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PRINTED: 01/21/2020 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 purpose of form PSR is to report specific information to the relevant authorities.

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Form PSR requires the reporting of certain financial and transactional information.

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