Below average — CMS composite of the measures below.
Past the typical resurvey interval — a standard survey could occur at any time
Estimate from public CMS data, current as of July 2026. Survey timing is at the state agency's discretion.
Citation history
Health deficiencies cited at Forrest Manor Nursing Center during CMS and state inspections, most recent first.
The facility failed to transmit MDS assessment data to CMS within the required timeframe for six residents. The ADON, who recently took over MDS coordinator duties, was aware of overdue assessments, while the administrator was unaware of the issue. This resulted in non-compliance with submission timelines.
The facility did not have a full-time DON, as required by their staffing policy. The DON had resigned suddenly, and the facility was actively seeking a replacement. No other RN had been assigned the DON's duties since the resignation.
The facility did not submit direct care staffing information to CMS on time. A PBJ report indicated that the data for the third quarter of 2024 was not received. The administrator was responsible for sending the data to a corporate employee, who claimed to have submitted it but lacked proof. The administrator suggested the issue might stem from using different quarter schedules.
The facility failed to provide two residents the opportunity to create advance directives, violating their rights. One resident, with chronic pain and pressure ulcers, had no documentation of their code status or advance directive discussion. Another resident also lacked documentation and did not recall discussing an advance directive. The ADON and BOM confirmed these deficiencies during record reviews.
The facility failed to provide prescribed dietary interventions for two residents, one with end-stage renal disease and another with spina bifida and pressure ulcers. A resident did not receive a diet limiting phosphorus and calcium, while another did not receive double portions of protein for wound healing. The dietary manager and assistant director of nursing acknowledged the oversight in meeting these dietary needs.
A facility failed to conduct post dialysis assessments for a resident with end stage renal disease, who was scheduled for dialysis three times a week. Although pre-dialysis assessments were documented, post dialysis assessments were missing on several occasions. RN #1 confirmed the absence of documentation for post dialysis assessments, which should include checking weight, vital signs, dialysis site, and bruit.
The facility failed to ensure GDR requests were attempted and/or addressed by the physician for two residents receiving psychotropic medications. One resident with PTSD and major depressive disorder had no GDR attempts documented for their antidepressant and antianxiety medications. Another resident with dementia and anxiety disorder had a GDR recommended for risperidone, but it was not addressed by the physician, and no other GDR attempts were documented.
The facility failed to comply with regulations for psychotropic medications for two residents. A resident with anxiety was given Ativan PRN without a documented rationale for extending use beyond 14 days. Another resident with dementia and anxiety was prescribed risperidone without an appropriate diagnosis. The ADON acknowledged the oversight.
The facility failed to provide therapeutic diets as ordered for two residents. One resident with end-stage renal disease did not receive a diet with low sodium, less phosphorus, and no calcium, as the facility did not have a diet ordered. Another resident with spina bifida and pressure ulcers did not receive double portions of protein as prescribed, leading them to purchase their own supplements. The dietary manager and assistant director of nursing acknowledged the oversight and failure to meet dietary needs.
The facility failed to update dietary menus, provide nutritionally equivalent meal alternatives, and have a Registered Dietitian review the menus for nutritional adequacy. The Dietary Manager, new to the position, found the extended menu dated November 2022. The Business Office Manager created weekly menus based on outdated menus and resident requests, which were not reviewed by the RD. Residents could choose from an alternate menu that was not nutritionally equivalent to the served meals.
The facility failed to maintain sanitary meal service and use professional-grade kitchen equipment. Staff were observed handling food improperly, not changing gloves, and using household appliances. The dish machine was not reaching required temperatures, and staff were unsure of sanitizing procedures. These issues affected meal service for 61 residents.
The facility failed to accurately document the code status for two residents, leading to discrepancies in their medical records. One resident had conflicting stickers indicating both DNR and Full Code status, while another had a DNR form signed by a physician despite being listed as Full Code in other documents. The ADON acknowledged these issues, noting that staff relied on stickers for code status, which contributed to the confusion.
The facility failed to monitor trends related to infectious diseases due to missing documentation in their infection surveillance records for January, February, and March 2024. Despite having an infection control policy, the facility did not track infectious diseases or trends during these months. This was confirmed by the ADON, who acknowledged the lack of documentation.
