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PRINTED: 10/05/2016 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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The printed 1005 department is a form used for reporting income and expenses related to a specific department within a company.
The head of the department or the designated financial officer is required to file the printed 1005 department form.
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