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PRINTED: 12/27/2004 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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Sharon Health Care Willows is a form used to report health care coverage for individuals.
Employers and health insurance providers are required to file Sharon Health Care Willows.
Sharon Health Care Willows can be filled out online or submitted through mail with all required information.
The purpose of Sharon Health Care Willows is to report health care coverage provided to individuals.
Information such as the individual's name, Social Security number, and months of coverage must be reported on Sharon Health Care Willows.
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