms of documentation include a signed statement or form, an electronic form or e-mail from the healthcare worker, or a note, receipt or vaccination card from the outside vaccinating entity. Verbal statements are not acceptable for the module.The second numerator category is healthcare personnel who have a medical contraindication to the influenza vaccine. For this measure, for inactivated influenza vaccine, accepted contraindications include a severe allergic reaction after a previous vaccine dose or to a vaccine component including egg protein, or a history of GBS within six weeks after a previous vaccination. Healthcare personnel who have a medical contraindication to live attenuated influenza vaccine, other than a severe allergic reaction to a vaccine component, or a history of GBS within six weeks after a previous influenza vaccination, should be offered the inactivated influenza vaccine by their facility, if that’s available. Therefore, the medical contraindications stated above are the only accepted contraindications for this module. Documentation is not required for reporting a medical contraindication, and verbal statements are acceptable.The third numerator category is healthcare personnel who are offered and declined to receive influenza vaccine. Documentation is not required for reporting declinations. The fourth numerator category is healthcare personnel with unknown vaccination status, or they did not meet any of the criteria for the other numerator categories.Healthcare personnel working in an IRF unit that is mapped as an inpatient rehabilitation ward within an acute care facility or has a T or R in the third position of the CCN should be reported separately from the acute care facility in NHSN to fulfill requirements of the CMS Inpatient Rehabilitation Quality Reporting Program. This is important, as if it is not done, the IRF unit will not receive credit from CMS for data reporting. However, if a healthcare worker from the IRF unit also works in the acute care facility during the influenza season and meets protocol definitions, then that individual should also be included in the acute care facility’s summary data. Data from multiple IRF units located within a single facility should be combined and submitted to NHSN as a single summary data report. IRFs that are freestanding should enroll in NHSN separately and report their data separately. This slide reviews a few points about reporting requirements. Facilities are only required to report data once each influenza season after the reporting period of October 1st through March 31st has ended. Healthcare personnel in the denominator population who received an influenza vaccination during the time from when the vaccine became available, for example August or September through March 31st of the following year, are counted as vaccinated since influenza vaccine for a given season may be available as early as August or September. So, for example, an employee who receives influenza vaccine in August and physically works in the facility for one day or more during the October 1st through March 31st reporting period should be included in the data. Also, IRFs participating in the CMS Inpatient Quality Reporting program are still required to report healthcare personnel influenza vaccination summary data through NHSN, although reporting patient influenza vaccination is no longer required. Now I will turn the presentation over the Megan Lindley who will review data entry.Thanks, Elizabeth. My name is Megan Lindley and I work in the Immunization Services Division at CDC. Now we will go over data entry in NHSN. Facilities must use SAMS and can access the NHSN activity homepage by clicking on the link listed on this slide. You will then need to enter your SAMS username and password followed by your SAMS grid card numbers. If you have questions or need assistance with using SAMS, please contact the SAMS HelpDesk toll-free by phone or via e-mail using the information listed here. This slide shows the NHSN landing page that you will see when you login. Select the appropriate component, which in this case is Healthcare Personnel Safety, and the facility from the dropdown boxes. Next, click the ‘submit’ button to proceed. We want to remind you when you’re navigating through NHSN, please use the NHSN buttons to move forward and back rather than using your browser buttons, and please note that when navigating through NHSN, you can always see which facility, user, and component are in use at the top of the screen, and that’s displayed in the screenshot at the bottom of this slide.This slide shows the Healthcare Personnel Safety Component homepage. You will see that there is a navigation bar on the left-hand side of the page which you can use to access different parts of the module. First, facilities need to complete one monthly reporting plan for the entire influenza season. Please note that only acute care or critical care access hospitals who have a CMS IRF unit mapped within their NHSN facility will see this screen when adding a monthly reporting plan. Acute care and critical access hospitals with IRF units will need to select the appropriate month and year from the dropdown menus. Each facility or unit should check the appropriate boxes for ‘influenza vaccination summary’ under the Healthcare Personnel Vaccination Module heading. For example, to report data on inpatient and outpatient units for the acute care hospital, you check influenza vaccination summary for the hospital. To report data for an IRF unit that is part of the acute care or critical access hospital, you would check influenza vaccination summary for inpatient rehabilitation facility unit or units. Please note that to report both hospital units and IRFs, both boxes on the reporting plan should be checked.This slide shows what freestanding IRFs will see on their screen in NHSN when adding a monthly reporting plan. For both facility types, to add a monthly reporting plan, click ‘reporting plan’ and then ‘add’ on the