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IMPLEMENTING INDIANA CODE 16-28-2-6 State Form 19733 R4/11-00 Indiana State Department of Health-Division of Long Term Care PLEASE READ BEFORE COMPLETING THIS FORM IC 16-28-2-6 created a reporting requirement for some facilities which charge certain fees and have a name which implies association with a religious charitable or other nonprofit organization. This form was developed and approved by the Indiana Health Facilities Council in order to obtain the information required by law. Board...
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