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PRINTED: 07/31/2013 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: INDIANA UNIVERSITY HEALTH BLACKFOOT

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Printed 07312013 - in is a specific form used for reporting certain information to the designated authority.

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Printed 07312013 - in typically requires specific information such as financial data, personal details, or any other relevant information as specified by the authority.