left-hand navigation bar. Select the correct month and year from the dropdown menus. For example, if you are reporting data for the 2019-2020 influenza season, you can select ‘October 2019’ for your monthly reporting plan. It is extremely important to correctly submit your monthly reporting plan which includes identifying the correct influenza season because reporting plans that identify the wrong influenza season will not allow your data to be submitted in fulfilment of CMS requirements. Next, as shown on the previous slide for IRF units, users should select the box next to ‘influenza vaccination summary’ under the Healthcare Personnel Vaccination Module. After making the appropriate selections, the user must click the ‘save’ button to save the reporting plan.After completing the monthly reporting plan, facilities will need to enter their data into NHSN. To enter summary data, go to ‘add’ under ‘flu summary’ on the navigation bar. Click ‘continue’ to proceed as influenza vaccination summary data appears as the default option on the dropdown menu. Please remember that you will not be able to enter your influenza vaccination summary data until you have first added a monthly reporting plan. Again, for this slide, we are starting with the view for IRF units within acute care or critical access hospitals. Please note that users must complete all fields marked with an asterisk on this page. Influenza and seasonal are the default choices for vaccination type and influenza subtype. Next, the user will then select the appropriate flu season in the dropdown box. For example, if you are reporting data for the 2019-2020 influenza season, you must select 2019-2020 in the dropdown box. As noted previously, this is very important since data submitted under the incorrect influenza season will not be shared with CMS and therefore will not fulfill the IRF QRP reporting requirements. Facilities can always contact NHSN if they are unsure of which influenza season is currently being reported. The user should check the appropriate location from the dropdown box. For example, to report data on inpatient and outpatient units for the hospital, you would select ‘hospital.’ To report data for an inpatient rehabilitation unit that is part of the acute care or critical access hospital, you would check ‘IRF units.’ Please note that to report data for both hospitals and IRF units, a summary report should be submitted for each, so you would essentially go through these steps twice, selecting hospital once and IRF unit once, assuming you’re responsible for reporting your hospital, of course. Similar to the monthly reporting plan, freestanding IRFs will see a different screen when adding summary data. Again, you must complete all fields marked with an asterisk on this page. Influenza and seasonal are the default choices for vaccination type and influenza subtype. Again, users should select the appropriate influenza vaccination season in the dropdown box, and this is required for your data to be shared with CMS. You can see on this screen that there is no location dropdown box because the freestanding IRF is considered a whole facility within itself. This slide shows what the data entry screen looks like in the NHSN module. The asterisks on the screen indicate the columns that must be completed. Users can use the tab key on a computer keyboard to move across the columns. Users should enter a ‘zero’ into a field if no healthcare personnel at the facility fall into that category because, again, those asterisks indicated required entries so you will not able to save your summary data without having something in there. The comments box can be used to enter additional information, usually side notes or reminders. However, this information cannot be analyzed within NHSN. Once the data have been entered, click the gray ‘save’ button to save the record. Please note that the summary data report must be entered into NHSN prior to the May 15th reporting deadline in order to have your data shared with CMS to meet the IRF Quality Reporting Program requirements. Any data that are entered after the May 15th reporting deadline will not meet the submission requirements for the program. For each update of the influenza vaccination summary data after the initial entry, you will first see a message displayed at the top of the screen indicating that a record of the summary data already exists. The date last modified shows when the data were last entered and saved. To edit your influenza vaccination summary data report, click ‘edit’ at the bottom of the screen. Once you have completed any edits to the data, be sure to click the ‘save’ button at the bottom of the screen to save your updated data. You should see a message confirming that your data have been saved, which will appear at the top of your screen, and the date last modified will also be automatically updated by NHSN.We will now go over how facilities can verify their data entry in NHSN. After healthcare personnel vaccination summary data have been entered into NHSN, users can verify that the data have been saved correctly by running a report within the NHSN analysis feature. This report can be found in the CMS reports folder under the inpatient rehabilitation facility’s sub-folder. By clicking the gray ‘run’ button next to this report, the facility can review the healthcare personnel influenza vaccination data by influenza season, stratified by healthcare personnel category which are those employees, licensed independent practitioners, adults, students, trainees and volunteers, as well as all three categories combined. This report shows the exact information that will be submitted to CMS for your facility. Remember that by default the results will appear in a separate HTML window. If a second window does not appear when you click the ‘run’ button, please be sure to check your pop-up blocker and allow pop-ups from . You can refer to the link on this slide for step-by-step guidance for running and interpreting this report. In