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Printed: 02/08/2016 FORM APPROVED OMB NO 09380391 DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (XL) PROVIDER/SUPPLIER/CIA
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How to fill out xl completed name of:
01
Open the XL form template in your preferred spreadsheet software.
02
Locate the "Name" field in the form.
03
Enter the completed name in the designated space provided. Make sure to follow any specific formatting instructions, such as using first name, last name, or both.
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