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PRINTED: 04/02/2020 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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This document is a form used for reporting financial information to the appropriate authorities.
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The purpose of this document is to ensure transparency and compliance with financial regulations.
What information must be reported on this document?
The document requires reporting of income, expenses, assets, and liabilities among other financial information.
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