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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15556806/20/2013FORM

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How to fill out 200 short st

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Start by gathering all the necessary information, such as the name of the person or organization you are filling out the form for.

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Begin filling out the form by entering the street number and name in the appropriate fields.

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Move on to providing details about the city or town in which the address is located.

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Enter the state or province and the postal code in the designated spaces.

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Submit the form as per the instructions provided.

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