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PRINTED: 12/13/2018 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.
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Organizations or entities that fall under the regulatory guidelines outlined by the environmental authority or agency and meet the criteria set for green level III must file the necessary documentation.
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