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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:15547806/09/2015FORM
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Specify the date and time of the incident or issue that led to the complaint.
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Complaint in00170369 can be filled out by providing detailed information about the grievance or issue.
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Complaint in00170369 must include details about the issue, date, time, and any relevant supporting documents.
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