Get the free PRINTED: 12/14/2011 FORM APPROVED Division of Health Care Facilities STATEMENT OF DE...

PRINTED: 12/14/2011 FORM APPROVED Division of Health Care Facilities STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: (X2) MULTIPLE CONSTRUCTION A.

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The printed 1214 form approved is a document that verifies the approval of a printed form with the designation '1214.'

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