A resident was allowed to self-administer medications without a completed assessment to ensure their safety. The facility's policy requires an interdisciplinary team to assess the resident's abilities before allowing self-administration, but this was not done for the resident who was prescribed albuterol and ipratropium via nebulizer and tiotropium bromide inhalations.
A facility failed to provide a CMS-10123 form to a resident discharged from Medicare Part A services. The form, which was undated and unsigned, indicated the end of coverage, but the Business Office Manager admitted to forgetting to provide it. This oversight was identified during a survey, with six residents having been discharged from Medicare Part A in the previous six months.
A facility failed to complete a baseline care plan for a newly admitted resident with diabetes mellitus and hypertension within 48 hours. An RN was unaware of the completion status, and the ADON confirmed the absence of the care plan.
A facility failed to develop a comprehensive care plan for a resident with diabetes mellitus and hypertension. The absence of documentation was confirmed by the ADON during a record review and interview.
A facility failed to include the use of bedrails in the care plan for a resident. The care plan lacked any mention of a problem, goal, or intervention regarding bedrails, despite the resident using a bed with bedrails for about six months. The ADON confirmed that the care plan should have addressed the use of bedrails.
A resident did not receive scheduled showers twice a week, as required for their ADL care. The resident was observed with unkempt hair and reported missing weekend showers. The clinical record lacked documentation for several scheduled showers, and the ADON confirmed the need for proper charting even if a shower is refused.
A resident with bilateral contracted hands did not receive the care plan intervention of having contracture cushions or rolled rags in their hands. Observations showed the absence of these supports, and staff interviews confirmed inconsistent implementation of the care plan. The ADON acknowledged the oversight.
A facility failed to attempt alternatives and obtain informed consent for bed rail use for a resident with severe cognitive impairment. The ADON confirmed the absence of documentation for educating the resident's representative or attempting less restrictive interventions, violating the facility's Bed Safety policy.
A resident was prescribed and administered Macrobid without a prior urine culture to identify the infection-causing organism. The lab report indicated abnormal findings, but no culture was ordered. The ADON confirmed the oversight, acknowledging that determining the organism and effective antibiotics beforehand is best practice.
A facility failed to inspect a resident's bed and bedrails for safety before use, contrary to its Bed Safety policy. The resident was moved to a new room with a bed that had full side rails, unlike their previous bed. The maintenance supervisor admitted that safety inspections were not conducted prior to the use of bedrails, and the ADON acknowledged the oversight.
Failure to Timely Transmit MDS Assessments
Penalty
Summary
The facility failed to transmit Minimum Data Set (MDS) assessment data to the Centers for Medicare & Medicaid Services (CMS) within the required timeframe for six of the twenty sampled residents. The facility's policy, dated 2001, mandates that resident assessments be conducted and submitted in accordance with federal and state submission timeframes. However, a review of the facility's MDS 3.0 Assessment Summary Report revealed that the quarterly assessments for six residents were submitted to CMS beyond the required timeframe. The delays in transmission ranged from several days to over a month past the required submission dates. During interviews, the Assistant Director of Nursing (ADON) acknowledged that they had recently assumed the MDS coordinator duties and were aware of multiple overdue assessments that had not been transmitted. The facility administrator stated they were unaware that the MDS assessments had not been completed and transmitted, expressing an expectation that all MDS assessments would be opened, completed, and submitted in a timely manner. This oversight resulted in the facility's non-compliance with the required assessment submission timelines.
Failure to Employ Full-Time Director of Nursing
Penalty
Summary
The facility failed to employ a full-time Director of Nursing (DON), which is a requirement for maintaining proper nursing services staffing. The facility's policy stated that a full-time licensed RN or LPN should be appointed as the DON. However, the facility did not have a full-time DON at the time of the survey. The Business Office Manager (BOM) confirmed that the DON had resigned approximately three weeks prior to the survey, and the facility was actively advertising for a new DON. The administrator provided a letter indicating that the former DON had resigned suddenly via text message, and no other RN had been assigned the DON's duties since the resignation.
Failure to Submit Direct Care Staffing Data to CMS
Penalty
Summary
The facility failed to provide direct care staff information to CMS within the required time frame. The issue was identified through a PBJ report for the third quarter of 2024, which documented that the direct care staffing data had not been received by CMS. The facility administrator was responsible for sending the staffing data to an employee at corporate headquarters, who was then supposed to submit it to CMS. However, the employee claimed to have sent the data but could not provide documentation to prove it. The administrator acknowledged awareness of the submission time frame and speculated that the discrepancy might be due to the company's use of standard calendar-based quarters, which differed from the government's schedule.
