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PRINTED: 11/22/2013 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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Start by identifying the key information required for filling out the complaint form.
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Clearly state the nature of the complaint and provide a detailed description of what happened.
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Any individual or organization that has been affected by or witnessed the incident described in complaint in00139528 substantiated would need to submit this complaint form.
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The complaint in00139528 is considered substantiated when there is enough evidence to prove the allegations.
The complainant or the party affected by the issue is required to file the substantiated complaint.
To fill out the substantiated complaint, one must provide detailed information about the issue, evidence supporting the allegations, and contact information.
The purpose of the substantiated complaint is to address and resolve the issue raised by the complainant or affected party.
The substantiated complaint must include details of the issue, evidence, contact information, and any relevant supporting documents.
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