This government document is issued by Department of Aging for use in Pennsylvania
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https://www.google.com/url?client=internal-element-cse&cx=007572080359491747877:p5rt2izphxk&q=https://www.aging.pa.gov/local-resources/Lists/Aging/Attachments/949/Friends%2520Senior%2520Care%2520Center%252006-28.pdf&sa=U&ved=2ahUKEwj31-SU76_8AhXqTaQEHZ2JDiA4PBAWegQIBxAC&usg=AOvVaw1r1xn5UAUJ-DC8OTTIorLi