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PRINTED: 05/0212007 FORM APPROVED DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION OMS NO. 09380391 (X2) MULTIPLE CONSTRUCTION

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To fill out the rio07- form - dc police, follow these steps: 1. Obtain the rio07- form from the DC Police department or their website. 2. Fill in your personal information, including your name, address, and contact details. 3. Provide details about the incident, such as the date, time, and location. 4. Describe the nature of the incident and provide any additional relevant information. 5. If there were any witnesses, provide their contact information. 6. Sign and date the form. 7. Submit the completed form to the designated DC Police department.

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