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PRINTED: DEPARTMENT OF HEALTH AND HUMAN SERVICES CENTERS FOR MEDICARE & MEDICAID SERVICES STATEMENT OF DEFICIENCIES(X1) PROVIDER/SUPPLIER/LIGAND PLAN OF CORRECTIONIDENTIFICATION NUMBER:15577306/30/2021FORM

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What is this visit was for?

This visit is for a routine inspection by the authorities.

Who is required to file this visit was for?

The business owner or manager is required to file this visit for.

How to fill out this visit was for?

The visit form can be filled out online or printed and submitted in person.

What is the purpose of this visit was for?

The purpose of this visit is to ensure compliance with regulations and safety standards.

What information must be reported on this visit was for?

The visit must report details of the premises, operations, and any recent changes.

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