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5617 NW 7TH ST. MIAMI FL 33126-3216

Resident Acknowledgement of Visitation Policies and Procedures

EXHIBIT A

    I,

    acknowledge receiving the Visitation Policies and Procedures and agree to always abide by them.

    Yes, I will designate an Essential Caregiver.No, I will not designate an Essential Caregiver at this time.

    NOTE:
    If you selected "Yes," indicating that you will designate an essential caregiver, please complete Exhibit B (Designation of the Essential Caregiver) and ensure that the essential caregiver completes Exhibit C (Acceptance of the Role by the Essential Caregiver).