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PRINTED: 12/09/2015
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 1209 form approved?
The 1209 form approved is a document used to report certain financial transactions to the appropriate authorities.
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Entities or individuals engaged in specified financial activities are required to file the 1209 form approved.
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