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PRINTED: 09×18/2012 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER×SUPPLIER×CIA IDENTIFICATION
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Start by locating the printed 09182012 - CHFS form. This form is usually available online or can be obtained from a healthcare facility or organization.
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Fill in the personal information section of the form. This typically includes details such as your full name, date of birth, address, contact number, and any other relevant personal information required.
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