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PRINTED: 10/05/2015 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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What is form investigation of complaint?

Form investigation of complaint is a standardized document used to gather information about a complaint and investigate the issue.

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Anyone who wants to report a complaint and initiate an investigation is required to file form investigation of complaint.

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Form investigation of complaint can be filled out by providing detailed information about the complaint, including dates, names, locations, and a description of the issue.

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Information such as the nature of the complaint, parties involved, date of occurrence, and any supporting evidence must be reported on form investigation of complaint.

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