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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:08/07/2015FORM
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To fill out the printed 08072015 department of form, follow these steps:
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Start by writing your name and contact information in the designated fields at the top of the form.
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Next, provide the necessary details regarding the department you are associated with, such as the department name, address, and contact information.
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Fill in the required information about the date and time of the event or incident.
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Specify the nature of the event or incident and provide a detailed description in the designated section.
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