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PRINTED: 08/09/2017 FORM APPROVEDDEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION
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This visit was for a routine inspection.
The company's compliance officer is required to file this visit.
The visit should be filled out electronically using the designated online platform.
The purpose of this visit is to ensure regulatory compliance.
Information such as date of inspection, findings, corrective actions, and outcomes must be reported.
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