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PRINTED: 07/02/2018 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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The form investigation of complaint is a formal document used to initiate an investigation into allegations or grievances filed by individuals or entities.
Individuals or entities who believe they have been wronged or harmed by another party are required to file the form investigation of complaint.
To fill out the form investigation of complaint, provide detailed information about the complaint, including relevant facts, dates, involved parties, and any supporting documentation.
The purpose of the form investigation of complaint is to provide a structured way for complainants to present their grievances, ensuring that they are formally recorded and investigated.
The information that must be reported includes the complainant's details, a clear description of the complaint, names of involved parties, relevant dates, and evidence supporting the claim.
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