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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:15522412/21/2016FORM
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It is a preliminary document that indicates a party's intention to engage in a specific action, often related to legal or regulatory compliance.
Individuals or entities planning to undertake the specific action outlined in the form, typically when required by law or regulation.
The form must be completed by providing necessary details such as the individual's or entity's information, the specific action intended, and any supporting documentation as required.
The purpose is to officially notify relevant authorities or stakeholders of the intent to proceed with a particular action or process.
It typically requires basic information about the filer, details of the intended action, and potential impacts or beneficiaries involved.
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