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We appreciate the recommendation that cultural and linguistic factors be included as a care plan requirement and remind commenters that the typical care plan elements which are based on the those finalized in the CY 2020 PFS final rule (84 FR 62691), are not limited to that list

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[81] Previous reports have suggested that the RIDA method can detect higher concentrations of vitamin B 12 in foods compared to the microbiological assay method

Importantly, B12 deficiency can occur without anaemia, and some patients may present with neurological symptoms despite having normal haemoglobin levels