addition to running the CMS line listing described in the previous slide, IRFs can confirm two other pieces of information within NHSN to ensure their data will be shared with CMS appropriately. Both pieces of information can be confirmed on the facility information screen within NHSN. So first starting with IRF units, to get to the facility information screen, click on ‘facility’, then ‘facility info’ in the left-hand navigation bar. First, verify that the correct acute care or critical access facility CMS certification number, or CCN, and CCN effective date have been entered correctly. Your CCN effective date should be the date that your facility first received its CCN from CMS. If you cannot obtain or do not know that date, but it was prior to January 1st, 2017, please use January 1st, 2017 as your CCN effective date. You also need to ensure that your facility is enrolled in NHSN as the correct facility type for acute care facilities; for example, HOSP-GEN for general hospitals, CAH for critical access hospitals, HOSP-SURG for surgical hospitals, etc. If your facility is not correctly enrolled according to the facility information page, please contact nhsn@ for assistance. In addition, IRF units should review the specific details for the IRF unit of the acute care or critical access facility by going to the ‘locations’ tab under ‘facility’ on the left-hand navigation bar in NHSN. Ensure that “yes” is selected for the question: “Is this location a CMS IRF unit within the hospital?” Also, please ensure that the correct CCN and CCN effective date that are specific to the IRF unit are entered on this page. This is important because for IRF units it’s that specific CCN that is used to transmit your information to CMS. As long as your data appear in the CMS line listing for the current reporting period, your CCN and CCN effective date are correct for both your IRF units and acute care facility, and your facility is enrolled in NHSN correctly, no further action is required on your part. Your data will be shared with CMS following the reporting deadline. Please note that NHSN does not provide a confirmation e-mail to facilities once they have submitted their data. CDC recommends that facilities maintain printed copies or screenshots of their data entry for their records.For freestanding IRFs, verification steps are simpler. You can verify that the correct facility, CMS certification number and CCN effective date have been entered. You also need to ensure that your facility is enrolled in NHSN as the correct facility type. So, all freestanding IRFs should be enrolled as the facility type HOSP-REHAB. If your facility is not correctly enrolled, please contact nhsn@ for assistance. This is very important, as only data from facilities enrolled as HOSP-REHAB will be shared with CMS for freestanding facilities. As long as your data appear in the CMS line listing for the current reporting period, your CCN and CCN effective date are current, and your facility is enrolled correctly, again, no further action is required on your part for your data to be shared with CMS. Facilities can visit the NHSN website using the link on this slide. The website contains links to the protocol, data collection forms, frequently asked questions, comprehensive training slides, and recorded trainings for healthcare personnel influenza vaccination summary data reporting. Please note that the comprehensive training slides include more detail on topics such as data reporting and analysis features. Therefore, new facilities may find it helpful to also refer to these slides in addition to this training. If you have any questions about NHSN, please send an e-mail to user support at nhsn@. You should also include ‘HPS flu summary’ in the subject line of the email and specify ‘IRF,’ as this will allow us to more quickly assist you. This concludes the slide presentation for this webinar and we now have the opportunity to take questions. Again, if you have a question that you would like for us to address, please enter it into the Q&A box on your screen and we will read it aloud and answer it. We have a question about a psychiatric unit. The question is our hospital will be adding an in-patient psychiatric unit to our facility next year. How do I add a unit to a reporting plan? And this is helpful because it’s actually relevant to any of your facilities that might be adding an IRF unit and don’t already have one.So the screen that I showed you—I think I can click back to it—so this is a location screen in NHSN and in order for an IRF or IPF unit to appear in your reporting plan, you have to first map it as a location of your facility. So, you can do that by going to the locations entry under the facility heading in that left-hand navigation, adding a new location, and entering these data. I know that we’ve been recently advised that there is going to be some new guidance from CMS about adding these units for facilities that previously were not able to map this particular location in NHSN, so if your question is related to that, we are aware of that. We are working on it, and you can e-mail us at nhsn@ for additional information, but the short answer is for an existing facility, existing unit, that you can’t map in your facility now, you go to locations, , add a new location, enter the relevant data including that CCN, and it will appear on your reporting plan to add.It looks like our next question is: “Is there a separate webinar for acute care facilities?” So, this year we’ve given refresher trainings for the IRFs and the long-term acute care facilities. We did not give a refresher training for acute care facilities, although you can go on the CDC website, particularly the NHSN website in the acute care facility tab and there’s a link to training slides and pre-recorded presentations that we gave last year that are still relevant to facilities reporting data for this year. You can always refer to those trainings and listen to those recordings and review the