Get the free PRINTED: 07/27/2012 DEPARTMENT OF HEALTH AND - in

PRINTED: 07/27/2012 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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4. If the form requires specific dates or time frames, be sure to provide the correct information in the designated sections. Pay attention to any specific formatting requirements for dates, such as mm/dd/yyyy.
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