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PRINTED: 12/23/2020 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 report is a document required to be filed by certain individuals or entities with the Indiana State Department of Health (ISDH).
Healthcare facilities, such as hospitals, clinics, and nursing homes, are typically required to file this report.
The report can usually be filled out online through the ISDH's website by providing the requested information.
The purpose of this report is to gather data and information related to healthcare facilities and their operations for regulatory and tracking purposes.
Information such as patient demographics, medical procedures performed, and infection control measures must typically be reported on this form.
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