Get the free PRINTED: 08/09/2022 DEPARTMENT OF HEALTH

PRINTED: 08/09/2022 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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How to fill out printed 08092022 department of

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6. If there are any specific instructions or additional documents required, make sure to fulfill those requirements.
7. Once you have finished filling out the form, review it once again to ensure all the information is correct.
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Printed 0809 department is for reporting income from dividends, interest, or other sources.

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Income from dividends, interest, or other sources must be reported on printed 0809 department.