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PRINTED: 10101/2009 FORM APPROVEDHealth Regulation Administration STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:(X3) DATE SURVEY COMPLETED(X2) MULTIPLE

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1. To fill out the form approved by mpdc.dc.gov, follow these steps: 1. Obtain the form from the mpdc.dc.gov website or the relevant authority.
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4. Start filling out the form by entering the required personal information, such as name, address, and contact details.
5. Follow the provided format and guidelines to provide accurate and complete responses to the questions or sections.
6. Make sure to double-check all the entered information for any errors or omissions.
7. If applicable, attach any required supporting documents securely to the form.
8. Review the filled form once again to ensure everything is accurate and complete.
9. Sign the form using the designated signature area, if required.
10. Submit the completed form to the designated authority as instructed, either online or via mail or in-person.
11. Keep a copy of the filled form and any submitted documents for your records.
12. Follow up with the authority or agency to check the status of your submitted form, if necessary.

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1. The form approved by mpdc.dc.gov may be needed by individuals who need to fulfil administrative or legal requirements within the jurisdiction of the Metropolitan Police Department of the District of Columbia (MPDC). This could include individuals who want to file certain reports, request certain permits, licenses, or certifications, or participate in specific programs or services offered by MPDC. The specific form and its purpose may vary depending on the nature of the request or requirement, so it is recommended to refer to the relevant section or page on the mpdc.dc.gov website or contact MPDC directly for more information.

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