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PRINTED: 09/23/2020 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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The department is related to the Illinois Department of Public Health.
Healthcare facilities in Illinois are required to file.
The form can be filled out online or submitted via mail.
The purpose is to report certain healthcare data to the Illinois Department of Public Health.
Information such as patient demographics, facility statistics, and healthcare services provided must be reported.
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