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PRINTED: 09/23/2011 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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Printed 0923 department is a tax form used for reporting income and expenses related to a specific department within a company.
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Income, expenses, and any other financial transactions related to the specific department must be reported on printed 0923 department form.
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