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A commenter explicitly supported the use of a cohort median as the basis for the complex patient scoring adjustment but also recommended that CMS monitor the results of each ASM cohort to ensure that the complex patient scoring adjustment is properly sized

Signs That Your Bacteriostatic Water Has Gone Bad Cloudy appearance Visible particles or discoloration Unusual odor Vial open for more than 28 days Proper Storage to Prevent Early Expiration Keep the vial in a cool, dry place (6877F / 2025C) Avoid exposure to direct sunlight or high humidity Use sterile syringes and clean technique to draw the solution Always label the date of first use Why the 28-Day Rule Is Critical Even with benzyl alcohol as a preservative, bacteriostatic water can lose effectiveness over time