transcripts as well. And then, of course, if you have any questions after doing that, you can always contact us at nhsn@. Our next question is somebody who wishes to confirm that you only enter data on one occasion at the end of the required season, so at the end of March, and that is correct for this reporting, which we know is unique compared to the reporting that you do in the Patient Safety Component for other healthcare acquired infections. You only need to submit a single report for the influenza vaccination summary data for healthcare personnel and that does cover the entire season. If you wish to enter the report throughout the season in order to track your performance for your own internal use, you’re certainly welcome to do that, and that’s why we showed you how to edit the report earlier in this webinar, but each time you enter the report, the data on that screen would be overwritten so ultimately only one report would be saved and you’re only required to enter that one report after the March 31st reporting period ends, but prior to the May 15th deadline.Our next question is: “Do we still need to report flu vaccination data for inpatient psychiatric facilities? So many of you are probably aware that CMS suspended the requirements for inpatient psychiatric facilities and that started with the 2018-2019 flu season. So that has to do with CMS reporting requirements; however, we are encouraging the facilities to check with their state and other reporting entities just to make sure that reporting to their state or other localities is also cancelled. For example, some states may still want their IPFs to submit data through NHSN, so that’s one thing that we encourage everyone to follow-up on.Our next question is: “Can data be changed for the prior flu season? Absolutely. At any time, you can go into NHSN and look up your data for previous influenza seasons using the ‘find’ function. I’m clicking backwards through our slides and see if I can pull up the navigation bar while I’m talking. So, on this screen, you see the left-hand navigation bar under ‘flu summary.’ You can always select ‘find’ and it will appear as a list of prior seasons. You select the season you’re interested in the dropdown box and click ‘find’ and the summary vaccination report that you submitted for that season will come up and then you can edit it as we showed you on the prior slides. The important thing to note is that once that May 15th deadline has passed each year, we transmit the data to CMS and we do not send data to them again, so those changes that you would make for prior seasons would be for your own internal tracking purposes, but they will not be shared with CMS.Those are all the questions that we have. While we’re waiting for any final questions, I did want to remind people that these slides for this presentation are available to download here in the Adobe Connect pod, so if you’d like to obtain a copy of these slides in order to be able to access the URLs we referenced, you can download them there. So, we had a question, I’ll review again how to pull the previous year’s report. Sure. You would, in the Healthcare Personnel Safety Component login like this, you would look at the left-hand navigation bar, click on ‘flu summary’, and then rather than clicking on ‘Add’ to add a new one, you would click on ‘Find’ and when you do that, it will bring up a drop-down box that has all the previous seasons. You’d select the season that you’re interested in and then click the ‘Find’ button, and the report will appear on your screen. You can print it, edit it, whatever you would like to do.This real time chat is fun. Sorry, the analysis report. So, I will go quickly over that slide again since we have time and then if this doesn’t answer your question, you can always e-mail us at nhsn@. So, here’s the analysis entry in that left-hand navigation bar. So, under ‘analysis,’ when you look for that, you will see the menu that’s displayed on this slide. There’s a variety of different canned analyses that you can do on your data and as we noted, there’s a lot more detail about this in the full set of slides that’s on the NHSN website, so you can review that for additional details, but to review the data that will be sent to CMS, you can run the CMS line listing report. Our next question is: “Can we enter the data weekly or will each weekly erase the previous entry? So, you can enter the data as frequently as you like, so weekly is fine or monthly, but please note that once you update your data, the previous data that you entered will be overwritten. If you would like to keep a record of your previous data, we suggest that you print that out before you enter your new data. Also, we just wanted to let everyone know that entering one flu season report for the entire flu season is also acceptable, and the reporting deadline, again, is May 15, so as long as you have your information in by May 15th, then everything should be fine.Again, we’ll wait one more minute to see if there are any final questions. If you think of a question later or aren’t comfortable asking it now, you can always e-mail us at nhsn@ and include ‘flu summary report’. in the subject line. The question that we just received is: Is it better to input flu data for the quarterly reporting deadline? So unlike other NHSN reporting and CMS required reporting for IRFs and other facilities, the NHSN healthcare personnel vaccination data is only reported once. So, we use that May 15th deadline. Technically, the data does cross two quarters because it’s October through March, so it covers quarter four of the prior year and quarter one of the current year, but there’s no connection otherwise between these data and the other quarterly reporting deadlines. Seeing no further questions, we’ll go ahead and end a little early. Again, if you come up with a question later, e-mail nhsn@, we’ll be happy to help you. Thank you so much for attending. ................
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