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PRINTED: 11/07/2019 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:MILLER BEACH TERRACE (X4) ID PREFIX

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Start by providing your personal information such as name, address, and contact details.

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What is form investigation of complaint?

Form investigation of complaint is a document used to formally report and investigate a complaint or grievance.

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Anyone who wishes to report a complaint or grievance may be required to file form investigation of complaint.

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Form investigation of complaint can be filled out by providing required information such as details of the complaint, relevant evidence, and contact information.

What is the purpose of form investigation of complaint?

The purpose of form investigation of complaint is to address and resolve complaints or grievances in a formal manner.

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Information such as details of the complaint, relevant evidence, and contact information must be reported on form investigation of complaint.

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