Failure to Provide Opportunity for Advance Directives
Penalty
Summary
The facility failed to provide an opportunity for two residents to create an advance directive, which is a violation of their rights. Resident #9, who was admitted to the facility on an unspecified date, did not have any documentation indicating they were given the opportunity to create an advance directive. Interviews with the Assistant Director of Nursing (ADON) and the Business Office Manager (BOM) confirmed the absence of such documentation in the resident's records. Additionally, Resident #9 stated they did not recall discussing an advance directive with anyone. Similarly, Resident #50, who had diagnoses including chronic pain and pressure ulcers, also lacked documentation regarding the opportunity to create an advance directive. The resident's clinical record did not include their code status in the physician's orders or on the chart cover. During a review of the clinical record with the ADON and BOM, it was found that the facility form addressing advance directives was blank, indicating that the facility had not addressed this issue with Resident #50.
Failure to Provide Prescribed Dietary Interventions
Penalty
Summary
The facility failed to provide dietary interventions as ordered by the physician for two residents, leading to deficiencies in their nutritional care. Resident #19, diagnosed with end-stage renal disease, was supposed to receive a diet with less phosphorus and no calcium, as documented in a dialysis communication form. However, the facility did not have a diet ordered for the resident in the monthly physician's orders, and the dietary manager (DM) confirmed that all residents received the same meal options, which did not accommodate the resident's dietary needs. The assistant director of nursing (ADON) acknowledged that the facility was not meeting the resident's nutritional needs, as the available meal choices did not limit calcium and phosphorus intake as required. Resident #50, who had spina bifida and pressure ulcers, was ordered to receive double portions of protein to aid in wound healing. However, the resident reported not receiving the prescribed double portions or protein drinks with meals, leading them to purchase their own supplements. Observations confirmed that the resident's meal trays did not contain the ordered double portions of protein. The DM admitted that the staff overlooked the order on the diet card, and the ADON confirmed that the facility did not follow the physician's order for double portions of protein.
Failure to Perform Post Dialysis Assessment
Penalty
Summary
The facility failed to perform a post dialysis assessment for a resident with end stage renal disease who required dialysis. The resident was scheduled to attend dialysis three times a week as per the physician's orders for August 2024. Although the pre-dialysis assessments and communication from the dialysis unit were documented, there was no record of post dialysis assessments on multiple dates. RN #1 confirmed that the post dialysis assessment, which should include checking the resident's weight, vital signs, dialysis site, and bruit, was not performed. The dialysis log book, intended to facilitate communication between the dialysis center and the facility, lacked documentation of these assessments.
Failure to Ensure GDR Attempts for Psychotropic Medications
Penalty
Summary
The facility failed to ensure that Gradual Dose Reduction (GDR) requests were attempted and/or addressed by the physician for two residents who were receiving psychotropic medications. Resident #37, diagnosed with PTSD and major depressive disorder, was prescribed venlafaxine, mirtazapine, and buspirone. Despite the resident's routine use of these medications, there was no documentation of any GDR attempts in the medical records. The Assistant Director of Nursing (ADON) confirmed the absence of GDR documentation for this resident. Similarly, Resident #49, diagnosed with unspecified dementia and anxiety disorder, was prescribed risperidone and sertraline. A GDR was recommended for risperidone, but there was no documentation that the physician addressed this recommendation. The medical records did not contain any other GDR attempts for this resident, and the ADON confirmed the lack of documentation. These findings indicate a failure in the facility's process to ensure GDRs are attempted and documented as per guidelines.
Non-compliance with Psychotropic Medication Regulations
Penalty
Summary
The facility failed to ensure compliance with regulations regarding the use of psychotropic medications for two residents. Resident #42, who had a diagnosis of anxiety, was prescribed Ativan, an antianxiety medication, on a PRN basis without an end date. The medication was administered every four hours as needed, starting from February 19, 2024, and continued without a documented rationale or physician's signature for extending the order beyond the 14-day limit. This oversight was noted despite a Consultant Pharmacist Communication to the Physician highlighting the requirement for a clinical rationale and specific duration for extending PRN psychotropic orders. Resident #49, diagnosed with unspecified dementia and anxiety disorder, was routinely administered risperidone, an antipsychotic medication, based on a physician's order dated January 12, 2024. The order cited unspecified dementia as the indication for the medication, which the Assistant Director of Nursing (ADON) acknowledged was not an appropriate diagnosis for antipsychotic use. This lack of appropriate diagnosis for the use of antipsychotic medication was identified during a quarterly assessment conducted on May 3, 2024.
