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PRINTED: 09/11/2020 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:CORNERSTONE TREATMENT FACILITY
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Gather all the necessary information and documents required to fill out the NC DHHS form.
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Start by providing your personal information such as name, address, date of birth, and contact details.
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Fill out the sections related to your household information, including the number of people living in the household, their names, and their relationship to you.
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Provide details about your income, including any wages, government benefits, or other sources of income for you and your household members.
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Submit the filled-out form to the designated NC DHHS office or through their preferred submission method, such as online, mail, or in-person.

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Anyone who wishes to access or apply for healthcare-related services and benefits in North Carolina may need to fill out the NC DHHS form.
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Both residents and non-residents of North Carolina who meet the eligibility criteria may need to complete this form.
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nc dhhs North Carolina stands for North Carolina Department of Health and Human Services, which is a state government agency responsible for providing public health and human services in North Carolina.
Certain healthcare providers, facilities, and organizations are required to file with nc dhhs North Carolina based on state regulations and funding requirements.
To fill out nc dhhs North Carolina forms, one must provide accurate and detailed information as requested on the specific form being filed. It is important to follow the instructions provided by the agency.
The purpose of nc dhhs North Carolina is to oversee and administer a wide range of health and human services programs to improve the well-being of the residents of North Carolina.
The information required to be reported on nc dhhs North Carolina may vary depending on the specific form or program being filed. Generally, information related to healthcare services, providers, patients, and finances may be required.
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