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12/06/2019PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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Obtain the necessary forms from the Indian Creek Healthcare Center.
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Fill out the personal information section, including your name, address, and contact information.
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Fill out the medical history section, including any previous surgeries, allergies, or chronic conditions.
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Submit the completed form to the designated personnel at the Indian Creek Healthcare Center.

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Indian Creek Healthcare Center is a medical facility that provides healthcare services to individuals.
The administrators or owners of Indian Creek Healthcare Center are required to file the necessary paperwork.
To fill out Indian Creek Healthcare Center forms, you will need to provide information about the facility, services offered, and any relevant financial data.
The purpose of Indian Creek Healthcare Center is to provide quality healthcare services to patients in the community.
Information such as patient demographics, medical treatments provided, and financial statements must be reported on Indian Creek Healthcare Center forms.
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