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PRINTED: 02/12/2015 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 0212 refers to a specific form used by certain departments for reporting purposes, typically related to tax or business information.

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Individuals or entities involved in specific business activities or transactions as defined by the department are required to file printed 0212.

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The purpose of printed 0212 is to collect necessary data for compliance and reporting, allowing the department to monitor specific activities effectively.

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Information required may include details on transactions, entity identification, financial data, or any other information pertinent to the reporting requirements.

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