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PRINTED: 01/15/2013 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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What is this visit was for?
This visit is for a routine inspection of the premises.
Who is required to file this visit was for?
The business owner or the appointed representative is required to file this visit.
How to fill out this visit was for?
To fill out this visit, the individual must document any findings or observations during the inspection.
What is the purpose of this visit was for?
The purpose of this visit is to ensure compliance with regulations and safety standards.
What information must be reported on this visit was for?
The report must include details on any violations, corrective actions taken, and recommendations for improvement.
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