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PRINTED: 10/24/2019 FORM APPROVEDState of GA, Healthcare Facility Regulation Division STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:141020071(X2)

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dohseiaorgsitesdefaultdohseiaorg is a form required by the Department of Health Services.

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Healthcare providers and facilities are required to file dohseiaorgsitesdefaultdohseiaorg.

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Information such as patient data, treatment procedures, and billing codes must be reported on dohseiaorgsitesdefaultdohseiaorg.

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