Get the free PRINTED: 07/30/2019 DEPARTMENT OF HEALTH AND HUMAN SERVICES ... - Indiana

PRINTED: 07/30/2019 FORM APPROVED Indiana State Department of Health STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:CRAWFORDSVILLE PICKFORD COTTAGE

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1. Start by gathering all the necessary information and documents that you will need to fill out the form.
2. Read through the form carefully to understand the instructions and requirements.
3. Use a pen or a typewriter to fill out the form. Make sure your handwriting is neat and legible.
4. Begin by entering your personal information such as your name, address, phone number, and social security number.
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6. If there are any sections that are not applicable to you, make sure to mark them as 'N/A' or 'Not Applicable'.
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