Failure to Provide Therapeutic Diets as Ordered
Penalty
Summary
The facility failed to provide a therapeutic diet as ordered by the physician for two residents. Resident #19, diagnosed with end-stage renal disease, was supposed to receive a regular renal diet with low sodium, less phosphorus, and no calcium. However, the facility did not have a diet ordered for the resident as of August 2024, and the dietary manager (DM) admitted that all residents received the same meal or an alternate choice, leaving it to the residents to make appropriate meal choices. The assistant director of nursing (ADON) acknowledged that the facility was not accommodating the resident's dietary needs, as the available meal options did not allow for the necessary dietary restrictions. Resident #50, diagnosed with spina bifida and pressure ulcers, was ordered to receive double portions of protein to aid in wound healing. However, the resident reported not receiving the prescribed double portions of protein or the protein drink with each meal, leading them to purchase their own supplements. Observations confirmed that the resident's meal trays did not contain the required double portions of protein, and the DM admitted that the staff overlooked the order on the diet card. The ADON confirmed that the facility did not follow the physician's order for double portions of protein.
Failure to Update Menus and Ensure Nutritional Adequacy
Penalty
Summary
The facility failed to update the dietary menu, offer nutritionally equivalent alternatives to planned meals, and have a Registered Dietitian (RD) review the menus for nutritional adequacy. The Dietary Manager (DM), who was new to the position, was unable to locate the extended menu initially and later found it dated November 2022. The Business Office Manager (BOM) acknowledged that residents complained about receiving the same meals repeatedly and that they had requested updated menus from company representatives but did not receive them. Consequently, the BOM began creating weekly menus and substitutions based on the outdated November 2022 menu and resident requests, which were not reviewed or approved by the RD. Additionally, the DM stated that if a resident did not want the served meal, they could choose from an alternate menu offering soup, salad, grilled cheese, or a peanut butter sandwich, which was not nutritionally equivalent to the served meals. This affected 61 residents who ate meals from the kitchen, as identified by the DM.
Deficiencies in Meal Service and Kitchen Equipment
Penalty
Summary
The facility failed to adhere to professional standards in meal service, resulting in unsanitary food handling practices and improper use of kitchen equipment. Observations revealed that the hand washing sink in the kitchen was obstructed by various items, making it inaccessible. A staff member was seen handling food with gloved hands without changing gloves between tasks or residents, and touching various surfaces and their clothing, which compromised hygiene. Additionally, the staff member did not wear a beard guard. The dish machine was operated without reaching the required water temperature or applying disinfectant, and staff were unsure of the correct procedures for using sanitizing agents. Further observations indicated that kitchen staff used household-grade appliances instead of professional-grade equipment, which is not in accordance with professional standards. Staff members were seen using improper techniques to handle and serve food, such as using gloved hands to touch multiple surfaces and food items without changing gloves. One staff member admitted to not being trained adequately for serving food from the steam table, leading to improper handling of food items. These deficiencies affected the meal service for 61 residents who consumed meals prepared and served in the kitchen.
Code Status Documentation Errors
Penalty
Summary
The facility failed to ensure that the code status of residents was clearly identified in their medical records, leading to discrepancies in the documentation for two residents. Resident #9, who had diagnoses including chronic kidney disease and chest pain, had conflicting stickers on their medical chart indicating both 'Do Not Resuscitate' (DNR) and 'Full Code' status. Despite having a signed DNR consent form in the medical record, the sticker indicating 'Full Code' was not removed, which was acknowledged as a problem by the Assistant Director of Nursing (ADON). The ADON stated that staff should have checked the chart for the correct paperwork, but the facility's policy on code status was not provided. Similarly, Resident #18, with diagnoses including muscular dystrophy and vascular dementia, had a face sheet and physician orders indicating 'Full Code' status, while a DNR form signed by a physician indicated otherwise. The ADON confirmed that the resident's chart and paperwork should have documented a DNR status. The reliance on stickers for determining code status, as stated by RN #1, contributed to the confusion, as they were the most convenient method used by staff, despite the presence of a binder at the nurses' station with each resident's code status.
