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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:15004708/02/2019FORM

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What is this visit was for?

This visit was for a routine medical examination to assess the patient's health.

Who is required to file this visit was for?

The patient, or their guardian if underage, is required to file for this visit.

How to fill out this visit was for?

To fill out the visit, one must provide personal information, the date of the visit, and details of the services received.

What is the purpose of this visit was for?

The purpose of this visit was to monitor health conditions and provide necessary preventive care.

What information must be reported on this visit was for?

Information reported should include patient ID, provider details, date of service, and any diagnoses or treatments.

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