Get the free PRINTED: 01/28/2013 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FO...

PRINTED: 01/28/2013 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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7. Make a copy of the completed form for your records before submitting it to the appropriate authority or entity responsible for processing and approving the form.
8. Follow any additional instructions provided regarding submission, such as attaching supporting documentation or paying any required fees.
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