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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:15573810/07/2014FORM

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To fill out this visit resulted in, follow these steps:

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Start by gathering all the necessary information about the visit, such as date, time, and location.

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What is this visit resulted in?

This visit resulted in a detailed report on the findings and outcomes.

Who is required to file this visit resulted in?

The person conducting the visit is required to file the report.

How to fill out this visit resulted in?

The report should be filled out accurately and completely.

What is the purpose of this visit resulted in?

The purpose of this visit is to document the results of the inspection or assessment.

What information must be reported on this visit resulted in?

All relevant information and findings must be reported on this visit.

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