Get the free PRINTED: 02/12/2014 FORM APPROVED Division of Public and Behavioral Health STATEMENT...

PRINTED: 02/12/2014 FORM APPROVED Division of Public and Behavioral Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION (X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER: (X3) DATE SURVEY COMPLETED

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The printed 0212 form approved is a document used for reporting certain information to the authorities.

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