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05/17/2019PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICESFORM APPROVEDCENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION
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Printed 0504 department is the form used for reporting certain information to the Department of Revenue.
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Printed 0504 department can be filled out online on the Department of Revenue's website or manually using the paper form.
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