Inadequate Infection Surveillance Documentation
Penalty
Summary
The facility failed to consistently monitor for trends related to infectious diseases, as evidenced by the lack of documentation in their infection surveillance records for the months of January, February, and March 2024. The facility's infection control policy, updated in May 2022, mandates the establishment of an infection control program to investigate, control, and prevent infections. However, upon review, it was found that the facility did not track infectious diseases or look for trends during the specified months. This deficiency was confirmed during an interview with the Assistant Director of Nursing (ADON), who acknowledged the absence of documentation for infection surveillance during the mentioned period.
Failure to Assess Resident's Ability to Self-Administer Medication
Penalty
Summary
The facility failed to ensure that a resident was safe to self-administer medication. The deficiency involved one resident who was allowed to self-administer medications without a completed assessment to determine their ability to do so safely. The facility's policy on the right to self-administer medications requires an interdisciplinary team to assess the resident's cognitive, physical, and visual abilities before allowing self-administration. However, the Assistant Director of Nursing (ADON) identified that an assessment for self-administration of medication had not been completed for the resident, who was prescribed albuterol and ipratropium via nebulizer and tiotropium bromide inhalations, both of which were kept at the bedside.
Failure to Provide CMS-10123 Form Upon Discharge from Medicare Part A
Penalty
Summary
The facility failed to provide a CMS-10123 form to a resident who was discharged from Medicare Part A services. This deficiency was identified during a record review and interview, where it was found that one of the three sampled residents, referred to as Resident #50, did not receive the necessary form. The CMS-10123 form, which was undated, indicated that Resident #50's Medicare Part A coverage would end on 06/14/24, but the form was not signed. On 09/09/24, the Business Office Manager (BOM) admitted to forgetting to provide the form to Resident #50, who had been discharged from Medicare Part A services on 06/14/24. Additionally, the BOM stated that six residents had been discharged from Medicare Part A services in the previous six months leading up to the survey.
Failure to Complete Baseline Care Plan for New Admission
Penalty
Summary
The facility failed to ensure a baseline care plan was completed for a resident within 48 hours of admission. The resident had diagnoses including diabetes mellitus and hypertension. There was no documentation of a baseline care plan for this resident. During interviews, an RN stated they did not complete the resident's admission and were unaware if a baseline care plan was completed. The ADON confirmed that a baseline care plan for the resident was not located.
Failure to Develop Comprehensive Care Plan
Penalty
Summary
The facility failed to develop a comprehensive care plan for a resident diagnosed with diabetes mellitus and hypertension. During a review of records and an interview, it was found that there was no documentation of a completed care plan for this resident. The Assistant Director of Nursing (ADON) confirmed that a care plan had not been completed for the resident.
Failure to Care Plan Bedrail Use
Penalty
Summary
The facility failed to include the use of bedrails in the care plan for a resident, identified as #42, who was reviewed for accidents. The care plan, dated May 23, 2024, lacked any mention of a problem, goal, or intervention regarding the safe use of bedrails. On September 11, 2024, it was observed that the resident's bed had a full side rail attached to each side. A Certified Nursing Assistant (CNA) confirmed that the resident had been using a bed with bedrails for approximately six months. The Assistant Director of Nursing (ADON) acknowledged that the resident's current care plan did not address the use of bedrails, which should have been included.
Failure to Provide Scheduled Showers
Penalty
Summary
The facility failed to provide showers as scheduled for a resident who was dependent on staff for activities of daily living (ADL) care. The resident was observed with long, tangled, and greasy hair, indicating a lack of proper hygiene care. The resident reported being scheduled for two showers per week but only receiving one, specifically missing the weekend shower. A review of the resident's clinical record confirmed the absence of documentation for showers on several Saturdays, despite being scheduled. The Assistant Director of Nursing (ADON) acknowledged the issue, noting that a shower sheet should be completed even if the resident refused the shower.
