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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:15542811/29/2012FORM

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1. To fill out a complaint with the reference number in00118321, follow these steps:
2. Start by gathering all the necessary information related to the complaint, such as dates, times, parties involved, and any supporting documentation.
3. Identify the appropriate channel or platform through which the complaint should be lodged. This could be an online portal, email, or physical complaint form.
4. Make sure to provide accurate and detailed information while filling out the complaint form. Include the reference number in00118321 in the designated field.
5. Clearly articulate the nature of the complaint, providing specific details and any relevant evidence or documentation to support your claim.
6. Review the completed complaint form thoroughly to ensure all the necessary information is provided and there are no errors or omissions.
7. Submit the complaint through the designated channel as instructed. Make a note of any confirmation or reference number provided during the submission process.
8. Keep a copy of the completed complaint form and any supporting documents for your records, in case they are required for further investigation or follow-up.
9. Follow up on the complaint according to the instructions or timeline provided. Maintain regular communication with the relevant authorities or organizations regarding the progress or resolution of the complaint.
10. Note: The above steps offer a general guideline for filling out a complaint with the provided reference number. Please refer to any specific instructions or procedures provided by the concerned entity for a more accurate process.

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