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E <br />E <br />cop� <br />• V <br />l <br />0 <br />M <br />T <br />O <br />V— <br />LA LA <br />N <br />KINDRED HEALTH CARE, INC. <br />ATTENDANCE ROSTER <br />Program Title: O �� Program Length: 130 tm Date: <br />Location of Program: ❑ Center ❑ District Region ❑ Corporate CE Offering: ❑ No ❑ Yes - Number of Units: Cir Activity Number: <br />Center Name: Center Number: Course Materia! Attached: ❑ Yes ❑ No <br />Trainer/Facilitator Name (Print): Signature: <br />Signature of Trainer or Facilitator certifies that tine following persons aftended the trakina- <br />T pe of Trainin Check one <br />LQ_Em !o ee Name (Piease Print Title Signature Last 4 SSt# RB CORE Non -CCA <br />C' <br />Lun <br />ha <br />Mystgnature above indicates I attended the training program identirred on this form. <br />RB Rale Based <br />CORE Core <br />Non -CCA Non -Co rate Compliance Agiewent CCA <br />FRM 22001-02 (01116!08) R <br />Page L Of <br />0 <br />0 <br />0 <br />L, <br />0 <br />Cy -1 <br />V <br />0 <br />