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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:15578702/06/2012FORM

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How to fill out state licensure survey

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Review the instructions provided with the survey carefully.

02

Gather all necessary information such as personal details, work experience, educational background, etc.

03

Complete each section of the survey accurately and truthfully.

04

Double-check your responses to ensure all information is correct.

05

Submit the survey within the specified deadline.

Who needs state licensure survey?

01

Healthcare professionals such as doctors, nurses, pharmacists, etc. who are required to obtain state licensure to practice in their respective fields.

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What is state licensure survey?

State licensure survey is a survey conducted by state regulatory agencies to gather information about professional licenses held by individuals or businesses.

Who is required to file state licensure survey?

Individuals or businesses holding professional licenses are required to file state licensure survey.

How to fill out state licensure survey?

State licensure survey can typically be filled out online through the state regulatory agency's website.

What is the purpose of state licensure survey?

The purpose of state licensure survey is to ensure compliance with state licensing requirements and to maintain accurate records of licensed professionals.

What information must be reported on state licensure survey?

Information such as name, license number, expiration date, and any related continuing education credits may need to be reported on state licensure survey.

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