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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES OMB NO. 09380391(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTION07/19/2011FORM APPROVEDIDENTIFICATION

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Survey date 062911 refers to a specific survey or reporting requirement that was established on June 29, 2011.

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Required information typically includes demographic data, responses to specific survey questions, and any additional comments or notes as specified.

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