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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES01/03/2012FORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES OMB NO. 09380391STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION

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Survey date 121211 refers to a specific survey or report that is due or relevant as of December 12, 2011.

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