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C <br />ti <br />0 <br />KINDRED HEALTH CARE, INC. <br />1 � ckAn o� `- ATTENDANCE ROSTER <br />Program Title: Cf=�O Lei l- l W -U Program Length: 3 L >,'Yl 10 <br />Date: i -j 1 '�, i� I q <br />Location of Progralm: 10. Center ❑ District ❑ Region ❑ Corporate CE Offering: ❑ No ❑ Yes - Number of Units: CE Activity Number: <br />Center Name: V p��S Center Number: Course Material Attached: 4Yes ❑ No <br />TrainerlFacilitator Name (Print): lv qc' Signature <br />innatore of Trainer or Facilitator certifies that the foilawina parsons afcnrertraininn_ <br />Employee Name (Please Print) <br />Title <br />Signature <br />Last 4 SS# <br />Type of Training (Check one) <br />RB <br />CORE <br />Ston -CCA <br />1 <br />s <br />I <br />, <br />My signature above indicates I attended the Iraining program identified on this form. <br />"r <br />R i 4�59ed <br />Core <br />Nw Corporate GwgAiance rownerat WCA <br />FRM 22001-02 (01116108) R <br />0 <br />U <br />