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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES (X1) PROVIDER/SUPPLIER/CIA AND PLAN OF CORRECTION IDENTIFICATION NUMBER: 150035
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How to fill out s0000 this visit was
How to fill out s0000 this visit was:
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Start by entering the date of the visit in the appropriate field.
02
Provide the name and contact information of the individual or organization being visited.
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Indicate the purpose of the visit, whether it is for a meeting, consultation, or any other specific reason.
04
Mention the duration of the visit, including the start and end time.
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If applicable, specify the location of the visit, including the address and any relevant room or building number.
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Describe any important details or requirements for the visit, such as specific documents to bring or any special accommodations needed.
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If necessary, include additional notes or comments relevant to the visit.
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