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Get the free 06/22/2022 form approved - NC DHHS

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PRINTED: 06/22/2022 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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0622 form is the approved form used for reporting specific information to the relevant authority.
Certain individuals or entities as specified by the relevant authority are required to file the 0622 form.
The 0622 form can be filled out by providing the requested information in the designated fields according to the instructions provided.
The purpose of the 0622 form is to gather specific information for regulatory or compliance purposes.
The information required to be reported on the 0622 form may include but not limited to financial data, operational details, and other relevant information.
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