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DEPARTMENT OF HEALTH AND HUMAN SERVICESCENTERS FOR MEDICARE & MEDICAID SERVICESMEDICARE/MEDICAID CERTIFICATION AND TRANSMITTAL ID: 6ZVVPART I TO BE COMPLETED BY THE STATE SURVEY AGENCY 245523(L1)01774070001
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id 6zvv is a unique identification code assigned to a specific form or document.
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Individuals or entities specified by the governing body are required to file id 6zvv.
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