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PRINTED: 03/11/2022 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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Complaint in00373806 refers to a formal allegation that was investigated but ultimately found to lack sufficient evidence for substantiation.
Any individual or entity who believes they have experienced a violation or an issue relevant to the complaint can file it.
To fill out the complaint, one should provide detailed information regarding the issue, including dates, specific incidents, and any relevant evidence.
The purpose of the complaint is to formally document a concern or allegation and to initiate an investigation into the matter.
The complaint must include the complainant's details, a description of the alleged incident, any evidence, and relevant dates.
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