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PRINTED: 10/30/2020 FORM APPROVEDDivision of Health Service Regulation STATEMENT OF DEFICIENCIES AND PLAN OF CORRECTION(X1) PROVIDER/SUPPLIER/CIA IDENTIFICATION NUMBER:NEW HOPE HOME IV (X4) ID PREFIX
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01
Gather all necessary information and documentation related to the incident or allegation.
02
Complete the top section of the form with the facility name, address, and contact information.
03
Provide detailed information about the incident or allegation in the appropriate sections of the form.
04
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Who needs nc dhsr mhlcs statement?

01
Any healthcare facility regulated by the North Carolina Division of Health Service Regulation (DHSR) may need to fill out and submit a MHLCS statement in response to incidents or allegations of misconduct or violations.
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The nc dhsr mhlcs statement is a form used to report certain healthcare-related information to the North Carolina Department of Health Service Regulation (DHSR) Medical Health Licensure and Certification Section (MH LCS).
Healthcare facilities and providers in North Carolina are required to file nc dhsr mhlcs statement.
To fill out the nc dhsr mhlcs statement, providers need to include specific information about their facility or practice as outlined in the form instructions provided by DHSR.
The purpose of nc dhsr mhlcs statement is to ensure that healthcare facilities and providers in North Carolina are compliant with regulations and provide quality care to patients.
The nc dhsr mhlcs statement requires information such as facility details, services offered, staffing levels, financial data, and compliance with regulations.
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