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["Billable Days due to SOE for September 2020 & October 2020",null,null,null,null,null,null,"Updated: September 25, 2020"]
["For Services that are Billed Daily or by Trip"]
[null,null,null,null,null,"Vendor Name:","ABC"]
[null,null,null,null,null,"Vendor Number:","PE1234"]
[null,null,null,null,null,"Service Code:",110]
[null,null,null,null,null,"Invoice#:",1234567]
[null,"Alternative Services Instructions:"]
[null,"1. For September & October 2020, the vendor shall use the current authorized rate and each consumer's average monthly attendance over the prior"]
[null,"    12 months endeing February 2020 for each consumer who received Alternative Services and the provider complied with Section V."]
[null,"2. Providers shall not submit reimbursement claims for consumers who did not receive services"]
[]
[null,"To Fill Out Spreadsheet Below:"]
[null,"A) Enter number of days vendor provided services to consumer from March 1, 2019 to February 29, 2020"]
[null,"B) Enter the number of months consumer received services between March 1, 2019 to February 29, 2020"]
[null,"C) This is the average monthly days for the consumer and the amount to be claimed to ELARC"]
[]
[null,"Month Claimed:",null,2020]
[]
[]
[null,"Last Name","First Name","UCI","A","B","C"]
[1,"Examples:",null,null,null,null,{"$f":"+E21/F21","v":{"$error":"#DIV/0!"}}]
[{"$f":"+A21+1","v":2},"If consumer recieved services all prior 12 months (March 2019 to February 2020)",null,null,245,12,{"$f":"+E22/F22","v":20.416666666666668}]
[{"$f":"+A22+1","v":3},"If consumer started service in October 2019",null,null,96,5,{"$f":"+E23/F23","v":19.2}]
[4,null,null,null,null,null,{"$error":"#DIV/0!"}]
[5,null,null,null,null,null,{"$error":"#DIV/0!"}]
[6,null,null,null,null,null,{"$error":"#DIV/0!"}]
[7,null,null,null,null,null,{"$error":"#DIV/0!"}]
[8,null,null,null,null,null,{"$error":"#DIV/0!"}]
[9,null,null,null,null,null,{"$error":"#DIV/0!"}]
[10,null,null,null,null,null,{"$error":"#DIV/0!"}]
[11,null,null,null,null,null,{"$error":"#DIV/0!"}]
[12,null,null,null,null,null,{"$error":"#DIV/0!"}]
[13,null,null,null,null,null,{"$error":"#DIV/0!"}]
[14,null,null,null,null,null,{"$error":"#DIV/0!"}]
[15,null,null,null,null,null,{"$error":"#DIV/0!"}]
[16,null,null,null,null,null,{"$error":"#DIV/0!"}]
[17,null,null,null,null,null,{"$error":"#DIV/0!"}]
[18,null,null,null,null,null,{"$error":"#DIV/0!"}]
[19,null,null,null,null,null,{"$error":"#DIV/0!"}]
[20,null,null,null,null,null,{"$error":"#DIV/0!"}]
[21,null,null,null,null,null,{"$error":"#DIV/0!"}]
[22,null,null,null,null,null,{"$error":"#DIV/0!"}]
[23,null,null,null,null,null,{"$error":"#DIV/0!"}]
[24,null,null,null,null,null,{"$error":"#DIV/0!"}]
[25,null,null,null,null,null,{"$error":"#DIV/0!"}]
[26,null,null,null,null,null,{"$error":"#DIV/0!"}]
[27,null,null,null,null,null,{"$error":"#DIV/0!"}]
[28,null,null,null,null,null,{"$error":"#DIV/0!"}]
[29,null,null,null,null,null,{"$error":"#DIV/0!"}]
[30,null,null,null,null,null,{"$error":"#DIV/0!"}]
[31,null,null,null,null,null,{"$error":"#DIV/0!"}]
[32,null,null,null,null,null,{"$error":"#DIV/0!"}]
[33,null,null,null,null,null,{"$error":"#DIV/0!"}]
[34,null,null,null,null,null,{"$error":"#DIV/0!"}]
[35,null,null,null,null,null,{"$error":"#DIV/0!"}]
[36,null,null,null,null,null,{"$error":"#DIV/0!"}]
[37,null,null,null,null,null,{"$error":"#DIV/0!"}]
[38,null,null,null,null,null,{"$error":"#DIV/0!"}]
[39,null,null,null,null,null,{"$error":"#DIV/0!"}]
[40,null,null,null,null,null,{"$error":"#DIV/0!"}]
["Vendor Notes:"]

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