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PRINTED: 01/30/2019 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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Printed 0130 is a specific departmental form used for reporting certain financial or operational details as mandated by the relevant department.
Entities or individuals subject to the reporting requirements set forth by the department must file the printed 0130 form.
To fill out the printed 0130 form, follow the instructions provided in the form guidelines, ensuring all required fields are accurately completed.
The purpose of printed 0130 is to gather specific data necessary for compliance, assessment, or fiscal monitoring by the department.
The printed 0130 must include detailed information regarding financial transactions, operational metrics, or other data specific to the reporting requirements.
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