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PRINTED: 01/09/2018 FORM APPROVED Illinois Department of Public Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X2) MULTIPLE CONSTRUCTION A.

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Compliance with 77 Illinois refers to adhering to the regulations and guidelines set forth by the Illinois Department of Public Health regarding the operation of healthcare facilities and services.

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Information that must be reported includes facility details, staff qualifications, patient care policies, safety protocols, and any incidents or violations that may have occurred.

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