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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:15563708/14/2014FORM
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01
To fill out substantiated federal/state deficiencies re:
02
Review the regulations and guidelines provided by the federal/state authority regarding the specific deficiencies.
03
Gather all relevant supporting documentation and evidence for each deficiency identified.
04
Clearly identify each deficiency and provide a detailed description of the issue.
05
Provide any relevant context or explanation for the deficiency, if necessary.
06
Offer a proposed corrective action or plan to address each deficiency.
07
Include any additional information or recommendations that may be helpful for the federal/state authority to understand the deficiencies.
08
Double-check all information and make sure it is accurate and complete.
09
Submit the filled-out substantiated federal/state deficiencies report to the designated authority within the specified deadline.
10
Follow up with the authority to track the progress of the deficiencies addressed.

Who needs substantiated federalstate deficiencies re?

01
Organizations or entities involved in activities regulated by the federal/state authority may need to fill out substantiated federal/state deficiencies reports.
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Substantiated federalstate deficiencies re refers to deficiencies or violations that have been proven to exist at the federal or state level.
Any organization or individual that has been found to have substantiated deficiencies by federal or state authorities is required to file this report.
The report should be filled out with detailed information about the deficiencies found, actions taken to correct them, and any additional information requested by the authorities.
The purpose of this report is to ensure that organizations and individuals are held accountable for any deficiencies found and take corrective actions as needed.
Information such as the nature of the deficiencies, any corrective actions taken, and any penalties imposed must be reported.
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