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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:15522005/11/2017FORM

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1. To fill out complaints in00221771, follow these steps:
2. Start by documenting the details of the complaint, including the date, time, and location of the incident.
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4. Clearly describe the nature of the complaint and any specific incidents or actions that led to it.
5. Include any supporting evidence or documentation, such as photographs, videos, or witness statements, that can strengthen your case.
6. Specify any desired outcome or resolution you are seeking from the complaint.
7. Review and ensure the accuracy of all the information provided.
8. Submit the completed complaint by following the designated procedure or channel provided by the relevant authority.
9. Keep a copy of the submitted complaint for your records.
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