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PRINTED: 10/24/2019
FORM APPROVEDState of GA, Healthcare Facility Regulation Division
STATEMENT OF DEFICIENCIES
AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA
IDENTIFICATION NUMBER:025R1649(X2)
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What is 025-r-1649?
025-r-1649 is a specific form used for reporting certain financial information to the relevant authorities.
Who is required to file 025-r-1649?
Entities that meet specific criteria set by the governing regulations are required to file 025-r-1649.
How to fill out 025-r-1649?
To fill out 025-r-1649, follow the instructions provided on the form, ensuring all necessary fields are completed accurately.
What is the purpose of 025-r-1649?
The purpose of 025-r-1649 is to gather essential financial data for regulatory compliance and oversight.
What information must be reported on 025-r-1649?
The form requires reporting of financial details such as income, expenses, and other relevant financial metrics.
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