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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:15G81408/21/2017FORM
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This visit was for a routine check-up and assessment of the patient's health.
Patients who received treatment or consultative services during the visit are required to file.
To fill out this visit, complete the designated form with details of the visit date, provider information, and the services received.
The purpose of this visit was to ensure the patient’s health is monitored and any issues are addressed promptly.
The information that must be reported includes the patient's details, reason for the visit, treatments received, and any follow-up required.
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