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PRINTED: 01/05/2016 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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The 0105 form approved is a document used to report certain financial transactions to the appropriate authorities.
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Individuals or entities who have engaged in the specific financial transactions outlined in the form are required to file the 0105 form approved.
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