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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:15529403/10/2014FORM

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Forum at form crossing is a document that must be filed by individuals entering or leaving a country.

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All individuals entering or leaving a country are required to file forum at form crossing.

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Forum at form crossing can be filled out online or in person at the border crossing.

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