Get the free www.in.govhealthreportsPRINTED: 10/06/2017 DEPARTMENT OF HEALTH AND HUMAN SERVICES ...

PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES OMB NO. 09380391(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTION09/30/2011FORM APPROVEDIDENTIFICATION

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1. To fill out the wwwingovhealthreportsprinted 10062017 department of, follow these steps:
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4. Read the instructions carefully to understand the information required.
5. Fill in your personal details such as name, address, and contact information in the designated fields.
6. Provide any additional information or documentation as requested.
7. Review the filled form for any errors or missing information.
8. Once you are certain the form is complete and accurate, print it out.
9. Sign the form at the designated space.
10. Keep a copy of the filled form for your records.
11. Submit the filled and signed form to the appropriate department or authority.
12. Follow any further instructions provided by the department regarding submission or additional steps.
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