Failure to Implement Care Plan for Contracted Hands
Penalty
Summary
The facility failed to implement a care plan intervention for a resident with bilateral contracted hands. The care plan, updated on 06/04/24, specified that the resident should have contracture cushions or rolled rags in their hands if possible. However, observations on 09/08/24 and 09/10/24 revealed that the resident was not provided with any device or material to protect and support their contracted hands. Interviews with RN #1 and CNA #1 confirmed that the resident had contracted hands and that rolled rags were sometimes used, but there was no consistent implementation of this intervention. RN #1 and the ADON acknowledged that the rolled rags were part of the care plan, but staff had not been following it.
Failure to Obtain Consent and Attempt Alternatives for Bed Rail Use
Penalty
Summary
The facility failed to adhere to its Bed Safety policy by not attempting alternatives to the use of bed rails and not obtaining informed consent prior to their use for a resident. The policy requires an interdisciplinary assessment, consultation with the attending physician, and input from the resident or their legal representative, along with obtaining consent before using bed rails. However, for one resident with severe cognitive impairment due to Alzheimer's disease and atherosclerosis, these steps were not documented or followed. The Assistant Director of Nursing (ADON) confirmed that the resident had bed rails attached to their bed for about six months, but there was no documentation of the resident's representative being educated about the bed rails or providing written consent. Additionally, there was no evidence of less restrictive interventions being attempted in the resident's medical records. This oversight was identified during an observation and interview process, highlighting a deficiency in the facility's compliance with its own safety policies.
Failure to Culture Urine Sample Before Antibiotic Administration
Penalty
Summary
The facility failed to culture a urine sample before prescribing and administering an antibiotic to one of the 24 sampled residents reviewed for antibiotic use. A laboratory report indicated that a urine sample from the resident was collected, showing abnormal findings such as high nitrate and white blood cell levels, suggesting a culture was needed. However, no culture was ordered. Instead, a handwritten note by an RN on the laboratory report prescribed Macrobid, an antibiotic, to be administered twice daily for seven days. The resident confirmed taking the antibiotic, and the ADON later acknowledged that a culture had not been performed to identify the organism causing the infection or to determine the most effective antibiotic, which is considered best practice.
Failure to Inspect Bedrails for Safety
Penalty
Summary
The facility failed to inspect the bed and bedrails of a resident before the use of bedrails, which was identified during a survey. The facility's Bed Safety policy, dated December 2007, mandates regular inspections by maintenance staff to identify risks and problems, including potential entrapment risks. However, it was observed that a resident's bed had full side rails attached, and the maintenance supervisor admitted that bed or bedrail safety inspections were not performed prior to their use by residents. The resident had been moved to their current room about six months before the survey, and the bed they were assigned had rails attached, unlike the previous bed they used. The Assistant Director of Nursing (ADON) acknowledged awareness of the dangers associated with bedrails but confirmed that no safety inspection had been conducted for the resident's bed.
What surveyors are citing around you — mapped
All 10 risk areas, ranked with evidence
Repeat citations, what's rising near you, and quality measures — ranked so department heads know exactly where to look first.
Illustrative
What surveyors actually found near you
We read the 17 citations issued within 25 miles in the last 12 months — including the 1 immediate-jeopardy cases — and tell you exactly what happened, in plain English, matched to your record.
Resident with a documented fall history left unattended on the patio; found on the ground with a hip fracture.
Walk-in cooler logs missing for 12 days; expired supplements in the medication room fridge.
Illustrative
A prioritized, do-first checklist
Every risk area becomes concrete audit steps drawn from real citations at facilities like yours — run them this week, before your window opens.
Illustrative
Risk indicators are statistical estimates from public CMS data — not predictions, findings, or compliance advice.
Nursing homes near Dewey
How nearby facilities compare on the same public inspection record.
| Facility | Distance | Overall rating | Citations, 12 mo | Serious (J–L) |
|---|---|---|---|---|
| Medicalodges Dewey | 2.9 mi | ★★★★★ | 0 | 0 |
| Bartlesville Health And Rehabilitation Community | 3.7 mi | ★★★★★ | 1 | 1 |
| Ignite Medical Resort Adams Parc | 4.6 mi | ★★★★★ | 0 | 0 |
| Heritage Villa Care & Rehab Center | 4.8 mi | ★★★★★ | 5 | 0 |
| Osage Nursing Home, Llc | 17.5 mi | ★★★★★ | 0 | 0 |
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