Get the free www.in.govhealthreportsPRINTED: 07/01/2022 DEPARTMENT OF HEALTH AND HUMAN SERVICES ...

PRINTED: 01/18/2022 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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3. Provide any relevant identification or reference numbers, if required.
4. Specify the date of the report, which should be 07/01/2022 in this case.
5. Proceed to the department section and select the appropriate department from the provided options.
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