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10/18/2018PRINTED: 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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Indicate the date and time the emergency occurred or when it is expected to occur.

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To fill out e0000 for an emergency, provide detailed information about the situation, location, and any actions taken.

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