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PRINTED: 09/06/2018 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:CHANDLER PLACE (X4) ID PREFIX
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Begin by addressing the recipient of the complaint. Include their name, job title, and company name.
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Complaint in00271672 - substantiated refers to a confirmed report of misconduct or violation.
Any individual who has knowledge of the misconduct or violation is required to file the complaint in00271672 - substantiated.
To fill out the complaint in00271672 - substantiated, the individual must provide detailed information about the misconduct or violation, along with any supporting evidence.
The purpose of complaint in00271672 - substantiated is to address and resolve the reported misconduct or violation.
The complaint in00271672 - substantiated must include specific details of the misconduct or violation, names of parties involved, date and location of incident, and any supporting evidence.
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