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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:15G50905/12/2015FORM

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What is this visit was for?

This visit is for a routine health check-up.

Who is required to file this visit was for?

The patient who had the visit is required to file it.

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The visit can be filled out by providing accurate information about the health check-up.

What is the purpose of this visit was for?

The purpose of this visit is to monitor the patient's overall health and well-being.

What information must be reported on this visit was for?

Information such as vital signs, medical history, and any symptoms experienced must be reported.

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