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PRINTED: 07/15/2019 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 printed 0715 is a form used for reporting specific financial information to the Department of Revenue.

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Typically, businesses and individuals who meet certain income thresholds or engage in specific activities are required to file the printed 0715 form.

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